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<br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br /> <br />This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different <br />date is indicated below. <br /> <br />(The following "attaching clause" needs to be completed only when this endorsement is issued subsequent to preparation of the policy.) <br /> <br />This endorsement forms a part of Policy No. WZP8 0 92 8 955 <br /> <br />Issued to: Incledon Kirk Engineers lnc <br /> <br />By: American Automobile Ins. Co. <br /> <br />Premium (if any) TBD <br /> <br />- <br />We have a 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 <br />perform work under a written contract that requires you to obtain this agreement from us). <br /> <br />You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work <br />described in the Schedule. <br /> <br />The additional premium for this endorsement shall be 2-5% of the California workers compensation premium otherwise <br />due on such remuneration. <br /> <br />Schedule <br /> <br />Person or Organization <br /> <br />Job Description <br /> <br />Person or Organization: GWGC Inc dba <br />Gordon & Williams General Contractors <br />Inc and the City of Santa Ana, its <br />officers, agents, employees, volunteer, <br /> <br />GWGC Ine dba Gordon & Williams <br />General Contractors Ine <br />City of Santa Ana <br />2 Faraday <br />Irvine, CA 92618 <br /> <br /> <br />TO .F~) ~~Jv.~ <br /> <br />.___ ~ 9/tl <br /> <br />Laura Stitt Sheedy <br />Assistant City Attornev <br /> <br />~~ <br /> <br />WC 04 03 06 <br />/1::1"1 ~LRA\ <br /> <br />Countersigned by <br /> <br />A Ilth,.....i7al'l Danrc.ean"':lofjuD <br />