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Workers Compensation And Employers Liability Insurance <br /> CNAPolicy Endorsement <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS 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% of the California workers' compensation premium <br /> otherwise due on such remuneration. <br /> Schedule <br /> Person or Organization Job Description <br /> CITY OF SANTA ANA HUMAN RESOURCE <br /> DEPARTMENT, ITS OFFICERS, OFFICIALS, <br /> EMPLOYEES, AND VOLUNTEERS <br /> All other terms and conditions of the policy remain unchanged. <br /> This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, <br /> takes effect on the Policy Effective 'Date of said policy at the hour stated in said policy, unless another <br /> effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy <br /> unless another expiration date is shown below. <br /> Form No: WC 04 03 06 104-1984) Policy No:WC 7 34823993 <br /> Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 1 0/1 512 0 24 <br /> Endorsement No: 9; Page: 1 of 1 Policy Page: 44 of 49 <br /> Underwriting Company: Valley Forge Insurance Company, 151 N Franklin St, Chicago, IL 60606 <br /> Copyright 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. <br /> From the WCIRB's California Workers' Compensation insurance Forms Manual�'2001. <br />