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IN <br /> FE-6609 <br /> WORKERS COMPENSATION <br /> POLICY NUMBER: 92-TA-M894-3 <br /> WAIVER OF TRANSFER OF RIGHTS OF RECOVERY <br /> AGAINST OTHER TO US <br /> Policy Number: 92-TA-M894-3 <br /> Named Insured: Romo Enterprises Inc DBA DTSA Services <br /> SCHEDULE <br /> NAME OF PERSON OR ORGANIZATION: <br /> CITY OF SANTA ANA <br /> ATTENTION RISK MANAGEMENT <br /> 20 CIVIC CENTER PLAZA <br /> SANTA ANA, CA 92702 <br /> CITY OF SANTA ANA, IT'S CITY COUNCIL, OFFICERS, OFFICIALS, EMPLOYEES,AGENTS, <br /> &VOLUNTEERS. <br /> Information required to complete this Schedule,if not show above,will be shown in the Declarations. <br /> The following is added to Paragraph 10.b. of SECTION 1 AND SECTION II —COMMON <br /> CONDITIONS: <br /> We waive any right of recovery we may have against the person or organization shown <br /> in the Schedule above because of payments we make for any injury arising out of: <br /> c. Your ongoing operations; or <br /> d. Your work done under contract with that person or organization and included in the <br /> products-completed operations hazard. <br /> This waiver applies only to the person or organization shown in the Schedule above. <br /> All other policy provisions apply. <br /> FE-6671 <br /> ©,Copyright,State Farm Mutual Automobile Insurance Company,2008 <br /> Includes copyrighted material of Insurance Services Office,Inc.,with its permission. <br />