CENTENNIAL HERITAGE MUSEUM 1-2003

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. Jan'05 04 02:57p Disoover~ Museum 714 540-1932 p.l STATE COMPENSATION INSUFOANC", FUND HOME OFFICE SAN FRANCISCO EFFECTIVE ALL EFFECTIVE DATES ARE AT 12001 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME EXECUTIVE OFFICERS MINIMUM/MAXIMUM LIMITS 1594455-03 RENEWAL SP 2-70-70-02 PAGE 1L ENDORSEMENT AGREEMENT JUNE 30, 2003 AT 12.01 A.M. A -d.-OO3 -014-51.0 CENTENNIAL HERITAGE MUSEUM INC. 3101 W HARVARD ST SANTA ANA, CA 92704 ANY CONTRADIc'THiN RF.TWF.EN THE POLICY AND TH1S ENDORSEMENT WILL BE CONTROLLED BY THIS ENDORSEMENT. IT IS AGREF.n THAT UNLESS OTHERWISE EXCLUDED BY ENDORSEMENT THE ACTUAL REMUNERATION EARNED BY EACH EXECUTIVE OPfICER DURING THE POLICY PERIOD SHALL BE USED AS THE BASIS OF PRF.I'!TITM, SITEJECT TO THE .MINIMUM AMOUNT OF $ 28,600 PER ANNUM AND THE MAXIMUM AMOUNT OF $ 79,300 PER ANNUM AS SPECIFIED IN THE CALIFORNIA WORKERS' COMP£NSAHON UNIFORM STATlSTICAL REPORTING PlAN, FOR WORKERS' COMPENSATION INSURANCE IN EFFECT DURING THE POLICY PERIOD. ~C-~..//' /C:À'.Vl'~ //q NOTHING IN THIS ENDORSeMENT CONTAINED SHALL aE HELD TO VAPor, ALTER, WAIVE OR EXTEND ANY OF THE TEPoMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POliCY OTHER THAN AS STA'"'D. NOTHING ELSEWH.R. IN THIS POLICY SHALL BE HElD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNEIJ AND ISSUED AT SAN FRANCISCO: 'tf/Jtdn- JULY 22, 2003 ,ð.~ {!. &£- 3015 AUTHORIZED REPRESENTATIVE PRESIDENT