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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 02 C <br /> (Ed.9-14) <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS 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%of the applicable manual premium otherwise due on <br /> such remuneration subject to a policy maximum charge for all such waivers of 5%of total manual premium. <br /> The minimum premium for this endorsement is <br /> This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br /> Schedule <br /> PersonfOrganization: City of Santa Ana, its officials,officers,and employees <br /> 20 Civic Center Plaza(M-21),Santa Ana,CA 92702 <br /> Job Description:For all professional services as contracted through City, performed during the policy period. <br /> Payroll Subject <br /> Class State to Waiver <br /> 5606 CA <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 /> Policy No.: GRWC529454 Endorsement No.: <br /> Insurance Company: Oak River Insurance Company <br /> Countersigned by !_ <br /> WC990402C <br /> (Ed. 9-14) <br />