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Schedule <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <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 the <br />extent that you perform work under a written contract that requires 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 />"Any person or organization required by written contract or certificate of insurance." <br />"This endorsement is not applicable in California, Kentucky, New Hampshire, New Jersey, Texas <br />and Utah." <br />The endorsement does not apply to policies or exposure in Missouri where the employer is in the <br />construction group of classifications. According to Section 287.150(6) of the Missouri statutes, a <br />contractual provision purporting to waive subrogation rights is against public policy and void where <br />one party to the contract is an employer in the construction group of code classifications. For <br />policies or exposure in Missouri, the following must be included in the Schedule: <br />Any person or organization for which the employer has agreed by written contract, executed <br />prior to loss, may execute a waiver of subrogation. However, for purposes of work performed <br />by the employer in Missouri, this waiver of subrogation does not apply to any construction <br />group of classifications as designated by the waiver of right to recover from others <br />(subrogation) rule in our manual. <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 />Insured Premium $ <br />Insurance Company Countersigned by <br />0 <br />Hart Forms & Services <br />Reorder No. 14-4888 <br />WC 00 03 13 <br />(Ed. 4-84)Copyright 1983 National Council on Compensation Insurance. <br />:& 393268068/1/2023 <br /> Suarez & Munoz Construction Inc. <br />New Hampshire Insurance Company <br />DocuSign Envelope ID: 52B96F86-74CC-4885-A1BF-BB52674521CD