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DocuSign Envelope ID:7D69FBBF-740D-461 F-894A-506C56138C2AA <br /> WORKERS C()MPF 8A1 I0N AND EMPLOYERS LIASILITY INSURANCE POLICY WC 00 03 i$ <br /> (Ea,4�64) <br /> �. WAPXR OF OUR RIGHT TO RECOVER FROM OTHERS 5 4DOR8F'MENT <br /> We hnv*thn VM to renovar our paymef tts.from aityvnB 11010 40r an inJury c6y6ratt by thig paltry.WA WW itot anforoa <br /> your r�jm ou pedal nit sktlr 4�a wrti'm contra i that reyArlizown uI(ty you ld In OK Wo abtalnat ohIs ageornrmnl{n�mraomenj v ss.)e❑nry irs thn oxlAnt tRtll <br /> Thls agretrtnerit shall pot"rate directly or Indirac[ly to banefil anyone rKtt named lit the 5cv%dula <br /> s0ocluln <br /> Blanket WaiYer <br /> parca J[Segardtetivrr: ElankeL WDlvtr-Any person or csrganlrauon for wtuio Chi:Named insured hea <br /> spread by yrrmei%rbil"et to turmigh this waiver, <br /> Job Dtricelptinn <br /> AI(NC t WAVohs <br /> 7 andu c krn>jrri t astslae Eha vatikNY towisicJr i4 is gliuChad and is efteetlYe w Iha data i3suusf uniecs nt!tarwiscs al�ttFrd. <br /> I7ha 10ormrtin3 WOW is t*gvlteci srsty when thin andorarfnMnt 1*Nsursi ruhaarltient 0 ps+parxtiurn of Itke puljcy.} <br /> l5n&g,igFn;'n1 jf aalW6 Ridley No, kint7in <br /> Insured •�� <br /> Cam Yn G3vntsrsigm�d �. ...... ......... . <br /> Insurarr.*r P Y <br /> wo 00 4313 <br /> (IFd.4-64) <br /> f p631Sa1k+nr1 Gn3rrrlr�n CVH�A►.nMien�rwuroisea. <br />