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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br />(Ed. 4-84) <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. (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 any one not named in the Schedule. <br />Schedule <br />WHERE REQUIRED BY WRITTEN CONTRACT, PROVIDED THE <br />CONTRACT IS SIGNED AND DATED PRIOR TO THE DATE OF <br />LOSS TO WHICH THIS WAIVER APPLIES, IN NO INSTANCE <br />SHALL THE PROVISIONS AFFORDED BY THIS ENDORSEMENT <br />BENEFIT ANY COMPANY OPERATING AIRCRAFT FOR HIRE. <br />per RalicvMinimutp iv rPrnrrl`n�rL��y ,.tate: <br />$500: AL, AR, CA, CO, CT, DC, ID, IL, IN, IA, KS, ME, MD, MI, MS, MT, NV, NM, OR OK, OR, PA, RI, SD, I.T. VI VA, WA, WV <br />$250: AK, DE, LA, NY <br />$100: NC <br />$60: WI <br />N/A: A2, FL, GA, HI, MA, MN, MO, NE, SC, TN, TX <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 02/01/18 Policy No, T10180329 Endorsement No, 5 <br />Insured Rincon Consultants, Inc Policy Effective Date 02/01/18 <br />Insurance Company StarStone National Insurance Company <br />Countersigned By f <br />WC 00 03 13 <br />(Ed. 4-84) <br />copyright 1983 National Council on Componsation Insurance. <br />