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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 03 C (Ed.07-18) ENDORSEMENT AGREEMENT LIMITING AND RESTRICTING THIS INSURANCE OFFICERS AND DIRECTORS COVERAGE/EXCLUSION-CALIFORNIA If the employer named in Item 1 of the Information Page is a quasi-public or private corporation,this policy applies to all officers and members of boards of directors while rendering actual service for the corporation for pay, as employees,except those excluded below who 1. individually own at least 10 percent of the corporations issued and outstanding stock,or 2. individually own at least 1 percent of the corporations issued and outstanding stock if that officers or members parent, grandparent sibling, spouse, or child owns at least 10 percent of the corporations issued and outstanding stock and that officer or member is covered by a health insurance policy or a health care service plan,or 3. are officers or members of the board of directors of a cooperative corporation organized pursuant to the Cooperative Corporation Law(Corporations Code,Sections 12200-12704)who state that he or she is covered by both a health care service plan or health insurance policy,and a disability insurance policy that is comparable in scope and coverage,as determined by the Insurance Commissioner,to a workers compensation policy. If the employer named in Item 1 of the Information Page is a private corporation,or a private cooperative corporation organized pursuant to the Cooperative Corporation Law, this policy applies to an officer or director who is the sole shareholder of the corporation, as an employee,except if excluded below. The insurance under this policy is limited as follows:It is AGREED that,anything in this policy to the contrary notwithstanding,this policy DOES NOT INSURE: Officers,Directors and Trustees Excluded Title DONALD RHODES EXECUTIVE OFFICER JULIE RHODES EXECUTIVE OFFICER APPROVED By Cynthia Mora at 10:37 am, Dec 04, 2024 Nothing in this endorsement shall be held to vary,alter,waive or extend any of the terms,conditions,agreements,or limitations of this policy other than as above stated. Nothing elsewhere in this policy shall be held to vary, alter,waive or limit the terms, conditions, agreements or limitations in this endorsement. It is further agreed that remuneration when used as a premium basis for such insurance as is afforded by this policy shall not include the remuneration of any person excluded from coverage in accordance with the foregoing. FAILURE TO SECURE THE PAYMENT OF FULL COMPENSATION BENEFITS FOR ALL EMPLOYEES AS REQUIRED BY LABOR CODE SECTION 3700 IS A VIOLATION OF LAW AND MAY SUBJECT THE EMPLOYER TO THE IMPOSITION OF A WORK STOP ORDER,LARGE FINES,AND OTHER SUBSTANTIAL PENALTIES(Labor Code Section 3710.1,et seq.). This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the poll cy.) Endorsement Effective Policy No. Endorsement No. Insured Insurance Company Countersigned by WC 0403 03 C Page 1 of 1 (Ed.7-18) ©2017 by the Workers Compensation Insurance Rating Bureau of California.All rights reserved. 93-6418