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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br />(Ed. 4-84) <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 not enforce our <br />right against the person or organization named in the Schedule. (This agreement applies only to the extent that you per- <br />form 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 See Below % of the California workers' compensation premium <br />otherwise due on such remuneration. <br />Schedule <br />Person or Organization <br />City of Santa Ana <br />Attn: Risk Management Division <br />Job Description <br />20 Civic Center Plaza, 4th Floor Santa Ana, CA 92701 <br />Specific Waiver is $200 Flat Charge <br />DOO: <br />Re: Contract #A-2020-066-02 <br />City of Santa Ana, its officers, agents, employees and volunteers are named additional <br />insured with respect to the General Liability policy of the named insured. <br />The insurance provided in the General Liability and Network Security and Privacy Liability <br />policy is primary and any other insurance shall be excess only, and not <br />contributing. County of Orange, its elected and appointed officials, officers, agents and <br />employees are named additional insured with respect to the Network <br />Security and Privacy Liability. Waiver of Subrogation for Workers Compensation policy <br />applies in favor of Additional insured. <br />y ix ,uM <br />Countersigned by`4'�""'"m�'tl <br />WC 04 03 06 rsah n e ri nw i va <br />(Ed. 4-84) <br />rnyc <br />