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ACCIDENT FUND NATIONAL INSURANCE COMPANY WC 00 03 13 <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 4-84) <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 02/07/2025 Policy No.AF WCP 100110578 02 Endorsement No. <br />Insured BOER BROTHERS HEATING & COOLING, LLC Premium:$0 <br />Insurance Company ACCIDENT FUND NATIONAL <br />INSURANCE COMPANY <br />Countersigned by __________________________________________ <br />WC 00 03 13 <br />(Ed. 4-84) <br />© 1983 National Council on Compensation Insurance. <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 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 whom the Named Insured has agreed by written contract to furnish this waiver. <br />Docusign Envelope ID: AFE257DF-70E9-4F30-B47A-A944E856CFAE