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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 42 03 04 A <br /> (Ed. 1.00) <br /> TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br /> This endorsement applies only to the insurance provided by the policy because Texas is shown in Item S.A. of the <br /> Information Page. <br /> We have the right to recover our payments from anyone ilable for an injury covered by this policy.We will not enforce our <br /> right against the person or organization named in the Schedule, but this waiver applies only with respect to bodity injury <br /> arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver <br /> from us. <br /> This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br /> The premium for this endorsement Is shown in the Schedule. <br /> Schedule <br /> 1. ( )Specific Waiver <br /> Name of person or organization <br /> (x)Blanket Waiver <br /> , Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. <br /> 2. Operations:ALL OPERATIONS <br /> 3. Premium <br /> The premium charge for this endorsement shall be percent of the premium developed on payroll in connection <br /> with work performed for the above person(s)or organization(s)arising out of the operations described. <br /> 4. Advance Premium <br /> This sndorsoment changes the policy to which it Is attached and is effective on the date Issued unions otherwise stated <br /> (Ttte information below Is required only when this endorsement is ls*Lmd subsequent to preparation of vie policy.) <br /> Endorsement Effective Policy No.WC2093007771 Endorsement No. <br /> Insured Buxton Company Premium ffi <br /> Insurance Company Countersigned by <br /> WC420304A <br /> (Ed. 1-00) <br />