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Docusign Envelope ID:230C4AAA-8F3E-805F-8375-AC27622853D5 <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br /> This endorsement, effective on 11/20/2025 at 12:01 A.M. standard time, forms a part of <br /> Policy No. 1938579 <br /> Issued to Harris Brothers Electric and Controls, Inc. <br /> Issued by Federated Mutual Insurance Company <br /> Endorsement No. 8ic <br /> Authorized Representative <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 <br /> 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 /> Orange County <br /> 300 W Tryon St <br /> Hillsborough, NC 27278-2438 <br /> Additional Reference: <br /> Subject to the terms and conditions of the policy, Waiver of Subrogation also includes <br /> Orange County, its officers, official agents and employees. <br /> If work is performed in Missouri, this waiver does not apply to any construction group <br /> of classifications as designated by the Waiver of Our Right to Recover from Others rule <br /> in our manual. <br /> Copyright 1983 National Council on Compensation Insurance. <br /> WC 00 03 13 (04-84) Issue Date: 11/20/2025 <br />