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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC0403 66 <br /> (Ed.07-18) <br /> ENDORSEMENT AGREEMENT LIMITINGAND RESTRICTING THIS INSURANCE <br /> PROFESSIONAL CORPORATION COVERAGE/EXCLUSION-CALIFORNIA <br /> If the employer named in Item 1 of the Information Page is a professional corporation,as defined in Section 13401 of the Corporations <br /> Code,this policy applies to all owners who are practitioners rendering the professional services for which the professional corporation is <br /> organized,as employees,except those excluded below who state that lye or she is covered by a health insurance policy or a health care <br /> service plan. <br /> If the employer named in Item 1 of the Information Page is a professional corporation,as defined in Section 13401 of the Corporations <br /> Code,this policy applies to the owner who is the sole shareholder of the private professional corporation,as an employee, except if <br /> excluded below- <br /> The insurance under this policy is limited as follows:It is AGREED that,anything in this policy to the contrary notwithstanding,this policy <br /> DOES NOT INSURE: <br /> Owners/Trustees Excluded Title <br /> DONALD RHODES EXECUTIVE OFFICER <br /> JULIE RHODES EXECUTIVE OFFICER <br /> Nothing in this endorsementshall be held to vary,alter,waive or extend any ofthe terms,conditions,agreements,or limitationsof this <br /> policy other than as above stated.Nothing elsewhere in this policy shall be held to vary,alter,waive or limit the terms,conditions, <br /> agreements or limitations in this endorsement. <br /> It is further agreed that remuneration when used asa premium basis for such insurance as is afforded by this policy shall not include the <br /> remuneration of any person excluded from coverage in accordance with the foregoing. <br /> FAILURE TO SECURE THE PAYMENT OF FULL COMPENSATION BENEFITS FOR ALL EMPLOYEES AS REQUIRED BY LABOR CODE <br /> SECTION 3700 IS A VIOLATION OF LAW AND MAY SUBJECT THE EMPLOYER TO THE IMPOSITION OF A WORK STOP ORDER,LARGE <br /> FINES,AND OTHER SUBSTANTIAL PENALTIES(Labor Code section 3710.1,et seq.). <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> (The Information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.) <br /> E rid orsementEffective Policy No. Endorsement No. <br /> Insured Insurance Company <br /> Countersigned by <br /> WC040366 Page"I of 1 <br /> (Ed.7-18) <br /> �T2017 by the Workers Compensation Insurance Rating Bureau of California.All rights reserved. <br /> 93.6454 <br />