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THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. <br />ARIZONA ALCOHOL- AND DRUG-FREE WORKPLACE PREMIUM CREDIT <br />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 />Thisendorsementappliesonlytotheinsuranceprovidedc.Complywiththealcoholanddrugtestingpolicy <br />bythepolicybecauseArizonaisshowninItem3.A.ofrequirementsinaccordancewithTitle23, <br />the Policy Information Page.Chapter 2, Article 14. <br />Thisendorsementprovidesnoticethatpremiumforyourd.Conductalcoholanddrugtestingofprospective <br />policymaybeaffectedbytheArizonaAlcohol-andDrug-employees. <br />Free Workplace Premium Credit Program. <br />e.Conductalcoholanddrugtestingofan <br />Youmayqualifyfora5%premiumcreditifyouhaveemployee after the employee has been injured. <br />establishedandmaintainaqualifyingalcohol-anddrug- <br />f.Allowustohaveaccesstothealcoholanddrug <br />freeworkplaceprograminaccordancewithTitle23, <br />testing results under d. and e. above. <br />Chapter 2, Article 14 of Arizona Statutes. <br />3.Thedeterminationthatyouhaveestablishedand <br />Wewilldetermineyoureligibilityforthispremiumcredit <br />maintainaqualifyingprogrammustbemadeduring <br />aftertotalpremiumhasbeenpaidforthepolicyperiod <br />eachpolicytermthatyoureceivethepremium <br />andmayberevisedatthetimeyourfinalpremiumaudit <br />credit. <br />is processed. <br />4.Yourcertificationandanyotherinformationrelied <br />Thedeterminationthatyouhaveaqualifyingprogram <br />uponbytheinsureringrantingthepremiumcredit <br />mustbemadeeachyearthatyoureceivethepremium <br />mustbekeptintheinsurer’sunderwritingfilesand <br />credit.Toimplementapremiumcreditprogram,the <br />madeavailabletotheDepartmentofInsuranceupon <br />following guidelines must be established: <br />request. <br />1.Insurersofferingthepremiumcreditprogrammay <br />5.Thepremiumcreditmaybeappliedaftertotal <br />apply a 5% premium credit to qualifying employers. <br />premiumhasbeenpaidforthepolicyperiodand <br />2.To receive the premium credit, you must:mayberevisedatfinalaudittotheemployer’s <br />policy.Thecreditisapplicableasasupplementto <br />a.Provideawrittenstatementtotheinsurerprior <br />deviatedratesandisappliedinamultiplicative <br />toorwithin30daysafterthebeginningofthe <br />manner,aftertheapplicationoftheexperience <br />policyeffectivedateeachyear,certifyingthat <br />modification,andbeforetheapplicationofthe <br />thebusinesshasimplementedaprogram <br />premium discount and expense constant. <br />meetingtherequirementsofTitle23,Chapter2, <br />Article 14.6.Youmustreimbursethepremiumcreditifitis <br />determinedthatyouwerenotincompliancewiththe <br />b.Atanytimeduringthetermofthepolicy,provide <br />provisions of the program. <br />additionalinformationtotheinsurer,asrequired, <br />toconfirmthataqualifyingprogramhasbeen7.Minimumpremiumpoliciesareeligibleforthis <br />established and is being maintained.premium credit. <br />8.Residualmarketemployersareeligibletoapplyfor <br />this premium credit. <br />Form WC 02 04 01 CPrinted in U.S.A <br />Process Date:08/17/24Policy Expiration Date:09/26/25 <br /> <br />