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dftk <br />TravielersPro�tyCCa �t �'� I <br />ENDORSEMENT WC <br />POLICY NUMBER: UB-C2318577 <br />CITY OF SANTA ANA <br />Planning and Building Agency <br />Anv <br />12/26/20J(pproved <br />FOR PERMIT ISSUANCE <br />COMPENSATION <br />AND <br />M&'D: POLICY <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br />ENDORSEMENT - CALIFORNIA <br />(BLANKET WAIVER) <br />(00) <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. <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 pre- <br />mium otherwise due on such remuneration. <br />Schedule <br />Person or Organization Job Description <br />Evidence of Insurance <br />88571763 1 COASTDEV 1 25-26 GL, Auto, XLS, Poll I Carmen Vacio 1 12/26/2025 10:30:45 AM (PST) I Page 2 of 2 <br />