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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 37 <br />(Ed. 5 -02) <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 <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 />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 5% of the California Workers' Compensation premium <br />otherwise due on such remuneration, subject to a minimum premium of $50.00. <br />Person or Organization <br />City of Santa Ana <br />60 Civic Center Plaza <br />Santa Ana CA 92701 <br />Policy Number: WSD 5024711 00 <br />Endorsement Effective: 10/1/13 <br />Issue Date: 04/24/14 <br />WC 99 06 37 <br />(Ed. 5 -02) <br />Schedule <br />Job Description <br />Re: Towing <br />Insured: B & D Towing Inc <br />Coverage Provided by: Insurance Company of the West <br />Countersigned by: <br />