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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 /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> Republic Indemnity Company of America <br /> Company Number 19739 <br /> Insured AIDS Services Foundation Orange County <br /> Policy Number 257739-01 <br /> Endorsement Number 9 <br /> Endorsement Effective January 01, 2025 <br /> Printed On January 03, 2025 <br /> Countersigned by <br /> WC 00 03 13 2 of 2 <br /> (Ed. 04-84) <br /> 0 1983 National Council on Compensation Insurance. <br />