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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br />(Ed. 4-84) <br />WAIVER OF OUR RIGHT 70 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 notenforca <br />our right against the person or organization named in the Sohedute. (This agreement applies only to tire extent that <br />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 the <br />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 />Scnedule <br />129=11.01-0=017AW ,Job Descriotton <br />City of Santa Ana, Its officers, employees an agents and representatives are <br />additional insureds with respect to general liability and auto tlabtity per TRAFFIC DATA <br />the attached endorsements or as required by written contract. <br />Insurance Is primary and Non•Corrtrlbutory. <br />This endorsement changes the policy to which it Is attached and is effective on the date issued unless ohenwise stated.. <br />(rile information below is required only wdien this endorsement is Issued subsequent In preparation or the policy.) <br />Endorsement Effective Policy No, 92-GA-D960-8 Eneorsmnent No. <br />Insurod insuranos Company Stare Farm General insurance Company <br />AIMTD, LLC <br />7515 WEIR CANYON RD STE 157-158 <br />ANAHEIM, CA 97=8 <br />q� r-tl,t�r� $ C;<xin�trerrsiigned{Bry'�----- <br />WC 04 03 06 RE Y � t_LL+ iY Ae" r" rSiJV1..Lt Ptin:c`tt in l! 3.A. <br />(Ed. 4.84) $Y Risk ANAGEMENT D 4`ISION <br />11' <br />M. LAMBERT <br />