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Workers' Compensation and Employers' Liability Policy <br /> Named Insured Endorsement Number <br /> ICF INTERNATIONAL INC. <br /> 1902 RESTON METRO Policy Number <br /> PLAZA Symbol: RWC Number: (26)7175-43-37 <br /> Policy Period Effective Date of Endorsement <br /> 07-01-2025 TO 07-01-2026 09-04-2025 <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 /> 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 <br /> the 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 <br /> to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract <br /> to obtain this waiver from us. <br /> You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the <br /> work described in the Schedule. <br /> Schedule <br /> 1. ( X ) Specific Waiver <br /> Name of person or organization: <br /> The City of Santa Ana,its City Council,its officers,officials,employees,and volunteers <br /> ( ) Blanket Waiver <br /> Any person or organization for whom the Named Insured has agreed by written contract to furnish this <br /> waiver. <br /> 2. Operations: <br /> ALL OPERATIONS CONDUCTED BY AN INSURED PURSUANT TO SUCH <br /> WRITTEN CONTRACT <br /> 3. Premium: <br /> The premium charge for this endorsement shall be 1.0 percent of the California premium developed <br /> on payroll in connection with work performed for the above person(s)or organization(s) arising out of the <br /> operations described. <br /> 4. Minimum Premium: $0 <br /> Authorized Representative <br /> WC 90 03 75(05/18) <br />