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DocuSign Envelope ID: E5CFB54D-45A2-4A52-A7A0-8998D2AA66F6 <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br /> JEd. 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 <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 /> Any person or organization that you perform work for that is liable for an injury, covered by this policy, that <br /> prior to the injury has written contract requiring a waiver of our right to recover from them, <br /> NORT14 CAROLINA <br /> This endorsement changes the policy to which it is attached and is effective an the date issued uniess otherMse stated. <br /> (The information below is required only when this endorsement is Issued subsequent to Preparation of the p*llcy,) <br /> Endorsement Effective 11/4/2014 Poficy No, 5FI20546 Endorsement No, <br /> insured TILE RESTORATION, INC. Premium$ <br /> Insurance Company EMASCC) INSURANCE CoMpANy Countersigned by dX44�-JUt,4 '` <br /> WC 00 03 13 <br /> (Ed. 4-84) Copyright 1963 National Council on Compensatuon Insurance. <br />