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F� <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ENDORSEMENT AGREEMENT LIMITING AND RESTRICTING <br />THIS INSURANCE <br />OFFICERS AND DIRECTORS COVERAGE / EXCLUSION - CALIFORNIA <br />Policy Number: 72 WEC AB1 Z5Q Endorsement Number: <br />Effective Date: 02/01/20 Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Address: AEF Systems Consulting Inc <br />8502 E CHAPMAN AVE STE 376 <br />ORANGE CA 92869 <br />Name of California Insurer: Trumbull Insurance Company <br />If the employer named in Item 1 of the Information Page is a quasi -public or private corporation, this policy applies to all <br />officers and members of boards of directors while rendering actual service for the corporation for pay, as employees, <br />except those excluded below who <br />individually own at least 10 percent of the corporation's issued and outstanding stock, or <br />2. individually own at least 1 percent of the corporation's issued and outstanding stock if that officer's or member's <br />parent, grandparent, sibling, spouse, or child owns at least 10 percent of the corporation's issued and <br />outstanding stock and that officer or member is covered by a health insurance policy or a health care service <br />plan, or <br />3. are officers or members of the board of directors of a cooperative corporation organized pursuant to the <br />Cooperative Corporation Law (Corporations Code, Sections 12200 - 12704) who state that he or she is covered <br />by both a health care service plan or health insurance policy, and a disability insurance policy that is comparable <br />in scope and coverage, as determined by the Insurance Commissioner, to a workers' compensation policy. <br />If the employer named in Item 1 of the Information Page is a private corporation, or a private cooperative corporation <br />organized pursuant to the Cooperative Corporation Law, this policy applies to an officer or director who is the sole <br />shareholder of the corporation, as an employee, except if excluded below. <br />The insurance under this policy is limited as follows: It is AGREED that, anything in this policy to the contrary <br />notwithstanding, this policy DOES NOT INSURE: <br />Officers, Directors and Trustees Excluded <br />Annette Feliciani <br />Title <br />Officer <br />Form WC 04 03 03 C (07/18) Printed in U.S.A. <br />Process Date: 12/23/19 Policy E <br />Rime Mattagmient DMsion <br />REVIEWED&APPRDVEDBY: <br />°�1„3�1 Ia•);' faaa.o:.a.e �.. V:,@QRnzbl <br />'� Risk Management Analyst <br />