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PIINN/LCOL 7501 E. Lowry Blvd. <br /> Denver, CO 80230-7006 <br /> ASSURANCE 303.361.4000/800.873.7242 <br /> Pinnacol.com <br /> NCCI #: WC000313 <br /> Policy#: 4240414 <br /> 110%, Inc. <br /> PO Box 538 <br /> Salida, CO 81201-0538 <br /> ENDORSEMENT: Waiver Of Subrogation <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 requires you to obtain this agreement from us.) <br /> This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br /> SCHEDULE <br /> City of Santa Ana <br /> 20 Civic Center Plaza <br /> Santa Ana, CA 92701-4058 <br /> "City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers." <br /> Effective Date: April 1, 2025 <br /> Pinnacol Assurance has issued this endorsement May 7, 2025 <br /> 7501 E.Lowry Blvd Denver,CO 80230-7006 <br /> Page 1 of 3 P matthew.david@110percent,net- 04/0112025 12:49:30 4240414 84997230 UW137 <br />