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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 42 03 04 B <br />(Ed. 6-14) <br />TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the <br />Information Page. <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, but this waiver applies only with respect to bodily <br />Injury arising out of the operations described In the Schedule where you are required by a written contract to obtain <br />This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br />The premium for this endorsement Is shown in the Schedule. <br />Schedule <br />1. ( ) Specific Waiver <br />Name of person or organization <br />( X) Blanket Waiver <br />Any person or organization for whom the Named Insured has agreed by written contract to furnish this <br />waiver. <br />2. Operations: <br />3. Premium: Per Schedule <br />The premium charge for this endorsement shall be 0 . 02 percent of the premium developed on payroll In <br />connection with work performed for the above person(s) or organizatlon(s) arising out of the operations described. <br />4. Advance Premium: Per Schedule <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 Date:06/01/2020 Policy No. WC 928638713484 <br />Policy Effective Date: 06/01/2020 to 06/01/2021 <br />Insured: IEC Corporation <br />DBA: <br />Carrier Name / Code: Argonaut Insurance Company <br />WC 42 03 04 B Countersigned by <br />(Ed. 6-14) <br />©Copyright 2014 National Council on Compensation Insurance, Inc. All Righis Reserved. <br />Endorsement No. <br />Premium $ <br />H� Risk Managan"Diviatan <br />gA ® REAEvvED&APPRev8Y: <br />' 1ri'E•fnl�R P,Vd&4411 <br />Risk Management Analyst <br />