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DocuSign Envelope ID: 34524780-73C6-4CB6-96BA-FBCD698FCD21 <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br /> (Ed. 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 not enforce <br /> our right against the person or organization named in the Schedule. (This agreement applies only to the extent that <br /> 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 /> Effective Expiration Persons Organization <br /> 12/31/2015 12/31/2016 blanket blanket <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br /> Endorsement Effective 12/31/2015 12:00:00 AM Policy No. WC100-0002205-2015A Endorsement No. 0 <br /> Insured Corley Redfoot Architects, Inc. Premium $5,190 <br /> Insurance Company Countersigned by <br /> Stonewood Insurance Company <br /> WC 00 03 13 <br /> (Ed. 4-84) <br /> f <br /> i <br /> ®1993 National Council on Compensation Insurance. <br />