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<br />WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 99 03 76 (00) -- <br />POLICY NUMBER: UB7836YB14 <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br />ENDORSEMENT - CALIFORNIA <br />(BLANKET WAIVER) <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. <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 <br />mium otherwise due on such remuneration. <br />% of the California workers' Compensation pre- <br />Schedule <br />Person or Organization: <br />City of Santa Ana <br />Attn: David Ip <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Job Description: <br />O loo <br />g5 Z <br />??? ?9 SZO?Co pe`1 <br />?.?`'P ?G{rJ ptt <br />DATE OF ISSUE: 09/15/08