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EXTENSION OF THE INFORMATION PAGE - ITEM 3.D - ENDORSEMENTS <br />Policy Number:76WEGAZ6AMUEndorsement Number: <br />Effective Date:09/26/24Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Address:Beginners Edge Sports Training <br />7432 E TIERRA BUENA LN <br />SCOTTSDALEAZ85260 <br />Item 3.D. of the Information Page is completed to include the following endorsements: <br />G-4119-0POLICYHOLDER NOTICE-PAYROLL BILLING <br />PN049901IPOLICYHOLDER NOTICE - YOUR RIGHT TO RATING AND DIVIDEND INFORMATION <br />WC000000CWORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WC000001A.1INFORMATION PAGE <br />WC000001A.2INFORMATION PAGE <br />WC000313WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />WC000403EXPERIENCE RATING MODIFICATION FACTOR ENDORSEMENT <br />WC000414A90-DAY REPORTING REQUIREMENT- NOTIFICATION OF CHANGE IN OWNERSHIP <br />ENDORSEMENT <br />WC000419APART FIVE - PREMIUM AMENDATORY ENDORSEMENT <br />WC000421FCATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUM <br />ENDORSEMENT <br />WC000422CTERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE <br />ENDORSEMENT <br />WC000424AUDIT NONCOMPLIANCE CHARGE ENDORSEMENT <br />WC020401CARIZONA ALCOHOL AND DRUG-FREE WORKPLACE PREMIUM CREDIT <br />ENDORSEMENT <br />WC020601CArizona Cancellation and Nonrenewal Endorsement <br />WC020603AARIZONA AMENDATORY ENDORSEMENT <br />WC040301BBPOLICY AMENDATORY ENDORSEMENT - CALIFORNIA <br />WC040306WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - <br />CALIFORNIA <br />Form WC 99 03 68Printed in U.S.A. <br />Process Date:08/17/24Policy Expiration Date:09/26/25 <br /> <br />