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DocuSign Envelope ID:070B6BC7-CDE2-4AO8-BE62-07FA6BFDO53B <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br /> WC 00 03 13 (Ed. 04 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 not <br /> enforce our right against the person or organization named in the Schedule. (This agreement applies only to the <br /> 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 /> "Organizations for which the Named Insured has agreed to by written contract executed prior to the loss to furnish waiver' <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 1/6/2021 Policy No.A823975 Endorsement No. <br /> Insured ASJ Wilson Construction, LLC Premium$ <br /> Insurance Company West Bend Mutual Insurance Countersigned by <br /> WC 00 03 13 (04 84) Page 1 of 1 <br /> Copyright 1983, National Council on Compensation Insurance, Inc. <br />