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A01 <br />TRAVELERS ^ WORKERS COMPENSATION <br />AND <br />ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY <br />HARTFORD CT 06183 <br />ENDORSEMENT WC 04 03 06 (01) — 007 <br />POLICY NUMBER: UE-4X180519-24-42-G <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br />ENDORSEMENT-CALIFORNIA <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. (This agreement applies only to the <br />extent that you perform 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 <br />the work described in the Schedule. <br />THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 5.00% OF THE CALIFORNIA WORKERS' <br />COMPENSATION PREMIUM OTHERWISE DUE ON SUCH REMUNERATION. <br />SCHEDULE <br />JOB DESCRIPTION <br />THE CITY OF SANTA ANA, ITS OFFICERS, AND EMPLOYEES VIDEO <br />PRODUCTION <br />DATE OF ISSUE: 12-19-24 ST ASSIGN: Page 1 of 1 <br />