Orange County NC Website
Browse       Search
DocuSign Envelope ID:35DE8770-E58E-4C2C-927C-2DA561B203BF <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br /> (Ed. 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 /> Any person or organization that you perform work for that is liable for an injury, covered by this policy, that <br /> prior to the injury has written contract requiring a waiver of our right to recover from them. <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 1/1/2021 Policy No. WCV6179537 Endorsement No. <br /> Insured r miumS <br /> Summit Design and Engineering Services PLLC I l \ <br /> Insurance Company Countersigned by <br /> Accident Fund General Ins Co <br /> WC000313 <br /> (Ed. 4-84) Copyright 1983 National Council on Compensation Insurance. <br />