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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />PARTNERS, OFFICERS, AND OTHERS EXCLUSION <br />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 />The policy does not cover bodily injury to any person described in the Schedule. <br />The premium basis for the policy does not include the remuneration of such persons. <br />You will reimburse us for any payment we must make because of bodily injury to such persons. <br />Partners <br />Officers <br />SCHEDULE <br />Others <br />SEIP SHANNON <br />KELLY PARTHEN <br />Sole Proprietors <br />Countersigned by <br />ew cF RAMwagementDMsian <br />°RE�AED&APPROVED SY: <br />Form WC 00 03 08 Printed in U.S.A. x <br />.V <br />Process Date: 05/25/20 Policy E �__ _ � RA Pjanagement Analpt <br />