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TRAVELERS WORKERS COMPENSATION <br /> AND <br /> ONE TOWER SQUARE <br /> HARTFORn CT 06183 EMPLOYERS LIABILITY POLICY <br /> HAR <br /> ENDORSEMENT WC 04 03 06(01) — 001 <br /> POLICY NUMBER; UB-7P572611-24-42-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 /> PERSON OR ORGANIZATION JOB DESCRIPTION <br /> City of Santa Ana, its City Council, officers, officials, employees, Work done for the City of <br /> agents and volunteers Santa Ana <br /> DATE OF ISSUE: 04-01-24 STASSIGN: Page 1 of 1 <br />