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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ILLINOIS WORKERS COMPENSATION AND EMPLOYERS LIABILITY <br />INSURANCE POLICY EXCLUSION 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 />C. Change Part Two — C. Exclusions 1. as follows: <br />This insurance does not cover <br />1. liability assumed under a contract, and/or <br />any agreement to waive your right to limit <br />your liability for contribution to the amount of <br />Form WC 12 03 06 A Printed in U.S.A. <br />Process Date: 05/25/20 <br />benefits payable under the Workers <br />Compensation Act and the Workers <br />Occupational Disease Act. This exclusion <br />does not apply to a warranty that your work <br />will be done in a workmanlike manner; <br />ew cF RAMwagementDMsian <br />Jy/\'x REVIEWED & APPROVED BY.- <br />V"° <br />Policy E _� RFskPjanagementAnalpt <br />