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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 enforce <br />our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you <br />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 />Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a <br />waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation <br />does not apply to any construction group of classifications as designated by the waiver of right to recover from others <br />(subrogation) rule in our manual. <br />Where required by contract or written agreement prior to loss and allowed by <br />law. <br />In the states of Alabama, Arizona, Arkansas, Colorado, Georgia, Illinois, <br />Indiana, Michigan, Mississippi, Missouri, Nevada, New Mexico, North Carolina, <br />Oklahoma, South Carolina, the premium charge is 2% of the total manual <br />premium, subject to a minimum premium of $100 per policy. <br />In the states of Connecticut, Florida, the premium charge is 1% of the total <br />manual premium, subject to a minimum premium of $250 per policy. <br />In the state of Louisiana, the premium charge is 2% of the total standard <br />premium, subject to a minimum premium of $250 per policy. <br />In the state of Tennessee, the premium charge is 2% of the total manual <br />premium, subject to a minimum premium of $250 per policy. <br />In the state of Virginia, the premium charge is 5% of the total manual <br />premium, subject to a minimum premium of $250 per policy. <br />In the state of Wisconsin, the premium charge is 2% of the total manual premium <br />plus EL Increased Limits, subject to a minimum premium of $50 per policy. <br />Issued by Employers Insurance Company of Wausau 15555 <br />For attachment to Policy No. WCC-691-467423-031 <br />Issued to Cotton Holdings, Inc. <br />Effective Date Premium$ <br />Endorsement No. <br />WC 00 0313 <br />Ed. 04/01/1984 <br />© 1983 National Council on Compensation Insurance .Page 1 of 1 <br />Attachment Code: D580422 Certificate ID: 16927711 <br />DocuSign Envelope ID: E737BD71-2898-4C23-ADC2-40E10C31F966