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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ILLINOIS AMENDATORY ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 This endorsement applies because Illinois is shown in Item 3.A. of the Information Page. Part Two - Employers Liability Insurance, Section B. (We Will Pay), Item 3. of the policy is replaced by the following: For consequential bodily injury to a party to a civil union, spouse, child, parent, brother or sister of the injured employee; provided that these damages are the direct consequence of bodily injury that arises out of and in the course of the injured employee's employment by you; and Part Five - Premium, Section G. (Audit) of the policy is replaced by the following: G. Audit You will let us examine and audit all your records that relate to this policy. These records include ledgers, journals, registers, vouchers, contracts, tax reports, payroll and disbursement records, and programs for storing and retrieving data. We may conduct the audits during regular business hours during the policy period and within three years after the policy ends. Information developed by audit will be used to determine final premium. The National Council on Compensation Insurance has the same rights we have under this provision. Part Six - Conditions, Section A. (Inspection) of the policy is replaced by the following: Form WC 12 06 01 F Printed in U.S.A. Process Date: 05/25/20 A. Inspection We have the right, but are not obliged, to inspect your workplaces at any time. Our inspections are not safety inspections. They relate only to the insurability of the workplaces and the premiums to be charged. We may give you reports on the conditions we find. We may also recommend changes. While they may help reduce losses, we do not undertake to perform the duty of any person to provide for the health or safety of your employees or the public. We do not warrant that your workplaces are safe or healthful or that they comply with laws, regulations, codes, or standards. The National Council on Compensation Insurance has the same rights we have under this provision. Part Six - Conditions, Section D. (Cancellation) of the policy is replaced by the following: D. Cancellation 1. You may cancel this policy. You will mail or deliver advance written notice to us, stating when the cancellation is to take effect. 2. We may cancel this policy. We will mail to each named insured at the last known mailing address advance written notice stating when the cancellation is to take effect. We will maintain proof of mailing of the notice of cancellation. A copy of all such notices shall be sent to the broker or agent of record, if known, at the last known mailing address. The broker or agent of record may opt to accept notification electronically. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- ,v Policy E) R.Wjanagementftalpt