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DocuSign Envelope ID:440150D2-FD41-4BE9-A7A3-C63D04B87273 <br /> WORKERS COMPENSATION AND E4+f'LOYERS L IAWL TY INSURANCE POLICY we 0a 03 is <br /> _...._................. ................--................w:. (Ed. 4-&4) <br /> WAVER OF OUR PIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br /> We,rave the right to r>rover oL.r phy;ngrit5'zmm anyone fiabie€car an injury covered by ifri;paii€y.Wo w-T not enforce <br /> our right agaimt the perm or organ :,Lion named in the SmeduleT ►;This agmee rent applies only to the extent thaL <br /> you parf6rm"work under a wriften tY nfracf,hat rt qui,es you to ol~tnin tta$agreement from us.) <br /> This agreem?ent shatl not operate dir ectiy 4r irndirec€iy to bene i anyone not narne-J jr,'he Sohedute. <br /> Schedule <br /> Blanket Waiver <br /> 1� �'x4i't (7�l' T3rri;r3Y3CPr3: Hlarket lVaiver-Any pw5ion Dr cr,3aniz,'.1ini,for SviFom ti'se t4amed Insun cl has <br /> bI wr itte,-, contract tc furnish this-waiver, <br /> bo a r3escrtlate¢sa� walvar Premium <br /> AR RFC A7erations I4#.00 <br /> This channas ftr p,�licy to vrhic h it is aq ta,had and fy Oective on the da#e issued un#ass 4ihanvise sfatt�d. <br /> (The infarrrtat109 helOw is required only whi sn this ondorsemotst it is;suad sub�-.Zqu t to prsparati4m Of the policy,) <br /> Endorse cros;nt `—%otive Pc2iCF No, PRWC836165 <br /> insurance Cornp•rry Counf-rsi -se >-V, <br /> g° d ��- <br /> I <br /> we 00 t13 3 <br /> (Ed,x-84) <br /> Q 1931 NaVomf Comicu on Comp�oioo;ti u(unae. <br />