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and <br />insperily, INC. L/C/F <br />KOSMONT & ASSOCIATES, INC. <br />19001 Crescent Springs Drive <br />TO <br />CALIFORNIA <br />This endorsement applies only <br />Information Page. <br />We have the right to recover of <br />our right against the person or <br />injury arising out of the operatic <br />waiver from us. <br />You must maintain payroll reco <br />work described in the Schedule <br />1. (X) Specific Waiver <br />Name of person or <br />CITY OF SANTA P <br />20 CIVIC CENTER <br />SANTA ANA, CA £ <br />( ) Blanket Waiver <br />Any person or orgai <br />waiver. <br />2. Operations: <br />3. Premium: <br />The premium charge for t <br />payroll In connection with <br />described. <br />4, Minimum Premium: Ii� <br />WC 99 03 22 <br />Symbol: RWC Number: C66712679 <br />10/1/2019 <br />'ER FOUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />the nsurance provided by the policy because California is shown in Item 3.A. of the <br />)ay ants from anyone liable for an Injury covered by this policy, We will not enforce <br />rani ation named in the Schedule, but this waiver applies only wit i respect to bodily <br />de cribed in the Schedule, where you are required by a written contract to obtain this <br />segregating the remuneration of your employees while engaged in the <br />Schedule <br />4TH FLOOR <br />for whom the Named Insured has agreed by written contract to furnish this <br />shall be !N-QLUDED percent of the California premiu developed on <br />for the above person(s) or organization(s) arising out cf the operations <br />