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ENDORSEMENT AGREEMENT <br />HOME OFFICE <br />SAN FRANCISCO <br />ALL EFFECTIVE DATES ARE <br />AT 12:01 AM PACIFIC <br />STANDARD TIME OR THE <br />TIME INDICATED AT <br />PACIFIC STANDARD TIME <br />EXECUTIVE OFFICERS <br />MINIMUM MAXIMUM LIMITS <br />EFFECTIVE JULY 1, 2021 AT 12.01 A.M. <br />FRIENDS OF SANTA ANA ZOO <br />1801 E CHESTNUT AVE <br />SANTA ANA, CA 92701 <br />REP D1 <br />9048876-21 <br />RENEWAL <br />SP <br />3-68-03-58 <br />PAGE 1 OF <br />ANY CONTRADICTION BETWEEN THE POLICY AND THIS ENDORSEMENT <br />WILL BE CONTROLLED BY THIS ENDORSEMENT. <br />IT IS AGREED THAT UNLESS OTHERWISE EXCLUDED BY ENDORSEMENT <br />THE ACTUAL REMUNERATION EARNED BY EACH EXECUTIVE OFFICER <br />DURING THE POLICY PERIOD SHALL BE USED AS THE BASIS OF <br />PREMIUM, SUBJECT TO <br />THE MINIMUM AMOUNT OF $ 54,600 PER ANNUM <br />AND THE MAXIMUM AMOUNT OF $ 139,100 PER ANNUM <br />AS SPECIFIED IN THE CALIFORNIA WORKERS' COMPENSATION <br />UNIFORM STATISTICAL REPORTING PLAN, FOR WORKERS' <br />COMPENSATION INSURANCE IN EFFECT DURING THE POLICY PERIOD. <br />NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND <br />ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY <br />OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE <br />HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR <br />LIMITATIONS IN THIS ENDORSEMENT. <br />COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: <br />3015 <br />AUTHORIZED REPRESENT IVE <br />SCIF FORM 10217 (REV.4-2018) <br />JUNE 25, 2021 <br />PRESIDENT AND <br />1 <br />�oRaN <br />r.� <br />RiskManWmentDMsian <br />REVIEWED & APPROVED BY: <br />f R. VSA44a <br />Risk Management Analyst <br />