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HomeMy WebLinkAboutCONNELL RESOURCES INC - INSURANCE CERTIFICATE 2023-2024ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 2/27/2023 License # 0757776 (303) 252-3762 (866) 243-0727 16535 Connell Resources, Inc. 7785 Highland Meadows Parkway, Suite 100 Fort Collins, CO 80528 25674 A 2,000,000 X X GLO 5084929-01 3/1/2023 3/1/2024 100,000 10,000 1,000,000 4,000,000 4,000,000 2,000,000A X X BAP 5084930-01 3/1/2023 3/1/2024 10,000,000B CUP-5T070711-23-NF 3/1/2023 3/1/2024 10,000,000 10,000 A X WC 5084928-01 3/1/2023 3/1/2024 1,000,000 N 1,000,000 1,000,000 RE: 2221032 - Mack Street Waterline City of Fort Collins is included as additional insured under General Liability. City of Fort Collins P.O. Box 580 Fort Collins, CO 80522 CONNRES-02 MHOFF HUB International Insurance Services (COL) 2000 S. Colorado Blvd Tower 2, Suite 150 Denver, CO 80222 Lynn Bosman Lynn.bosman@hubinternational.com Zurich American Insurance Company Travelers Property Casualty Company of America X X X XX X X X X THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy No. GLO 1 Effective Date: 03/01/2023 Additional Insured – Automatic – Owners, Lessees Or Contractors U-GL-2162-A CW (02/19) Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc., with its permission. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A.Section II – Who Is An Insured is amended to include as an additional insured any person or organization whom you are required to add as an additional insured under a written contract or written agreement executed by you, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" and subject to the following: 1.If such written contract or written agreement specifically requires that you provide that the person or organization be named as an additional insured under one or both of the following endorsements: a.The Insurance Services Office (ISO) ISO CG 20 10 (10/01 edition); or b.The ISO CG 20 37 (10/01 edition), such person or organization is then an additional insured with respect to such endorsement(s), but only to the extent that "bodily injury", "property damage" or "personal and advertising injury" arises out of: (1)Your ongoing operations, with respect to Paragraph 1.a. above; or (2)"Your work", with respect to Paragraph 1.b. above, which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 1., insurance afforded to such additional insured: (a)Only applies if the "bodily injury", "property damage" or "personal and advertising injury" offense occurs during the policy period and subsequent to your execution of the written contract or written agreement; and (b)Does not apply to "bodily injury" or "property damage" caused by "your work" and included within the "products-completed operations hazard" unless the written contract or written agreement specifically requires that you provide such coverage to such additional insured. 2.If such written contract or written agreement specifically requires that you provide that the person or organization be named as an additional insured under one or both of the following endorsements: a.The Insurance Services Office (ISO) ISO CG 20 10 (07/04 edition); or b.The ISO CG 20 37 (07/04 edition), such person or organization is then an additional insured with respect to such endorsement(s), but only to the extent that "bodily injury", "property damage" or "personal and advertising injury" is caused, in whole or in part, by: (1)Your acts or omissions; or (2)The acts or omissions of those acting on your behalf, U-GL-2162-A CW (02/19) Page 2 of 4 Includes copyrighted material of Insurance Services Office, Inc., with its permission. in the performance of: (a)Your ongoing operations, with respect to Paragraph 2.a. above; or (b)"Your work" and included in the "products-completed operations hazard", with respect to Paragraph 2.b. above, which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 2., insurance afforded to such additional insured: (i)Only applies if the "bodily injury", "property damage" or "personal and advertising injury" offense occurs during the policy period and subsequent to your execution of the written contract or written agreement; and (ii)Does not apply to "bodily injury" or "property damage" caused by "your work" and included within the "products-completed operations hazard" unless the written contract or written agreement specifically requires that you provide such coverage to such additional insured. 3.If neither Paragraph 1. nor Paragraph 2. above apply and such written contract or written agreement requires that you provide that the person or organization be named as an additional insured: a.Under the ISO CG 20 10 (04/13 edition, any subsequent edition or if no edition date is specified); or b.With respect to ongoing operations (if no form is specified), such person or organization is then an additional insured only to the extent that "bodily injury", "property damage" or "personal and advertising injury" is caused, in whole or in part by: (1)Your acts or omissions; or (2)The acts or omissions of those acting on your behalf, in the performance of your ongoing operations, which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 3., insurance afforded to such additional insured: (a)Only applies to the extent permitted by law; (b)Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured; and (c)Only applies if the "bodily injury", "property damage" or "personal and advertising injury" offense occurs during the policy period and subsequent to your execution of the written contract or written agreement. 4.If neither Paragraph 1. nor Paragraph 2. above apply and such written contract or written agreement requires that you provide that the person or organization be named as an additional insured: a.Under the ISO CG 20 37 (04/13 edition, any subsequent edition or if no edition date is specified); or b.With respect to the "products-completed operations hazard" (if no form is specified), such person or organization is then an additional insured only to the extent that "bodily injury" or "property damage" is caused, in whole or in part by "your work" and included in the "products-completed operations hazard", which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 4., insurance afforded to such additional insured: (1)Only applies to the extent permitted by law; (2)Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured; (3)Only applies if the "bodily injury" or "property damage" occurs during the policy period and subsequent to your execution of the written contract or written agreement; and (4)Does not apply to "bodily injury" or "property damage" caused by "your work" and included within the "products-completed operations hazard" unless the written contract or written agreement specifically requires that you provide such coverage to such additional insured. U-GL-2162-A CW (02/19) Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc., with its permission. B.Solely with respect to the insurance afforded to any additional insured referenced in Section A. of this endorsement, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services including: 1.The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or 2.Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. C.Solely with respect to the coverage provided by this endorsement, the following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV – Commercial General Liability Conditions: The additional insured must see to it that: (1)We are notified as soon as practicable of an "occurrence" or offense that may result in a claim; (2)We receive written notice of a claim or "suit" as soon as practicable; and (3)A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured if the written contract or written agreement requires that this coverage be primary and non-contributory. D.Solely with respect to the coverage provided by this endorsement: 1.The following is added to the Other Insurance Condition of Section IV – Commercial General Liability Conditions: Primary and Noncontributory insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured provided that: a.The additional insured is a Named Insured under such other insurance; and b.You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional insured. 2.The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition under Section IV – Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence", offense, claim or "suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by a written contract or written agreement to provide coverage to the additional insured on a primary and non- contributory basis. E.This endorsement does not apply to an additional insured which has been added to this Coverage Part by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. F.Solely with respect to the insurance afforded to an additional insured under Paragraph A.3. or Paragraph A.4. of this endorsement, the following is added to Section III – Limits Of Insurance: Additional Insured – Automatic – Owners, Lessees Or Contractors Limit The most we will pay on behalf of the additional insured is the amount of insurance: U-GL-2162-A CW (02/19) Page 4 of 4 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 1.Required by the written contract or written agreement referenced in Section A. of this endorsement; or 2.Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. All other terms, conditions, provisions and exclusions of this policy remain the same. '311)6'-%0+)2)6%00-%&-0-8= '+ 8,-7)2(367)1)28',%2+)78,)430-'=40)%7)6)%(-8'%6)*900= ()7-+2%8)('327869'8-32463.)'8 7 +)2)6%0 %++6)+%8)0-1-8 8LMWIRHSVWIQIRXQSHMJMIWMRWYVERGITVSZMHIHYRHIVXLIJSPPS[MRK '311)6'-%0+)2)6%00-%&-0-8='3:)6%+)4%68 7',)(90) (IWMKREXIH'SRWXVYGXMSR4VSNIGXW A General Aggregate Limit applies to each construction project where the Named Insured is performing operations, however, a General Aggregate Limit does not apply to any construction project where the Named Insured is performing operations that are insured under a wrap up or any other consolidated or similar insurance program. -RJSVQEXMSRVIUYMVIHXSGSQTPIXIXLMW7GLIHYPIMJRSXWLS[REFSZI[MPPFIWLS[RMRXLI(IGPEVEXMSRW %*SV EPP WYQW [LMGL XLI MRWYVIH FIGSQIW PIKEPP] SFPMKEXIH XS TE] EW HEQEKIW GEYWIH F]SGGYVVIRGIW YRHIV 7IGXMSR -z 'SZIVEKI %ERH JSV EPP QIHMGEP I\TIRWIW GEYWIH F]EGGMHIRXW YRHIV 7IGXMSR -z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-RWYVERGI7IVZMGIW3JJMGI-RGSJ4EKI Policy Number: GLO1 &*SV EPP WYQW [LMGL XLI MRWYVIH FIGSQIW PIKEPP] SFPMKEXIH XS TE] EW HEQEKIW GEYWIH F]SGGYVVIRGIW YRHIV 7IGXMSR -z 'SZIVEKI %ERH JSV EPP QIHMGEP I\TIRWIW GEYWIH F]EGGMHIRXW YRHIV 7IGXMSR -z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z 0MQMXW 3J -RWYVERGI RSX SXLIV[MWI QSHMJMIH F] XLMW IRHSVWIQIRX WLEPP GSRXMRYI XS ETTP]EW WXMTYPEXIH '+-RWYVERGI7IVZMGIW3JJMGI-RG4EKI SJ POLICY NUMBER:COMMERCIAL GENERAL LIABILITY CG 24 17 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 24 17 10 01 ISO Properties, Inc., 2000 Page 1 of 1 CONTRACTUAL LIABILITY - RAILROADS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Scheduled Railroad: Designated Job Site: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) With respect to operations performed for, or affecting, a Scheduled Railroad at a Designated Job Site, the definition of "insured contract" in the Definitions sec- tion is replaced by the following: 9."Insured Contract" means: a.A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or or- ganization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; b.A sidetrack agreement; c.Any easement or license agreement; d.An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e.An elevator maintenance agreement; f.That part of any other contract or agreement pertaining to your business (including an in- demnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1)That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a)Preparing, approving or failing to pre- pare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifi- cations; or (b)Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; (2)Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the in- sured’s rendering or failure to render pro- fessional services, including those listed in Paragraph (1) above and supervisory, in- spection, architectural or engineering activi- ties. GLO 1 ONLY THOSE REQUIRED BY WRITTEN ONLY THOSE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT, EXECUTED CONTRACT OR AGREEMENT, EXECUTED PRIOR TO LOSS, EXCEPT WHERE PRIOR TO LOSS, EXCEPT WHERE PROHIBITED BY LAW PROHIBITED BY LAW Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer Add’l Prem. Return Prem. GLO 1 03/01/2023 03/01/2024 91966000 $INCL $ Waiver Of Subrogation (Blanket) Endorsement U-GL-925-B CW (12/01) Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: If you are required by a written contract or agreement, which is executed before a loss, to waive your rights of recovery from others, we agree to waive our rights of recovery. This waiver of rights shall not be construed to be a waiver with respect to any other operations in which the insured has no contractual interest. POLICY NUMBER: %$31 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are “insureds” for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured:&RQQHOO5HVRXUFHV,QF Endorsement Effective Date: SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS OR ADDITIONAL INSURED STATUS ON A PRIMARY, NON-CONTRIBUTORY BASIS, IN A WRITTEN CONTRACT OR WRITTEN AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 2 Each person or organization shown in the Schedule is an “insured” for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an “insured” under the Who Is An Insured provision contained in Paragraph A.1. of Section II – Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I – Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 2 of 2 POLICY NUMBER:BAP 301 COMMERCIAL AUTO CA 20 70 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CA 20 70 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 COVERAGE FOR CERTAIN OPERATIONS IN CONNECTION WITH RAILROADS This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIERS COVERAGE FORM With respect to coverage provided under this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured:&RQQHOO5HVRXUFHV,QF Endorsement Effective Date: SCHEDULE Scheduled Railroad Designated Job Site ONLY THOSE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT, EXECUTED PRIOR TO LOSS, EXCEPT WHERE PROHIBITED BY LAW ONLY THOSE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT, EXECUTED PRIOR TO LOSS, EXCEPT WHERE PROHIBITED BY LAW Information required to complete this Schedule, if not shown above, will be shown in the Declarations. With respect to the use of a covered "auto" in operations for or affecting a railroad designated in the Schedule at a Designated Job Site, the two exceptions contained in the definition of "insured contract" relating to construction or demolition operations performed within 50 feet of a railroad do not apply. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: BAP 1 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured:&RQQHOO5HVRXUFHV,QF Endorsement Effective Date: SCHEDULE Name(s) Of Person(s) Or Organization(s): ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the “accident” or the “loss” under a contract with that person or organization. WC 00 03 13 (Ed. 4-84) ©© 1983 National Council on Compensation Insurance. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION 3ROLF\1XPEHU:&1