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HomeMy WebLinkAboutIntegrated Fire and Security exp 202610/10/2025 Brown & Brown Insurance Services, Inc. 140 Fountain Parkway N Suite 600 St. Petersburg FL 33716 Keith Thompson (727) 461-6044 (727) 442-7695 Keith.Thompson@bbrown.com Integrated Fire & Security Solutions, Inc 1970 Dana Dr Fort Myers FL 33907 Lloyd's of London 085202 Bitco General Insurance Corporation 20095 CL2543016890 A Y Y GL252435R02 05/01/2025 05/01/2026 1,000,000 100,000 10,000 1,000,000 2,000,000 2,000,000 B Y Y CAP 3 757 746 05/01/2025 05/01/2026 1,000,000 A EX251545R02 05/01/2025 05/01/2026 5,000,000 5,000,000 B N Y WC 3 758 505 05/01/2025 05/01/2026 1,000,000 1,000,000 1,000,000 City of Sebastian is Additional Insured on a primary and non-contributory basis with respect to General Liability and Auto Liability if required by written contract. A Waiver of Subrogation in favor of the above applies to General Liability, Auto Liability, and Workers Compensation if required by written contract. City of Sebastian 1225 Main St Sebastian FL 32958 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY Integrated Fire & Security Solutions, IncBrown & Brown Insurance Services, Inc. 25 Certificate of Liability Insurance: Notes Excess Policy EX251545R02: 05/01/25 to 05/01/26 Underlying Policy Schedule: General Liability Policy GL252435R02: 05/01/25 to 05/01/26 Auto Liability Policy CAP 3 757 746: 05/01/25 to 05/01/26 Employers Liability Policy WC 3 757 745: 05/01/25 to 05/01/26 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: POLICY NUMBER: GL252435R02 COMMERCIAL GENERAL LIABILITY CG 20 10 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 10 10 01 © ISO Properties, Inc., 2000 Page 1 of 1  ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: ANY PERSON OR ORGANIZATION WHOM YOU ARE REQUIRED BY WRITTEN CONTRACT TO ADD AS AN ADDITIONAL INSURED ON THIS POLICY ONLY IF THE WRITTEN CONTRACT SPECIFICALLY REQUIRES ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRAC- TORS – SCHEDULED PERSON OR ORGANIZATION ENDORSEMENT CG 20 10 10 01 EDITION. Location(s) of Covered Operations: ALL LOCATIONS WHERE REQUIRED BY WRITTEN CONTRACT (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A.Section II – Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B.With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2.Exclusions This insurance does not apply to "bodily inju- ry" or "property damage" occurring after: (1)All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the addi- tional insured(s) at the site of the cov- ered operations has been completed; or (2)That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another con- tractor or subcontractor engaged in performing operations for a principal as a part of the same project. POLICY NUMBER: GL252435R02 COMMERCIAL GENERAL LIABILITY CG 20 37 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 37 10 01 © ISO Properties, Inc., 2000 Page 1 of 1 o ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: ANY PERSON OR ORGANIZATION WHOM YOU ARE REQUIRED BY WRITTEN CONTRACT TO ADD AS AN ADDITIONAL INSURED ON THIS POLICY ONLY IF THE WRITTEN CONTRACT SPECIFICALLY REQUIRES ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRAC- TORS – COMPLETED OPERATIONS ENDORSEMENT CG 20 37 10 01 EDITION. Location And Description of Completed Operations: ALL LOCATIONS WHERE REQUIRED BY WRITTEN CONTRACT (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II – Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" at the location designated and described in the schedule of this endorsement performed for that insured and included in the "products-completed operations hazard". POLICY NUMBER: GL252435R02 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 FOR WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ANY PERSON OR ORGANIZATION WHEN YOU AND SUCH PERSON OR ORGANIZATION HAVE AGREED IN WRITING IN A CONTRACT OR AGREEMENT THAT YOU WILL WAIVE ANY RIGHT OF RECOVERY AGAINST SUCH PERSON OR ORGANIZATION, THIS ALSO INCLUDES ANY OTHER PERSON OR ORGANIZATION YOU ARE REQUIRED TO ADD UNDER THE DESCRIBED CONTRACT OR AGREEMENT. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 FOR © Insurance Services Office, Inc., 2008 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 PRIMARY AND NONCONTRIBUTORY – OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. POLICY NUMBER: GL252435R02 BITCO GENERAL INSURANCE CORPORATION BITCO NATIONAL INSURANCE COMPANY AP-0402 (10/17)-1- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BROADENED COVERAGE - AUTOMOBILES The following modifies insurance provided under: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. 1 -Broad Form Named Insured 10 -Employee Hired Autos 2 -Automatic Waiver of Subrogation 11 -Bodily Injury Extension 3 -Automatic Additional Insured 12 -Hired Auto Physical Damage 4 -Primary and Noncontributory - Other Insurance Condition 13 -Enhanced Supplementary Payments 5 -Unintentional Failure to Disclose Hazards 14 -Fellow Employee Coverage for Designated Positions 6 -Extended Notice of Cancellation, Non-Renewal 15 -Physical Damage – Transportation Expenses 7 -When We Do Not Renew 16 -Rental Reimbursement Coverage 8 -Notice of Knowledge of Accident or Loss 17 -Loan/Lease Gap Coverage 9 -Employees as Insured 18 -Accidental Air Bag Discharge Coverage 1.BROAD FORM NAMED INSURED SECTION II. A. 1. - WHO IS AN INSURED - Paragraph d. is added: d.Any organization you newly acquire or form,except for a partnership,joint venture or limited liability company,and over which you maintain majority ownership or interest (51%or more) or for which you have assumed the active management,will qualify as a Named Insured if there is no other similar insurance available to that organization.However,coverage under this provision is only afforded until the end of the policy period or the 12-month anniversary of the policy inception date, whichever is earlier. 2.AUTOMATIC WAIVER OF SUBROGATION Section IV –Business Auto Conditions ,Paragraph A.5.,Transfer of Rights of Recovery Against Others to Us , is deleted and replaced with the following: a.If the insured has rights to recover all or part of any payment we have made under this Coverage Form,those rights are transferred to us.The insured must do nothing after loss to impair those rights.At our request,the insured will bring "suit"or transfer those rights to us and help us enforce them. b.If required by a written contract executed prior to loss,we waive any right of recovery we may have against any person or organization because of payments we make for damages under this coverage form. Policy Number: CAP 3 757 746 AP-0402 (10/17)-2- 3.AUTOMATIC ADDITIONAL INSURED SECTION II –WHO IS AN INSURED,Paragraph A.1,is amended to include as an "insured"any person or organization who is required by written contract or agreement to be an additional insured on your policy,but only with respect to liability arising out of operations performed by you or on your behalf for the additional insured. 4.PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance -Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1.Such "insured" is a Named Insured under such other insurance; and 2.You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". 5.UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Although we relied on your representations as to existing and past hazards,if unintentionally you should fail to disclose all such hazards at the inception date of your policy,we will not deny coverage under this Coverage Form because of such failure. 6.EXTENDED NOTICE OF CANCELLATION, NON-RENEWAL The COMMON POLICY CONDITIONS , Item A.2.b. is deleted and replaced with the following: A.2.b. 60 days before the effective date of the cancellation if we cancel for any other reason. 7.WHEN WE DO NOT RENEW SECTION IV – BUSINESS AUTO CONDITIONS , is amended to add Item B.9.: a.If we choose to nonrenew this policy,we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 60 days before the expiration date. b.If we do not give notice of our intent to nonrenew as prescribed in a.above,it is agreed that you may extend the period of this policy for a maximum additional sixty (60)days from its scheduled expiration date.Where not otherwise prohibited by law,the existing terms,conditions and rates will remain in effect during that extension period.It is further agreed that so long as it is not otherwise prohibited by law,this one-time sixty-day extension is the sole remedy and liquidated damages available to the insured as a result of our failure to give the notice as prescribed in 9.a. above. 8.NOTICE OF KNOWLEDGE OF ACCIDENT OR LOSS SECTION IV - BUSINESS AUTO CONDITIONS , Item A.2.a.is deleted and replaced with the following: 2.Duties in the Event of Accident, Claim Suit or Loss: a.You must see to it that we are notified of an "accident","claim","suit"or "loss"which may result in a claim as soon as practicable after the "occurrence"has been reported to you,a partner,a member,an officer,or an employee designated to give notice to us.Notice should include: (1)How, when and where the "accident" or "loss" occurred; BITCO GENERAL INSURANCE CORPORATION BITCO NATIONAL INSURANCE COMPANY AP-0402 (10/17)-1- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BROADENED COVERAGE - AUTOMOBILES The following modifies insurance provided under: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. 1 -Broad Form Named Insured 10 -Employee Hired Autos 2 -Automatic Waiver of Subrogation 11 -Bodily Injury Extension 3 -Automatic Additional Insured 12 -Hired Auto Physical Damage 4 -Primary and Noncontributory - Other Insurance Condition 13 -Enhanced Supplementary Payments 5 -Unintentional Failure to Disclose Hazards 14 -Fellow Employee Coverage for Designated Positions 6 -Extended Notice of Cancellation, Non-Renewal 15 -Physical Damage – Transportation Expenses 7 -When We Do Not Renew 16 -Rental Reimbursement Coverage 8 -Notice of Knowledge of Accident or Loss 17 -Loan/Lease Gap Coverage 9 -Employees as Insured 18 -Accidental Air Bag Discharge Coverage 1.BROAD FORM NAMED INSURED SECTION II. A. 1. - WHO IS AN INSURED - Paragraph d. is added: d.Any organization you newly acquire or form,except for a partnership,joint venture or limited liability company,and over which you maintain majority ownership or interest (51%or more) or for which you have assumed the active management,will qualify as a Named Insured if there is no other similar insurance available to that organization.However,coverage under this provision is only afforded until the end of the policy period or the 12-month anniversary of the policy inception date, whichever is earlier. 2.AUTOMATIC WAIVER OF SUBROGATION Section IV –Business Auto Conditions ,Paragraph A.5.,Transfer of Rights of Recovery Against Others to Us , is deleted and replaced with the following: a.If the insured has rights to recover all or part of any payment we have made under this Coverage Form,those rights are transferred to us.The insured must do nothing after loss to impair those rights.At our request,the insured will bring "suit"or transfer those rights to us and help us enforce them. b.If required by a written contract executed prior to loss,we waive any right of recovery we may have against any person or organization because of payments we make for damages under this coverage form. Policy Number: CAP 3 757 746 AP-0402 (10/17)-2- 3.AUTOMATIC ADDITIONAL INSURED SECTION II –WHO IS AN INSURED,Paragraph A.1,is amended to include as an "insured"any person or organization who is required by written contract or agreement to be an additional insured on your policy,but only with respect to liability arising out of operations performed by you or on your behalf for the additional insured. 4.PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance -Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1.Such "insured" is a Named Insured under such other insurance; and 2.You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". 5.UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Although we relied on your representations as to existing and past hazards,if unintentionally you should fail to disclose all such hazards at the inception date of your policy,we will not deny coverage under this Coverage Form because of such failure. 6.EXTENDED NOTICE OF CANCELLATION, NON-RENEWAL The COMMON POLICY CONDITIONS , Item A.2.b. is deleted and replaced with the following: A.2.b. 60 days before the effective date of the cancellation if we cancel for any other reason. 7.WHEN WE DO NOT RENEW SECTION IV – BUSINESS AUTO CONDITIONS , is amended to add Item B.9.: a.If we choose to nonrenew this policy,we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 60 days before the expiration date. b.If we do not give notice of our intent to nonrenew as prescribed in a.above,it is agreed that you may extend the period of this policy for a maximum additional sixty (60)days from its scheduled expiration date.Where not otherwise prohibited by law,the existing terms,conditions and rates will remain in effect during that extension period.It is further agreed that so long as it is not otherwise prohibited by law,this one-time sixty-day extension is the sole remedy and liquidated damages available to the insured as a result of our failure to give the notice as prescribed in 9.a. above. 8.NOTICE OF KNOWLEDGE OF ACCIDENT OR LOSS SECTION IV - BUSINESS AUTO CONDITIONS , Item A.2.a.is deleted and replaced with the following: 2.Duties in the Event of Accident, Claim Suit or Loss: a.You must see to it that we are notified of an "accident","claim","suit"or "loss"which may result in a claim as soon as practicable after the "occurrence"has been reported to you,a partner,a member,an officer,or an employee designated to give notice to us.Notice should include: (1)How, when and where the "accident" or "loss" occurred; BITCO GENERAL INSURANCE CORPORATION BITCO NATIONAL INSURANCE COMPANY AP-0402 (10/17)-1- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BROADENED COVERAGE - AUTOMOBILES The following modifies insurance provided under: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. 1 -Broad Form Named Insured 10 -Employee Hired Autos 2 -Automatic Waiver of Subrogation 11 -Bodily Injury Extension 3 -Automatic Additional Insured 12 -Hired Auto Physical Damage 4 -Primary and Noncontributory - Other Insurance Condition 13 -Enhanced Supplementary Payments 5 -Unintentional Failure to Disclose Hazards 14 -Fellow Employee Coverage for Designated Positions 6 -Extended Notice of Cancellation, Non-Renewal 15 -Physical Damage – Transportation Expenses 7 -When We Do Not Renew 16 -Rental Reimbursement Coverage 8 -Notice of Knowledge of Accident or Loss 17 -Loan/Lease Gap Coverage 9 -Employees as Insured 18 -Accidental Air Bag Discharge Coverage 1.BROAD FORM NAMED INSURED SECTION II. A. 1. - WHO IS AN INSURED - Paragraph d. is added: d.Any organization you newly acquire or form,except for a partnership,joint venture or limited liability company,and over which you maintain majority ownership or interest (51%or more) or for which you have assumed the active management,will qualify as a Named Insured if there is no other similar insurance available to that organization.However,coverage under this provision is only afforded until the end of the policy period or the 12-month anniversary of the policy inception date, whichever is earlier. 2.AUTOMATIC WAIVER OF SUBROGATION Section IV –Business Auto Conditions ,Paragraph A.5.,Transfer of Rights of Recovery Against Others to Us , is deleted and replaced with the following: a.If the insured has rights to recover all or part of any payment we have made under this Coverage Form,those rights are transferred to us.The insured must do nothing after loss to impair those rights.At our request,the insured will bring "suit"or transfer those rights to us and help us enforce them. b.If required by a written contract executed prior to loss,we waive any right of recovery we may have against any person or organization because of payments we make for damages under this coverage form. Policy Number: CAP 3 757 746 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) Copyright 1983 National Council on Compensation Insurance 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 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 05/01/25 to 05/01/26 Policy No WC3758505. Endorsement No. Insured Premium Insurance Company Countersigned by ______________________________________ WC 00 03 13 (Ed. 4-84) ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED IS OPERATING UNDER A WRITTEN "INSURED CONTRACT" WHEN SUCH CONTRACT REQUIRES A WAIVER OF SUBROGATION.