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EXTENSION OF THE INFORMATION PAGE - ITEM 1 - NAMED INSURED <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 />Item 1 of the Information Page is completed to include as named insured: <br />Named Insured: BAY SPROUTS LLC <br />State ID : Not Applicable <br />FEIN : 46-2577161 <br />DBA Name <br />BEAN SPROUTS CAFE <br />BEAN SPROUTS CAFE & COOKING & BEAN SPROUTS SANTA ANA <br />BEAN SPROUTS CAFE & COOKING SCHOOL <br />BEAN SPROUTS LOS ANGELES & BEAN SPROUTS CAFE <br />BEAN SPROUTS SANTA ANA <br />Form WC 99 03 65 Printed in U.S.A. <br />Process Date: 05/25/20 <br />ew cF RAMwagementDMsian <br />Jy/\'x REVIEWED & APPROVED BY.- <br />V"° <br />Policy E _� RFskPjanagementAnalpt <br />