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DocuSign Envelope ID:3F1D7CF6-245A-4714-B5DB-30373A05897A <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br /> ( d. 4-84) <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br /> We have the right to recover our payments from anyone liable for an injury covered by this policy. We will <br /> not enforce our right against the person or organization named in the Schedule. (This agreement applies <br /> only to the extent that you perform work under a written contract that requires you to obtain this <br /> agreement from us.) <br /> This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br /> Schedule <br /> EXCLUDES OPERATIONS ON-SITE UNDER A WRAP-UP COVERAGE FOR SKANSKA USA IN NORTR CAROLINA. <br /> WC 00 03 13 04 84 COVERS ONLY OPERATIONS OFF-SITE NOT INCLUDED IN WRAP-UP OPERATIONS. <br /> BUILDERS MUTUAL INSURANCE COMPANY INC IS NOT A CONTRIBUTOR TO ANY WRAP-UP PROJECT- <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> (The Information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br /> Endorsement Effective Policy No. Endorsement No. <br /> Insured Premium n <br /> insurance Company Countersigned by <br /> WC 00 03 13 <br /> (Ed. 4-84) Copyright 1983 National Council on Compensation insurance. <br />