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INSURED: InfoSend, Inc. <br />POLICY #: WCV5504862` <br />POLICY PERIOD: 02/01/2022 TO: 02/01/2023 <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 03 13 C <br />(Ed- 7-091 <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will <br />not enforce Our right against the person or organization named in the Schadula. {This agreement applies <br />only to the extent that you perform work under a written contract that requires you to obtain this <br />agreement from us.) <br />You must maintain payroll records accurately segregating the remuneration of your employees while <br />ongaged in thework described in the Schedule. <br />Tice additional premium for this endorsement shall he $ <br />Schedule <br />Any person or organization that You perform work for that is liable for an injury, covered by this poky, that <br />prior to the injury has written contract requiring a waiver of our right to recover from them. <br />Person Or Organization Job Description <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza, 4th floor <br />SANTA ANA, CA 92701-0000 <br />This endorsement changes the policy to which 9 is attached and is effective on the date issuer/ unless otherwise stated. <br />[She information bellow is required only when this endorsement is issued subsequent to preparation of the poliey.l <br />WC 99 03 13 C <br />(Ed. 7-091 <br />Welt Mougemmt Division <br />} REwewEQi APPROVm BY. <br />Is <br />`' A+� Aewedo <br />®' Risk Management Specialist <br />