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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />WC 00 03 13 <br />(Ed. 04-84) <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 />This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br />Schedule <br />State <br />Person or Organization <br />Job Description <br />California <br />City of Santa Ana <br />Work performed by the insured <br />20 Civic Center Plaza <br />Santa Ana, CA 92701-4058 <br />The premium charge for this endorsement shall be $250. This charge will be billed at the final audit. <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise ctatari <br />Republic Indemnity Company of America <br />Company Number <br />19739 <br />Insured <br />Think Together, Inc. <br />Policy Number <br />181511-12 <br />Endorsement Number <br />30 <br />Endorsement Effective <br />May 13, 2022 <br />Printed On <br />May 13, 2022 <br />WC 00 03 13 <br />(Ed. 04-84) <br />Countersigned by : >v.kiwwzan <br />cl, ^' �•�e; RsviEwm 6 NroRav®Bv: <br />®. <br />A A�w <br />- Risk Management Specialist <br />® 1983 National Council on Compensation Insurance. <br />