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Workers' Compensation and Employers' Liability Policy <br />Named Insured <br />Endorsement Number <br />WATER WORKS ENGINEERS, LLC <br />7500 N DOBSON RD STE 200 <br />SCOTTSDALE, AZ 85266-2723 <br />Policy Number <br />Symbol: WLR Number: C74039376 <br />Policy Period <br />Effective Date of Endorsement <br />10/01 /2025 -ro 10/01 /2026 <br />10/01 /2025 <br />Issued By {Name of Insurance ompany <br />Indemnity Insurance Company of North America <br />[nsertthe policy number, rhe remainder of the in or nation Is to be completed only when this endorsement is issued subsequent to the preparation of the policy. <br />This endorsement changes the policy towhich 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. <br />of 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 <br />respect to bodily injury arising out of the operations described in the Schedule, where you are required by a <br />written contract 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 />City of Santa Ana -Public Works Agency <br />P.O. Box 1988 <br />Santa Ana, CA 92702-1988 <br />WAIVER OF sUBROGATION IN FAVOR OF City of Santa Ana its City Council officers officials employees agents and volunteers WHEN REQUIRED BY WRITTEN CONTRACT. <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 />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. Ir <br />4. Minimum Premium: INCLUDED AW;;;;r <br />Authorized <br />WC 90 03 75 (05118 <br />