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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br />(Ed. 04 84) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - <br />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 />our right against the person or organization named in the Schedule. (This agreement applies only to the 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 5 % of the California workers' compensation premium <br />otherwise due on such remuneration. <br />PERSON OR ORGANIZATION <br />THE CITY OF SANTA ANA, 20 CIVIC <br />CENTER PLAZA, SANTA ANA, <br />CALIFORNIA 92702; ITS OFFICERS, <br />EMPLOYEES, AGENTS AND VOLUNTEERS <br />2320 REDHILL AVE., SANTA ANA, CA <br />92705. <br />SCHEDULE <br />JOB DESCRIPTION <br />FUNDING <br />REVIEWED & APPROVED <br />By Risk MANngEM,ENT DivisioN <br />JUL 2024 <br />ANf IE ACEVEdO <br />©1998 by the Workers' Comperssdm Irr rswe RaBrg Bureau of California. All rights reserved. <br />From the WCIRB's California Workers' Compensation Insurance Forms Manual © 1999. <br />iNs ED <br />