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Insured: Larry Walker Associates, Inc. <br />Policy Number: WZP81038775 <br />Effective Date: 04/01/2017 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ 0CAREFULLY. <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 ororganization named inthe Schedule. (This agreement applies only bothe <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 additional premium for this endorsement shall be 96 of the California workers' compensation premium <br />otherwise due on such remuneration. <br />Person or Organization <br />City of Santa Ana <br />Clerk of the City Council <br />P.O. Box 1988 <br />Santa Ana, CA 92702-1988 <br />SCHEDULE <br />Job Description <br />SCHEDULE CONTINUATION: The City ofSanta Ana, its officers, employees, agents, and <br />representatives <br />v <br />Countersigned by <br />Authorized Representative <br />Form VVCO4O3OG (1) Printed inU.S�� <br />