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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br /> (Ed.4-84) <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 /> Blanket Waiver <br /> Person/Organization: Blanket Waiver-Any person or organization for whom the Named <br /> Insured has agreed by written contract to furnish this waiver. <br /> Job Description Waiver Premium <br /> All Covered States Operations <br /> Excluding CA, UT <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: 04/01/2026 Policy No.: LNWC728591 Endorsement No.: <br /> Insured: L.N. CURTIS&SONS, INC. Premium $ <br /> Insurance Company: Berkshire Hathaway Homestate Ins Cc <br /> WC 00 03 13 Countersigned by <br /> (Ed. 4-84) <br /> ©1983 National Council on Compensation Insurance <br />