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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br /> (Ed. 04-84) <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> Republic Indemnity Company of California <br /> Company Number 27561 <br /> Insured William H Nuesse MD and Mary Ann Nuesse Do, a Medical Corp <br /> Policy Number 256017-04 <br /> Endorsement Number 12 <br /> Endorsement Effective August 01, 2025 <br /> Printed On October 03, 2025 <br /> Countersigned by : <br /> I <br /> WC 00 03 13 2 of 2 <br /> (Ed. 04-84) Insured Copy <br /> 01983 National Council on Compensation Insurance. <br />