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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />FOREIGN COVERAGE ENDORSEMENT <br />Policy Number: 59 WEC AC9055 Endorsement Number: <br />Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Address: BAY SPROUTS LLC <br />655 S MAIN ST STE 200-317 <br />ORANGE CA 92868 <br />This endorsement supersedes any other Foreign Coverage Endorsement attached to this policy as respects Wisconsin <br />employees. Foreign Coverage for Wisconsin employees is provided under Part One of the policy, at no additional charge. <br />Countersigned by <br />Form WC 48 06 03 B Printed in U.S.A. <br />Process Date: 05/25/20 <br />Authorized Representative <br />ew cF RAMwagementDMsian <br />Jy/\'x REVIEWED & APPROVED BY: <br />V"° <br />Policy E _� RFskPjanagementAnalpt <br />