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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br /> (Ed. 04-84) <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br /> We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce <br /> our right against the person or organization named in the Schedule. (This agreement applies only to the extent that <br /> you perform work under a written contract that requires you to obtain this agreement from us.) <br /> This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br /> Schedule <br /> State Person or Organization Job Description <br /> California City of Santa Ana, Operations of the named insured <br /> Attention: Human Resources <br /> Department <br /> 20 Civic Center Plaza, CA 92701 <br /> Santa Ana, CA 92701 <br /> The premium charge for this endorsement shall be $250. This charge will be billed at the final audit. <br /> WC 00 03 13 1 of 2 <br /> (Ed. 04-84) Insured Copy <br /> ©1983 National Council on Compensation Insurance. <br />