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TRAVELERSI" WORKERS COMPENSATION <br /> OIMAND <br /> AR TOWFORDr� SQUARE 618 EMPLOYERS LIABILITY POLICY <br /> I3P�RTP'ORD C'� 06183�,83 <br /> ENDORSEMENT WC 04 03 OB(01) — oo1 <br /> POLICY NUMBER: ua-7P572611-24-42-G <br /> WAIVER OF OUR FIGHT 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 ADDIT4ONAL PREMIUM POR 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 /> . i <br />