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DocuSign Envelope ID: BBE2812E-C8CC-4A62-A991-7B4A2DC9F2F3 <br /> WORKERS COMPEsNSAY10 N AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 <br /> (Ed.4-64) <br /> WAIVER OF OUR R1lG'FH C TO RECOVER FROM OTHERS ENDORSEMENT <br /> We have the light to rewvaf our payments frorn anyone HaDle for an Injury covered 43 thsv fi014.We will("enforeA <br /> our light�QOIRSt tP►e person or organization named in Rio Schedule. (This agree3meni pppling only to the extant that <br /> you peri'or'tr work irrxler a written contract that requtras you to obtain this sgreernar� Irom o9j <br /> This agreerrient shall not berate directly or indlredly to benefit anyone nOt earned in the Schadula. <br /> Schedule. <br /> Blanket Waiver <br /> person/0gPnizallion.. Slanket Weiver-Any person or organization for wh:+rn tfie tamed Insured has <br /> agreed by writben contract to furnish this waiver. <br /> Sob Deveriptlnn <br /> All NC Operations <br /> This endo^r:wnant cbanges the policy to which d is mUrhed and is effective on the date issued unless ot4onvion stated. <br /> (The Infornnation below Is required only when this snrlormnant to itasued subsequent to preparstion of Ike policy.) <br /> Endomernent Effective Wolicy No, vaWCeeave rrdn r IJa. <br /> Insured <br /> �y <br /> Insurance Company Countersigned by,,,. _-.- -. •4 x:: ..........:............. <br /> wo 00 0313 <br /> (Ed.4-84) <br /> O IM 1011k owr Gmlrf'A an CWtIpIrlORtrM�uwurancu. <br />