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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />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 <br />not enforce our right against the person or organization named in the Schedule. (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 />engaged in the work described in the Schedule. <br />The additional premium for this endorsement shall be 0 % of the California workers' compensation <br />premium otherwise due on such remuneration. <br />Schedule <br />Person or Organization <br />CITY OF SANTA ANA <br />801 W CIVIC CENTER DR STE 200 <br />SANTA ANA CA 92701 <br />The charge for this endorsement is $ 250 <br />Job Description <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br />This endorsement, effective 02/02/2025 <br />Policy No. EIG 2196672 10 <br />Issued to KID EDUCATION LLC <br />Premium $5,500 <br />Countersigned at <br />at 12:01 AM standard time, forms a part of <br />Of the EMPLOYERS PREFERRED INS. CO. <br />Carrier Code 00920 <br />o <br />By: <br />Endorsement No. <br />/�. 0-4,,9_Q� <br />Authorized Representative <br />WC 04 03 06 <br />(Ed. 4-84) © 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. <br />