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¤¤ 1983 National Council on Compensation Insurance. <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICYWC 00 03 13 <br /> (G  <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />:HKDYHWKHULJKWWRUHFRYHURXUSD\PHQWVIURPDQ\RQHOLDEOHIRUDQLQMXU\FRYHUHGE\WKLVSROLF\:HZLOOQRWHQIRUFH <br />RXUULJKWDJDLQVWWKHSHUVRQRURUJDQL]DWLRQQDPHGLQWKH6FKHGXOH <br /> <br />7KLVDJUHHPHQWVKDOOQRWRSHUDWHGLUHFWO\RULQGLUHFWO\WREHQHILWDQ\RQHQRWQDPHGLQWKH6FKHGXOH <br />6FKHGXOH <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />7KLVHQGRUVHPHQWFKDQJHVWKHSROLF\WRZKLFKLWLVDWWDFKHGDQGLVHIIHFWLYHRQWKHGDWHLVVXHGXQOHVVRWKHUZLVHVWDWHG <br /> <br />(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br />(QGRUVHPHQW(IIHFWLYH 3ROLF\1R (QGRUVHPHQW1R <br />,QVXUHG  3UHPLXP <br /> <br />,QVXUDQFH&RPSDQ\ &RXQWHUVLJQHGE\BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB <br /> <br /> <br /> <br /> <br />WC 00 03 13 <br /> (G  <br />4022 <br />Smith Sinnett Architecture, P.A. <br />PSW0003488 <br />03-16-2021 <br />RLI Insurance Company <br />(This agreement applies only to the extent that you perform work under a written contract that requires you to obtain <br />this agreement from us.) <br />Any person or organization that you have agreed with in a written contract to provide this agreement. <br />DocuSign Envelope ID: D8D55CD0-DBB0-4B4E-A7CF-D813F272CB8D