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DocuSign Envelope ID: BEC19F48-B45F-4E24-9B06-510E862BB015 <br /> WORKERS CCU MPENSNTION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03I <br /> (PC.4-64) <br /> WAW-R OF OUR RIIGHT TO RECOVER FROM OT14ERS 15NDORSEMENT <br /> We have thonght to renvvar our payments froFn a,,Wone liable for an InjuPI mvered by thiq Policy.Wq, 'Afill enforve <br /> our rkjM avjohist Mo person or ca and named in ft Schedule. (This agreement 9pplies only to the Oxlertt ffifil <br /> you i:xxfoar-work RAWer a wriften wrisract ttiat requires you to obtain ft,agreemerid ficisn ass.) <br /> This agreement shall riot operate direWy or indirectly to benefit onyone wt named In tho Sched,110 <br /> senedule <br /> Blanket Waiver <br /> Perk on/organizatiorn Blanket Waiver -Any persor,or organization for whfWn the Named Insured has <br /> ngreted by%-rit-cen i-mitract to rurNsh this waiver. <br /> Job Description <br /> All NC Operations <br /> Thils ondoriierrient ebanges the P�Aov to whUi i'l k aftched and is offective on the data issued unless othenvi&C shfleRd, <br /> (The€rtformWor®below Is requirad only whan this andorainnont Is issued Subs04uOnt 10 PrOlsilr8tiOn 01 ths Po'llcy®) <br /> Endurnoment Effoctiva Puflloy No PR-76 <br /> Insured <br /> Insuranou Company by <br /> WC 00 0313 <br /> (Ed.4-84) <br /> 1963 NTID 16aurar33 tre compoftdwi <br />