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Moore lacofano Goltsman, Inc. <br />WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 99 03 76 (00) -- <br />POLICY NUMBER: UB3,1040141 <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 this policy. We will not <br />enforce our right against the person or organization named 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 />Re: RFP #17-082, Santa Ana General Plan Update Planning Studies, Existing <br />Land Use and Build -Out Analysis (PS1) - PERSON OR ORGANIZATION, <br />City of Santa Ana CONT.: City of Santa Ana, its officers, employees, agents, volunteers and <br />Planning and Building AgencylM20 representatives. <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />DATE OF ISSUE: 04ro1/2017 <br />