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WORKERS' COMPENSATION AND EMPLOYERS <br />LIABILITY INSURANCE POLICY <br />WC 42 03 04 A <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 our <br />right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury <br />arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver <br />from us. <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 fumish this waiver. <br />2. Operations: ALL TEXAS OPERATIONS <br />3. Premium <br />The premium charge for this endorsement shall be 2.00 percent of the premium developed on payroll in <br />connection with work performed for the above person(s) or organization(s) arising out of the operations described. <br />4. Advance Premium INCLUDED, SEE INFORMATION PAGE. <br />This endorsement changes the policy to which It Is attached effective on the inception date of the policy unless a different date is indicated below. <br />(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) <br />This endorsement, effective on 8/18/2014 at 12:01 A.M. standard time, forms a part of <br />Policy No. TSF0001215133 of the Texas Mutual Insurance Company <br />Issued to SANITATION SOLUTIONS INC <br />Endorsement No. <br />Premium $ <br />Authorized Representative <br />WC420304A (ED. 1.01-2000) <br />INSURED'S COPY OUSER 8 -16 -2013 <br />