Orange County NC Website
Browse       Search
DocuSign Envelope ID:4109B2DB-ED41-4F53-BO69-OD7CB196EEA9 <br /> WORKER$COMPENSATION AND EMPLOYERS LIABILMY INSURANCE POLICY We 00 03 13 <br /> (Ed.4-64) <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br /> We have tho raght to rerovar our paytnofits from a,,Wone Wale for an lMur,;coyetOd by'thi$0014.W)Mil not eflf0r("; <br /> our rkjM(Qahist itie person or oiganizarvi oamLd in tt*Scnedule. (This agreement apitlift ONY 10 tho OXI(Al thf)l <br /> you pwfoqr,worm iiii(jer as writtet)wrilrad that requires you to obtain this agwMant from 09.) <br /> Thle agrou"at tiball rict opeamte diroody or irdredly to benefit anyone wt nanvd hl the S0Kqdt90 <br /> Schedule,, <br /> afankgit Waiver <br /> rat N re.gram ar8lrart; Blanket Walvtir-Any porson or orqanlxaUwi fov wIvAn tile.Harned 1-un-M has <br /> mqret 1 by wrjupll ccoo-act to tjrn;";l1 this ywiver, <br /> 30h 000tription <br /> All K Oporations <br /> TN,4 eWoi im-rwg 0)ang&;s the Pdiz-v to wt*.-Ji a k aitache4 and it,0ective an the Me issuad unless othvnvisc sittiod. <br /> (The Inforotatlon below Is required only whom this olidorasme"t Is$"U*d substf1u4nt tea Pr*P"Uun Of Ohs P011GY-) <br /> Endomarnant Effeativo PohW No. <br /> O.j <br /> Companq <br /> we 00 0313 <br /> 0 1293 Wkiml Cour,,h 6A Compo"Atfid"114arg"g-9. <br />