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�,... I <br />FE-6609 <br />POLICY NUMBER: <br />WORKERS COMPENSATION <br />92-GA-H506-1 <br />WAIVER OF TRANSFER OF RIGHTS OF RECOVERY <br />AGAINST OTHER TO US <br />Policy Number: 92-GA-H506-1 <br />Named Insured: Downtown Inc <br />SCHEDULE <br />NAME OF PERSON OR ORGANIZATION: <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA <br />SANTA ANA, CA 92702 <br />Information required to complete this Schedule, if not show above, will be shown in the Declarations. <br />The following is added to Paragraph 10.b. of SECTION 1 AND SECTION II — COMMON <br />CONDITIONS: <br />We waive any right of recovery we may have against the person or organization shown <br />in the Schedule above because of payments we make for any injury arising out of: <br />a. Your ongoing operations; or <br />b. Your work done under contract with that person or organization and included in the <br />products -completed operations hazard. <br />This waiver applies only to the person or organization shown in the Schedule above. <br />All other policy provisions apply. REVIEWED & APPROVED <br />FE-6671 By RISK MANAGEMENT DIVISION <br />©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 <br />Includes copyrighted material of Insurance Services Office, Inc., with its permission. AUG 0 2 2ois <br />FRANCINE R. VILLAREAL <br />