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Policy No.: <br /> WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 <br /> 6.1.C. - Page 22 54500 (Ed. 4-84) <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- <br /> CALI FOR NIA <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. (This agreement applies only to the <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 0 . 00 % of the California workers' compensation pre- <br /> mium otherwise due on such remuneration. <br /> Schedule <br /> Person or Organization Job Description <br /> THE CITY OF REDWOOD CITY, ITS ALL CA OPERATIONS <br /> COUNCIL MEMBERS, OFFICERS, <br /> BOARDS, COMMISSIONS, EMPLOYEES <br /> AND AGENTS <br /> WC 252(4-84) <br /> WC 04 03 06(Ed.4-84) Page 1 of 1 <br /> 29190190 HSWHOLD-01 15/16 GL AU XS WC Stephanie Hughes 3/28/2016 4:42:24 PM (EDT) Page 7 of 12 <br />