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Workers' Compensation and Employers' Liability Policy <br /> Named Insured <br /> TriNet Group,Inc.L/C/F PowerPivotPro LLC Endorsement Number <br /> 1 Park Place,Suite 600 <br /> Dublin,CA 94568-7983 <br /> Policy Number <br /> Symbol:WLR Number:C57632124 <br /> Policy Period Effective Date of Endorsement <br /> 07/01/2024 TO 07/01/2025 07/01/2024 <br /> Issued By(Name of Insurance Company) <br /> ACE American Insurance Company <br /> Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br /> This endorsement applies only to the insurance provided by the policy because California is shown in item 3.A. of the <br /> Information Page. <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, but this waiver applies only with respect to <br /> bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to <br /> obtain this waiver from us. <br /> You must maintain payroll records accurately segregating the remuneration of your employees while <br /> engaged in the work described in the Schedule. <br /> Schedule <br /> 1. (X) Specific Waiver <br /> Name of person or organization: <br /> City of Santa Ana Public Works Agency-Water Resources Division <br /> 20 Civic Center Plaza(M-30),PO BOX 1988 <br /> Santa Ana,CA 92702 <br /> O Blanket Waiver <br /> Any person or organization for whom the Named Insured has agreed by written contract to <br /> furnish this waiver. <br /> 2. Operations: <br /> 3. Premium: <br /> The premium charge for this endorsement shall be INCLUDED percent of the California premium <br /> developed on payroll in connection with work performed for the above person(s) or organization(s) <br /> arising out of the operations described. <br /> 4. Minimum Premium: INCLUDED APPROVED <br /> By Cynthia Mora at 2:22 pm, Dec 04, 2024 <br /> Authorized Representative <br /> WC 90 03 75 (05/18) <br />