Orange County NC Website
a " <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br /> (Ed. 4-84) <br /> a <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 <br /> not enforce our right against the person or organization named in the Schedule. (This agreement applies <br /> only to the extent that you perform work under a written contract that requires you to obtain this <br /> agreement from us.) <br /> This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br /> Schedule <br /> BLANKET WAIVER OF SUBROGATION <br /> PROJECT: ANY PERSON OR ORGANTZATION WHEN REQUIRED BY WRITTEN CONTRACT <br /> This endorsement changes the policy to which it is attached and is effective on the datAby <br /> se stated. <br /> (The information below Is required only when this endorsement W issued subsequenoUoy.) <br /> Endorsement Effective 10/31/2013 Policy No.pWC1009951 <br /> Insured <br /> I i �sn �rir Quilders Inc. Countersigne <br /> Builders Mutual Insurance Co. <br /> WC 00 03 13 <br /> (Ed. 4-84) Copyrigh t 1983 National Council on Compensation Insurance. <br />