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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br />(Ed. 4-84) <br />WAIVER OP OUR RIGHT TO RECOVER FROM OTHER'S ENDORSEMENT - CALIFORNIA <br />We have the Tight 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 extentthat <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 ____-1-0/6 of the California workers' compensation premium <br />otherwise due on such remuneration. <br />Schedule <br />Polaormt Qr0nzzotiop Job Oeminiilnn. <br />City of Santa Ana Risk Management Division u ;. TRAFFIC DATA <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />This ondorsomeni changes the polley to which It Is altaehod and is affective on the date Issued unless otherwise stated, <br />((he information below Is required only when this endorsement IS issued subsequent to preparation of the policy,) <br />Endorsement Elfecliva <br />Insured <br />AIMTD, LLC . <br />7515 WEIR CANYON RR 5TE 157-158 <br />ANAHEIM,CA.92808 <br />WC040306 <br />(Ed,4-n4) <br />Policy No 92-9P200-4 Endorsement No. <br />insurance Company State Farm General Insurance company <br />Countwsigned By <br />Frintod in USA,. <br />,� 1tiakManagementDtvlalon , <br />gREvaswEo & APPRavE) BY: <br />r Risk NtailaegementµndlYst 3 <br />