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Insured: Larry Walker Associates, Inc. <br />Policy Number: WZP81031046 <br />Effective Date: 04m1s01e <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <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 hothe <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 ahuU be 96 of the California workers' compensation premium <br />otherwise due on such remuneration. <br />6MMIC110� <br />Person orOrganization Job Description <br />SCHEDULE CONTINUATION: The City m Santa Ana, its officers, employees, agents, and <br />representatives <br />m � <br />City <br />Clerk o, the City Council <br />P.O. Box 1988 <br />Santa Ana, CA 92702'1988 <br />° <br />Countersigned by <br />Authorized Representative <br />Form VVCO403OG (1) Printed inU.S.A. <br />Process Date: Pol.icy Expiration Date: <br />REVIEWED BY: /'�/~ ���~ / ~ EQNICEHEREDLA (PG ��x�- <br />