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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />CALIFORNIA INSTALLMENT FEE DISCLOSURE 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 />because California is shown in Item 3.A. of the <br />Information Page. <br />A service fee of $7.00 is charged for each installment <br />Form WC 99 03 75 Printed in U.S.A. <br />Process Date: 05/25/20 <br />when your premium is paid in installments. The service <br />fee is $5.00 per withdrawal when you select an <br />electronic fund transfer payment plan. The service fee <br />will be added to the premium amount shown on your <br />premium billing statement. <br />ew cF RAMwagementDMsian <br />Jy/\'x REVIEWED & APPROVED BY.- <br />V"° <br />Policy E _� RFskPjanagementAnalpt <br />