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THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. <br />AUDIT NONCOMPLIANCE CHARGE ENDORSEMENT <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 />PartFive-Premium,SectionG.(Audit)oftheWorkersCompensationandEmployersLiabilityInsurancePolicyisrevised <br />by adding the following: <br />Ifyoudonotallowustoexamineandauditallofyourrecordsthatrelatetothispolicy,and/ordonotprovideaudit <br />informationasrequested,wemayapplyanAuditNoncomplianceCharge.ThemethodfordeterminingtheAudit <br />Noncompliance Charge by state, where applicable, is shown in the Schedule below. <br />IfyouallowustoexamineandauditallofyourrecordsafterwehaveappliedanAuditNoncomplianceCharge,wewill <br />revise your premium in accordance with our manuals and Part 5 - Premium, E. (Final Premium) of this policy. <br />Failuretocooperatewiththispolicyprovisionmayresultinthecancellationofyourinsurancecoverage,asspecified <br />under the policy. <br />Schedule <br />Basis of Audit NoncomplianceMaximum Audit Noncompliance <br />State(s) <br />ChargeCharge Multiplier <br />AL,AR,CO,CT,DC,DE,GA,IA,ID,Estimated Annual PremiumUp to two times <br />IL,KY,MD,ME,MI,MN,MS,NE,NJ, <br />NM,OR,RI,SC,SD,TN,UT,VA,VT, <br />WV <br />AZ, HI, KS, OKEstimated Annual PremiumTwo times <br />NCEstimated Annual PremiumUp to three times <br />NVEstimated Annual PremiumUp to one times <br />WIEstimated Annual PremiumOne time <br />Form WC 00 04 24Printed in U.S.A. <br />Process Date:08/17/24Policy Expiration Date:09/26/25 <br /> <br />