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r► <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />TEXAS WAIVER OF OUR RIGHT TO <br />RECOVER FROM OTHERS ENDORSEMENT <br />,J, <br />rj <br />`' Policy Number- 61 WE AD1841 Endorsement Number: <br />.I <br />Effective Date: 12/31/12 Effective hour is the same as stated on the Information Page of the policy. <br />C11 Named Insured and Address: BROWN AND GAY ENGINEERS, INC. <br />., <br />C_) <br />.{ <br />10-i;-1 WPS'.1'HY,1MER RD S'VE u010 <br />.401.11S TON, 'f'X 77042 <br />This endorsement applies only to the insurance provided by the policy because Texas is shown in item 3.A. of the <br />n information Page. <br />y 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, but this waiver applies only with <br />respect to bodily injury arising out of the operations described in the Schedule where you are required by a written <br />contract to obtain this waiver 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 />t® 1. (} Specific Waiver <br />Name of person or organization: <br />m� <br />tit <br />�i (x) Blanket Waiver <br />Any person or organization for whom the gamed Ensured has agreed by written contract to furnish this <br />waiver. <br />2. Operations: <br />�e <br />ALL TEXAS OP-ERATTONS <br />n� <br />3. Premium: tNC L <br />J� The premium charge for this endorsement shall be 2 - 4 percent of the premium developed on payroll in <br />M connection with work performed for the above person(s) or organizations) arising out of the operations <br />described. <br />4. Advanced Premium: INCL <br />vc r <br />Countersigned by <br />Authorized Representative <br />Form WC 42 03 04 Printed in U.S.A. <br />Process Date: 12/31/12 Policy Expiration Date: 12/31/13 <br />