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Insured: Larry Walker Associates, Inc, <br />Policy Number: WZP81031046 <br />Effective Date: 04/01/2016 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />WAIVER OF OUR RIGHT TO RECOVER FROM <br />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 % of the California workers' compensation premium <br />otherwise due on such remuneration. <br />SCHEDULE <br />Person or Organization Job Description <br />SCHEDULE CONTINUATION: The City of Santa Ana, Its officers. employees, agents, and <br />City of Santa Ana representatives <br />Clerk of the City Council <br />P.O. Box 1988 <br />Santa Ana, CA 92702-1988 <br />Countersigned by 4-C" <br />-C" <br />Authorized Representative <br />Form WC 04 03 06 (1) Printed in U.S.A. <br />Process Date: Policy Expiration Date: <br />REVIEWED BY: ZZ11.,_. // I._.. EUNICE HEREDIA (PG S—OP,�—) <br />