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WORKERS'COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br /> (Ed. 4-84) <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA <br /> We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our <br /> right against the person or organization named in the schedule(This agreement applies only to the extent that you per- <br /> form work under a written contract that requires you to obtain this agreement from us.) <br /> You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work <br /> described in the Schedule. <br /> The additional premium for this endorsement shall be $0 of the California workers' compensation premium <br /> otherwise due on such remuneration. <br /> SCHEDULE <br /> Person or Organization Job Description <br /> IN FAVOR OF: <br /> City of Santa Ana its City Council, officers, officials, <br /> employees, agents and volunteers. <br /> 20 Civic Center Plaza <br /> Santa Ana CA 92701 <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> (The information below is required only when this endorsement is issued subsequent to preparation of the policy,) <br /> Endorsement Effective: 05/08/2025 Policy No: WC 12-68-329-04 Endorsement No: <br /> Insured: paychex PEO Holdings, LLC Alt. Emp: HydroApps LLC <br /> Insurance Company: American Zurich Insurance Company Countersigned by <br /> WC 04 03 06 { ; <br /> Copyright 1983 National Council on Compensation Insurance <br /> 20307464 I PaychexPEOHoldingsLLC MAST {MD) WC226832904 I AG 105108/2025 3:47:52 PM EDT I Page 2 of 2 <br />