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WC Od 03 08 <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (CO.4-EA) <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 enforce <br />your riht against the ou perforrm work underrson or organization named in a written contract the, requiresthe Schedule. yo to obtain hislagreement from unt sies -) <br />you only to the extant that <br />you must maintain payroll records accurately segregating the remuneration of your employees while engaged in the <br />work described in the Schedule. <br />s °l� premium <br />The additional premium for this endorsement shall be or the California workers' compensation <br />._� <br />otherwise due on such remuneration. <br />Schedule <br />P�75.229L9t9a ,14t!p1191i <br />City of Santa Ana, its officers, employees an agents and representatives are <br />additional tnsurad's with respect to general lability and auto liability per TRAFFIC DATA <br />the attached endorsements or as required by written contract. <br />Insurance is primary and Nan -Contributory. <br />This andorsement chantias the policy to which It is attached and is effective on the date issued unless 01118rensa stated <br />(The Information below Is required only where tills endorsement is issued subsequentto preparation of the policy.) <br />EA00rsomontEffective po;icvNo.92-CH-M1790 Endorsement No. <br />Insured Insurance Company State Farm General Insurance Company <br />AIMTD, U.0 <br />751 S WEIR CANYON RD STE 157.158 <br />ANAHEIM, CA 97808 <br />Countersigned 6y <br />WC Od 03 00 R V'C. / k /� `a[{{�� Pmwd h u.S.A <br />(Ed. 4-84) n.. n:,.l.l'AAAmAnvMENT DivistON <br />t <br />M, LAMBERT <br />