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DocuSign Envelope ID:2E150770-7335-4B4E-BDA7-47D76E2FC4C6 <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br /> Insured Name: DICKERSON FENCING CO INC dba <br /> Policy Number: 010-WC14A-71429 <br /> Agency Name: 4009, SIA Group Inc <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 not <br /> enforce our right against the person or organization named in the Schedule. This agreement applies only to the <br /> extent that you perform work under a written contract that requires you to obtain this agreement from us. <br /> This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br /> SCHEDULE <br /> All persons or organizations that, in a written contract executed by both parties prior to the date of the injury covered <br /> by this policy, require you to obtain this agreement from us. <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise noted. <br /> Issued by: National. Trust insurance Company 27367 <br /> Endorsement Number: 0000011 <br /> Effective Date: 10/24/14 Date Issued: 11/12/14 <br /> Countersigned by <br /> Authorized Representative <br /> WC 00 03 13 <br /> Copyright 1983 National Council on Compensation Insurance <br /> EZ0201, 6/04 <br />