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DocuSign Envelope ID:25652F75-AF12-4268-84EE-407518477C5B <br /> WORKERS COMPENSAY10N AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 <br /> (Ed.4-64) <br /> ................ <br /> WAIVER OF OUR R1lG'FHT TO RECOVER FROM OTHERS ENDORSEMENT <br /> We have the Vht to rewvaf out payments frorn anyone fiaDle for an Injury Covered by thi,$ptilicy.We VAI)not enforeA <br /> Our light�IOIRSt til►ft POrSDO or organization namW in Rio Schedule. (This sgmernent applies;only to the extent that <br /> you prAiorm,work jgoxj9r a written Contract that requires yOU to obtain this agrearnerd fix)m in-) <br /> This agrearriant shall not berate directly or irmPredly to benefit anyone rK)t narned in the Schedule. <br /> Schedule <br /> Blanket Waiver <br /> Person/omanizallion.. Blanket Waiver-Any person or organization for vs&,+rn the Named Insured has <br /> agreed by written contract to furnish this waiver. <br /> Sob Description <br /> All NC Operations <br /> This cbanges the policy to wj*jj a is oUrhad and is effective an the date issued unless ot4onvion stat"d. <br /> (The InfornmPon below 1*required only when this&"dormna"t is slaued subsequent to prepaintion of"1130111cV.) <br /> Endomernant Effective ftficy No, PRWOOM70 <br /> Insured <br /> Insurance Company Countersigned <br /> by-44 .......................... <br /> wo 00 0313 <br /> (Ed.4-84) <br /> O IM 1011kows Cm%qrfA an C"Psr4olbn <br />