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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />CALIFORNIA VOLUNTEER COVERAGE - EXCESS VOLUNTARY COMPENSATION <br />AND EMPLOYERS LIABILITY COVERAGE ENDORSEMENT <br />This endorsement modifies insurance provided under the following: <br />SPECIFIC EXCESS WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />A. How This Insurance Applies <br />This insurance applies, with respect to this endorsement, to "bodily injury by accident" or "bodily <br />injury by disease" provided that the: <br />1. "Bodily injury" must be sustained by a person included in the group of volunteers described <br />in the Schedule; <br />2. "Bodily injury" must arise out of and in the course of volunteer activities necessary or <br />incidental to your operations in a "state" listed Schedule below; <br />3. "Bodily injury' must occur in the United States of America, its territories or possessions, or <br />Canada, and may occur elsewhere if the employee is a United States or Canadian citizen <br />temporarily away from those places; and <br />4. "Bodily injury by accident" must occur during the "policy period ". <br />5. "Bodily injury by disease' must be caused or aggravated by the conditions of your <br />operations. The volunteer's last day of last exposure to the conditions causing or <br />aggravating such "bodily injury by disease" must occur during the "policy period ". <br />SCHEDULE <br />Volunteers <br />Designated Workers Compensation Law <br />All volunteers who donate their services to you and <br />are not subject to Workers Compensation Law or <br />Occupational Disease Law <br />Workers Compensation Law and Occupational <br />Disease Law of the "state" where the injury takes <br />place. <br />B. We Will Reimburse <br />We will reimburse you for the amount equal to the benefits that is excess of Your Retained Limit <br />stated in Item 5 of the Declarations Page that would be required of you if you and your volunteer(s) <br />described in the Schedule above were subject to the "Workers Compensation Law" shown in the <br />Schedule. This reimbursement by us will not exceed Our Limit of Liability as stated in Item 6 A. of <br />the Declarations Page. <br />Endorsement Number: 2 <br />Policy Number: WCX 0055277 00 <br />Named Insured: Western Orange County Self- Funded Workers' Compensation Agency <br />This endorsement is effective on the inception date of this Policy unless otherwise stated herein: <br />Endorsement Effective Date: July 1. 2013 <br />00 GL0368 05 (01 08) <br />Page 1 of 2 <br />