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DocuSign Envelope ID: Fl E99030-036D-407F-B588-94BC3741A806 <br /> WORKERS COMPENSA1lON AND EMPLOYERS LIAElur(INSURANCE POLICY WC 00 03 93 <br /> (Ed.6-84) <br /> WAIVER OF OUR RIONY TO RECOVER FROM OTHERS ENDORSEMENT <br /> We have the right to recover our payments from anyone(Pablo for an Injury covered by this policy.We will not enforce <br /> our tight against the person or organization named In the Schedule.(This agreeMent apulles only to the extent that <br /> you perform wont under a written contract that requlree you b obtain this egreereerri from us.) <br /> This agreement shall not operate directly or indlreCtly to benefit anyone not named in the Schedule. <br /> Schedule <br /> gterrket Waiver <br /> Person/Orgsnixetitsrrs Blanket Waiver-Any person or organization fur whom the Flamed Insured has <br /> egrend by written contract to furnish this waiver, <br /> Job Description <br /> All NC Operations <br /> This endoreemenl changes the collcy to which It is sitschud and la effective on the date issued unless at envisu eluted. <br /> (The leform/11k n below is required only when thle endorsement Is Issued subsequent to preparation of the policy.) <br /> Endorsement Effective Policy No. P+ 1e Ensjo purls r No. <br /> Insured p t p 7rr <br /> Insurer✓l Company Covntereigned tfy "�^ . . x:....> <br /> WC 00 0313 <br /> (Ed.4.484) <br /> 01683 Kalinin*Cew 1I on Comp Ma Olen rruraraum. <br />