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DocuSign Envelope ID: DF078B63-CCED-42B9-8016-A67D8F6DF779 <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 IS REQUIRED BY WRITTEN CONTRACT EXCEPT <br /> OPERATIONS RELATED TO WRAP—UPS. BUILDERS MUTUAL INSURANCE COMPANY INC IS NOT A <br /> 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$ <br /> Insurance Company Countersigned by <br /> WC 00 03 13 <br /> (Ed. 4-84) Copyright 1983 National Council on Compensation Insurance. <br />