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Civil Source, Inc. <br />WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 99 03 76 (00) -- <br />POLICY NUMBER: uss779v59a <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 Ihis policy. We will not <br />enforce ovr right against fhe person or organization Hamad in the Schedule. <br />You must maintain payroll records accurately segregating the remuneration of your employees while engaged <br />in the work described in the Schedule. <br />The additional premium for this endorsement shall be % of the California workers' compensation premium <br />otherwise due on such remuneration_ <br />Schedule <br />Person or Organization: Job Description: <br />Addlltonal Insureds Continued: City of Santa Monica, Its officers, ofilclals, <br />employees and volunteers <br />City of Santa Monica <br />Civil Eng $Arch Srvcs <br />9717 4th Slreel, Suites 250 <br />Santa Monica, CA 90401 <br />DATE OF ISSUE: on2or9a <br />