Orange County NC Website
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WC 00 03 13 04 84 <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT_WC 00 03 13_04/84 <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 <br />10/20/2024 <br />Policy No. <br />TWC 7024349 11 <br />End orsement No. <br />Insured <br />Wildebeest Topco LLC <br />Premium <br />Insurance Company:Countersigned by <br />Berkley National Insurance Company <br />WC 00 03 13 04 84 © 1983 National Council on Compensation Insurance Page 1 of 1 <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br />ENDORSEMENT <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not <br />enforce our right against the person or organization named in the Schedule. (This agreement applies only to the <br />extent that you 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 you have agreed to waive your rights of recovery in a written contract, <br />provided such contract was executed prior to the date of loss. <br />31