Laserfiche WebLink
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />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 MAN_gC,EMEM DiViSiON <br />JUL 8 2020 <br />ANgiE Accvedo <br />©1998 by th Workers Cmperm8m Irtwrame Rating Bureau of Califamia. All rig Ns reserved. <br />From the WCIRB's California Workers' Compensation Insurance Forms Manual © 1999. <br />wsLREo <br />