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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br />(Ed.04-64) <br />WAIVER, OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA <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 you <br />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 5.00% of the California workers' compensation premium <br />otherwise due on such remuneration. <br />Person or Organization <br />City of Sante Ana Community <br />Schedule <br />Job Description <br />City of Santa Ana Community Development Agency <br />Attn: Terri Eggers <br />333 W. ocean Blvd., Long Beach, CA 92701 <br />Contract # 2012-050. City of Santa Ana, its officers, <br />agents, employees and volunteers <br />All operations of the Named Insured <br />This endorsement changes the policy to which It is attached and is effective on the date Issued uNess otherwise stated, <br />(The information below is required only when this endorsement Is Issued subsequent to preparation of the policy.) <br />Endorsement Effective 2017-02.-01 <br />insured <br />Interval House <br />Insurance Company <br />New York Marine and General Insurance <br />Company / 26746 <br />We 04 0.105 <br />Policy No, Endorsement No. <br />WC201700005078 <br />Countersigned By <br />(Ed. 0484) <br />01996 by the Workers' Compensatlon Insurance Rating Bureau of California. All rights reserved. <br />