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DocuSign Envelope ID: 12DCC4E1-4D61-4DOE-A2A2-7C6E689613AC <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br /> ENDORSEMENT <br /> We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not <br /> enforce our right against the person or organization named in the Schedule. (This agreement applies only to <br /> the extent that you perform work under a written contract that requires you to obtain this agreement from us.) <br /> This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br /> Schedule <br /> Orange County <br /> P O Box 8181 <br /> Hillsborough,NC 27278 <br /> Project Location: <br /> Orange County <br /> 2551 Homestead Road <br /> Chapel Hill,NC 27516 <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless other- <br /> wise 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 /> 01/08/2019 WCP106230201 <br /> Insured Muter Construction LLC <br /> Premium$ Incl. <br /> Insurance Company <br /> Builders Mutual Insurance Company Countersigned b <br /> 9 Y <br /> WC000313 <br /> 01983 National Council on Compensation Insurance. <br />