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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />AMENDATORY ENDORSEMENT <br />COLORADO <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 />It is agreed that this policy covers all employees of the insured, including statutory employees, and covers all business <br />operations of the insured in any lawful endeavors, whether naturally connected or not, with respect to compensation and <br />other benefits required of the insured by the Workers Compensation Law. <br />Countersigned by <br />Form WC 99 00 69 Printed in U.S.A. <br />Process Date: 05/25/20 <br />cF RAMmVmentDMsian <br />REVIEWED & APPROVED BY.- <br />v <br />Policy E Wsk Pjanagement Analpt <br />