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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 03 C ( Ed . 07 -18) ENDORSEMENT AGREEMENT LIMITING AND RESTRICTING THIS INSURANCE OFFICERS AND DIRECTORS COVERAGE / EXCLUSION CALIFORNIA If the employer named in Item 1 of the Information Page is a quasi-public or private corporation , this policy applies to all officers and members of boards of directors while rendering actual service for the corporation for pay, as employees , except those excluded below who 1 , individually own at least 10 percent of the corporation ' s issued and outstanding stock , or 2 , individually own at least 1 percent of the corporation 's issued and outstanding stock if that officer's or member' s parent, grandparent, sibling , spouse , or child owns at least 10 percent of the corporation' s issued and outstanding stock and that officer or member is covered by a health insurance policy or a health care service plan , or 3 . are officers or members of the board of directors of a cooperative corporation organized pursuant to the Cooperative Corporation Law (Corporations Code , Sections 12200 - 12704) who state that he or she is covered by both a health care service plan or health insurance policy , and a disability insurance policy that is comparable in scope and coverage , as determined by the Insurance Commissioner, to a workers' compensation policy . If the employer named in Item 1 of the Information Page is a private corporation , or a private cooperative corporation organized pursuant to the Cooperative Corporation Law, this policy applies to an officer or director who is the sole shareholder of the corporation , as an employee , except if excluded below. The insurance under this policy is limited as follows : It is AGREED that, anything in this policy to the contrary notwithstanding , this policy DOES NOT INSURE : Officers , Directors and Trustees Excluded Title James Day Secretary Kulvir Mehroke Ceo Nothing in this endorsement shall be held to vary , alter, waive or extend any of the terms , conditions , agreements , or limitations of this policy other than as above stated . Nothing elsewhere in this policy shall be held to vary , alter, waive or limit the terms , conditions , agreements or limitations in this endorsement. It is further agreed that " remuneration " when used as a premium basis for such insurance as is afforded by this policy shall not include the remuneration of any person excluded from coverage in accordance with the foregoing . FAILURE TO SECURE THE PAYMENT OF FULL COMPENSATION BENEFITS FOR ALL EMPLOYEES AS REQUIRED BY LABOR CODE SECTION 3700 IS A VIOLATION OF LAW AND MAY SUBJECT THE EMPLOYER TO THE IMPOSITION OF A WORK STOP ORDER, LARGE FINES , AND OTHER SUBSTANTIAL PENALTIES ( Labor Code Section 371 0A et seq . ) . c This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated . (The information below is required only when this endorsement is issued subsequent to preparation of the policy . ) Endorsement Effective 12/11 /2021 Policy No . WWC3560056 Endorsement No . 0 Insured Tank-Tight Systems Inc Insurance Company Wesco Insurance Company Countersigned by WC040303C ( Ed . 07- 18)