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WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY <br />1XtC 04 03 06 (Ed. 4 -84) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - <br />CALIFORNIA <br />This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is <br />indicated below. <br />(The following "attaching clause" need be completed only when this endorsement is issued subsequent to prepuaLion of the policy.) <br />This endorsement, effective on 4/1/2012 at 12:01 A.M. standatd titre, fors a part of <br />(DATE,) <br />Policy No. 72\VE DQ2237 of the HARTFORD ACCIDENT AND INDEMNITY COMPANY <br />(NAME OF INSURANCE COMPANX) <br />issued to BEST, BEST & KRIEGER LLP <br />Endorsement No. <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right <br />against the person or organization named in the Schedule. (Plus agreement applies only to the extent that you perfotm work under a <br />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 the work described in <br />the Schedule. <br />The additional premium for this endorsement shall be 1.00 % of the California workers' compensation premium otherwise due on <br />such remuneration. <br />Schedule <br />Person or Organization <br />City of Santa Ana 20 Civic Center Plaza, Santa Ana, CA 92701 <br />\\rC 252 (4 -84) <br />VirC 04 03 06 (ED. 4 -84) <br />Attachment Code: D466017 <br />Certificate ID: 11767171 <br />Job Description <br />See Attached Certificate and Description of Operations <br />Page i of 1 <br />