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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 <br />(Ed. 4-84) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not <br />enforce our right against the person or organization named in the Schedule. (This agreement applies only to <br />the extent that you perform work under a written contract that re quires you to obtain this agreement from us.) <br />This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br />Schedule <br />ANY PERSON OR ORGANIZATION WHERE WAIVER OF OUR RIGHT TO <br />RECOVER IS PERMITTED BY LAW AND IS REQUIRED BY WRITTEN <br />CONTRACT PROVIDED SUCH CONTRACT PROVIDED SUCH CONTRACT WAS <br />EXECUTED PRIOR TO DATE OF LOSS <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br />Endorsement Effective Policy No. Endorsement No. <br />Premium INCL. Insured <br />Insurance Company ARCH INSURANCE COMPANY <br />Countersi gned By ______________ _ <br />© 1983 National Council on Compensation Insurance. <br />ZAWCI183000807/01/2025 <br />The Inside Source, Inc.