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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />WISCONSIN LAW 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 applies only to the insurance provided <br />by the policy because Wisconsin is shown in Item 3.A. of <br />the Information Page. <br />This policy is amended to reflect the following changes <br />and/or additions to clarify or comply with Wisconsin Law: <br />If our agent has knowledge of a change in or a <br />violation of a policy condition, this will be considered <br />our knowledge and will not void the policy or defeat a <br />recovery for a claim. <br />"Workers Compensation Law" means Chapter <br />102, Wisconsin Statutes. It does not include and <br />Countersigned by <br />this policy does not apply to any obligation under <br />Chapter 40, Wisconsin Statutes, or Section 66.191, <br />Wisconsin Statutes, or any amendment to these <br />laws. <br />III. Any language involving "Actions Against Us" is <br />replaced and amended to provide that no legal <br />action may be brought against us until there has <br />been full compliance with all terms of this policy. <br />IV. If an injury occurs that may be covered by this <br />insurance, the policy is amended to provide that you <br />must notify us of that injury as soon as reasonably <br />possible. <br />Form WC 48 06 01 C Printed in U.S.A. <br />Process Date: 05/25/20 Policy <br />cF Risk Managanad Msian <br />Jy/ 1'x REVIEWED & APPROVED BY.- <br />V"° <br />--� Risk janagement Analyst <br />