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WORKERSÓ COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br />(Ed. 4-84) <br /> <br /> <br /> <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT Î CALIFORNIA <br /> <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 per- <br />form work under a written contract that requires you to obtain this agreement from us.) <br /> <br />You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work <br />described in the Schedule. <br /> <br />The additional premium for this endorsement shall be of the California workersÓ compensation premium <br />$0 <br />otherwise due on such remuneration. <br />SCHEDULE <br /> <br />Person or Organization Job Description <br /> <br />City of Santa Ana, its City Council, officers, officials, employees, agents, <br />IN FAVOR OF: <br />and volunteers <br /> <br />City of Santa Ana Attn: Informational Technology Department <br /> <br />20 Civic Center Plaza, M-42 <br />Santa Ana, CA 92701 <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <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: Policy No: Endorsement No: <br />03/12/2026WC 69-08-189-00 <br />Insured: <br />Rippling PEO 1, Inc. Labor Contractor, for co-employees of: C3 Office Solutions LLC <br />dba: C3 Tech <br />Insurance Company: Countersigned by <br />American Zurich Insurance Company <br /> <br />WC 04 03 06 <br /> <br />Copyright 1983 National Council on Compensation Insurance <br />