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WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 99 03 76 (00) -- <br />POLICY NUMBER: UB6771Y518 <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br />ENDORSEMENT -CALIFORNIA <br />(BLANKET WAIVER) <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. <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 <br />mium otherwise due on such remuneration. <br />of the California workers' Compensation pre- <br />Schedule <br />Person or Organization: <br />City o£ Santa Ana <br />Attn: Raul Godinez <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />Job Description: <br />Re: City Engineering Services. The <br />City o£ Santa Ana and their <br />officers, agents and employees <br />DATE OF ISSUE: 0 5/ 2 9/ 2 0 12