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Marsh, Inc <br />8/24/2006 4:54 PM PAGE 8/008 Eastern Time Zone <br />Workers' Compensation and Employers' Liability Policy <br />Named Insured: Johnson Controls, Inc. <br />Endorsement Number: AA <br />Policy Number: WLRC44333879 <br />WLRC44333880 - CA <br />Policy Period:10 -1 -05 TO 10 -1 -06 <br />Effective Date of Endorsement: 10 -1 -05 <br />Issued by (Name of Insurance Company): Indemnity Insurance Company of North America and for CA: ACE American <br />Insurance Company <br />Insert the policy number. The remainder of the information of the information is to be completed only when this endorsement is issued subsequent to <br />the preparation of the policy. <br />.................................................................................................................................................................................... ............................... <br />...................................................................................................................................................................................... ............................... <br />...................................................................................................................................................................................... ............................... <br />Person or Organization: If required by contract, City of Santa Ana, its officers, employees, agents, volunteers <br />and representatives <br />Job Description: <br />- _......._.. ....__......_ ................ -_ <br />:::: :W.A4VER:OF:OUR:RIGMTT.RECOVE .FROM: OTHERS :::::::::::::::::::::::: ::::::::::::::::::::::::::::::: <br />.................. ............................... ............. ..........................I.... . <br />.... . ......................................................................... ............................... <br />WC 00 03 13 <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce <br />our right against the person or organization named in the Schedule. <br />This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this <br />agreement from us. <br />This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br />... ....................... <br />�i .R J OEM NA 'LIP 0, : <br />WC 04 03 os Ed. 4 -84 <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 required 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 —INCLUDED _% of the California workers' compensation <br />premium otherwise due on such remuneration. <br />Copyright 1982 -83, National Council on Compensation Insurance <br />Authorized Agent <br />