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Workers' Compensation and Employers' Liability Policy <br />Named Insured <br />TriNet Group, Inc. L/C/F Kajeet Inc <br />I Park Place, Suite 600 <br />Endorsement Number <br />Dublin, CA 94568-7983 <br />Policy Number <br />Symbol WLR Number: C71188954 <br />Policy Period <br />Effective Date of Endorsement <br />07/01/2022 TO 07/01/2023 <br />07/01/2022 <br />Issued By (Name of Insurance Company) <br />ACE American Insurance Company <br />Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. <br />CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />This endorsement applies only to the insurance provided by the policy because California is shown in item 3.A. of the <br />Information Page. <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not <br />enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to <br />bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to <br />obtain this waiver from us. <br />You must maintain payroll records accurately segregating the remuneration of your employees while <br />engaged in the work described in the Schedule. <br />Schedule <br />1. (X) Specific Waiver <br />Name of person or organization: <br />City of Santa Ana, and it's officers, employees, agents and representatives. <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />O Blanket Waiver <br />Any person or organization for whom the Named Insured has agreed by written contract to <br />furnish this waiver. <br />2. Operations: <br />3. Premium: <br />The premium charge for this endorsement shall be percent of the premium developed on <br />payroll in connection with work performed for the above person(s) or organization(s) arising out of the <br />operations described. <br />Authorized Representative <br />WC 90 03 75 (05/18) --- <br />REmEvisD&AmovED Ryr <br />yiewdo <br />"•.'rirsl<M1r9::anagcnxri4CYerira(Psdie <br />