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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />PREMIUM DUE DATE ENDORSEMENT <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 />Section D of Part Five of the policy is replaced by this provision: <br />PART FIVE <br />PREMIUM <br />D. Premium is amended to read: law is not valid. The due date for audit and <br />You will pay all premium when due. You will pay the retrospective premiums is the date of the billing. <br />premium even if part or all of a workers compensation <br />Countersigned by <br />Form WC 00 04 19 Printed in U.S.A. <br />Process Date: 05/25/20 Policy <br />cF RAMmWmentDMsian <br />REVIEWED & APPROVED BY.- <br />V"° <br />--� Risk janagement Analyst <br />