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Policy No.: WC 017954500 <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY 6.1.C. - Page 23 <br /> (Ed. 4-84) <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <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 /> This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br /> Schedule <br /> THE CITY OF REDWOOD CITY,ITS COUNCIL MEMBERS,OFFICERS,BOARDS, COMMISSIONS,EMPLOYEES AND <br /> AGENTS ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED,EXECUTED PRIOR TO <br /> THE ACCIDENT OR LOSS,THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK <br /> PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION. <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br /> Endorsement Effective Policy No. Endorsement No. <br /> Insured Premium$ <br /> Insurance Company Countersigned By _ <br /> WC 00 03 13 <br /> (Ed. 4-84) <br /> 29190190CQRYWzK34 Nati99 46191 119P cPmPRP 4114 W-990 8/28/2016 4:42:24 PM (EDT) Page 8 of 12 <br />