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TRAVELERS Jw WORKERS COMPENSATION <br />AND <br />ONE TOWER SQUARE HARTFORD CT 06183 EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 0403 06 (01) — 024 <br />POLICY NUMBER: UE-6P363599-22-42-G <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br />ENDORSEMENT-CALIFORNIA <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 />You must maintain payroll records accurately segregating the remuneration of your employees while engaged in <br />the work described in the Schedule. <br />THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 5.00% OF THE CALIFORNIA WORKERS' <br />COMPENSATION PREMIUM OTHERWISE DUE ON SUCH REMUNERATION. <br />SCHEDULE <br />PERSON OR ORGANIZATION JOB DESCRIPTION <br />CITY OF SANTA ANA, RISK MANAGEMENT DIVISION, 20 CIVIC CENTER DEMOGRAPHY <br />PLAZA, SANTA ANA, CA 92702 CONSULTING FOR <br />REDISTRICTING <br />DATE OF ISSUE: 12-17-21 ST ASSIGN: Pagi <br />RW1MmegatattDiM1on <br />Rizm r o&APPROVPD BY. <br />® <br />Risk Management Analyst <br />