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WORKERS COMPENSATION <br />POLICY NUMBER: 92-GA-H506-1 <br />WAIVER OF TRANSFER OF RIGHTS OF RECOVERY <br />AGAINST OTHER TO US <br />Policy Number: 92-GA-H506-1 <br />Named Insured: Downtown Inc <br />SCHEDULE <br />NAME OF PERSON <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA <br />SANTA ANA, CA 92702 <br />(Information required to complete this Schedule, if not show above, will be shown in the Declarations. <br />The following is added to Paragraph 10.b. of SECTION 1 AND SECTION II — COMMON <br />CONDITIONS: <br />We waive any right of recovery we may have against the person or organization shown <br />in the Schedule above because of payments we make for any injury arising out of: <br />a. Your ongoing operations: or <br />b. Your work done under contract with that person organization and included in the <br />products -completed operations hazard. <br />This waiver applies only to the person or organization shown in the Schedule above. <br />All other policy provisions apply. <br />EVI ED &APPROVED <br />FE-6671 IS .1NACIPMENI ENVISION <br />O, Copyright. State Farm Mutu Aonce Company. 2068 <br />Includes copyrighted material of Insu n (,.2A ILLyUU�L�LUgUth its permission. <br />M. LAMBERT <br />