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WORKERS' COMPENSATION AND EMPLOYERS LABILITY INSURANCE POLICY <br />WC 124 <br />(4-814) <br />WC 00 €33 13 <br />WAIVER F OUR RIGHT TO RECO'V'ER FROM OTHERS ENDORSEMENT <br />This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a <br />different date is indicated below. <br />(rhe toHow `attar! arg clause" need be completed onry urban this endorsement is issued suosequent to preparation of the policy.) <br />This andorsenent, effective an 09/1212012 at 12:01 A. M. standard time, forms a }cart of <br />(Df+76f <br />Policy Number (13)7173-87-17 of the PACIFIC €NiDEMNITY COMPANY <br />issued to GORES N-C HOLDINGS, LLC <br />Endorsement No. <br />Authorized RepresentaWe <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 any one not named in the Schedule. <br />Schedule <br />ALL PERSONS OR ORGANIZATIONS <br />WITH WRITTEN CONTRACTS OR AGREEMENTS <br />EXECUTED BETWEEN THE INSURED AND SUCH <br />PERSONS OR ORGANIZATIONS, PROVIDED THE <br />INSURED HAS WAIVED THEIR RIGHTS OF <br />RECOVERY AGAINST SUCH PERSONS OR <br />ORGANIZATIONS PRIOR TO THE DATE OF <br />INJURY COVERED BY THIS POLICY <br />THIS WAIVER GOES NOT APPLY TO THE <br />STATE OF WISCONSIN <br />wC 124 to-84) <br />WC 00 03 13 Copyright 1983 Natimal Camcfi on Compensation Insurance. Wage 1 of 1