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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA <br />WC 04 03 06 <br />(Ed. 4-84) <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce <br />our right against the person or organization named in the Schedule. (This agreement applies only to the extent that <br />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 the <br />work described in the Schedule. <br />The additional premium for this endorsement shall be 2 of the California workers' compensation premium <br />other-wise due on such remuneration. <br />Person orOrganization <br />City nf Santa Ana, <br />its officers and employees <br />Schedule <br />Job Description <br />Jobs performed for any person cx organization that you <br />have agreed with in a written contract to provide this <br />agreement. <br />This endorsement m`onoro the policy to which Kis attached and |s effective nnthe date issued unless otherwise stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br />Endorsement Effective 1O/31/2U15 <br />Insured <br />Joseph C. Truxaw and Associates, Inc. <br />Policy No. PSVV0001252 <br />Insurance Company <br />RL| Insurance Company <br />Countersigned By <br />Endorsement No. <br />mnembv the Workers' Compensation Insurance Rating Bureau ur California. �Itrights <br />REV�EWED BY., <br />