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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. WZP80933953 <br /> <br />Issued to: David Taussig & Associates <br /> <br />By: American Automobile Ins. Co. <br /> <br />Premium (if any) TBD <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 />City of Santa Ana <br />Clerk of the City Council <br />20 Civic Center Plaza(M-30) <br />P.O. Box 1988 <br />Santa Ana, CA 92702-1988 <br /> <br />Re: All Operations as pertains to named <br />insured. City of Santa Ana, its <br />officers, employees, consultants, <br />special council and representatives <br /> <br />APPROVED AS TO FORM <br /> <br />~(~~y <br /> <br />AS:::.lslant City Attor~.I~Y <br /> <br />..1Vv"1A1 f "".t:..u.- <br /> <br />WC 04 03 06 <br />(Ed. 4-84) <br /> <br />Countersigned by ~____~~____~~____~~____~_____~____~____~__ <br />Authorized Representative <br />