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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 />WC040360BEMPLOYERS LIABILITY COVERAGE AMENDATORY ENDORSEMENT - CALIFORNIA <br />WC040421OPTIONAL PREMIUM INCREASE ENDORSEMENT - CALIFORNIA <br />WC040422CALIFORNIA SHORT-RATE CANCELLATION ENDORSEMENT <br />WC040601BCALIFORNIA CANCELATION ENDORSEMENT <br />WC420301LTEXAS AMENDATORY ENDORSEMENT <br />WC550011DEmployees Claim for Workers compensation Benefits <br />WC550022ANOTICE TO WORKERS' COMPENSATION POLICYHOLDERS IN TEXAS LETTER <br />WC880400INotice to Employees - Injuries Caused By Work (TITLE IN SPANISH) <br />WC880401INotice to Employees - Injuries Caused By Work <br />WC990001KSignature/Copyright <br />WC990002WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY BUSINESS INSURANCE <br />POLICY <br />WC990005SCHEDULE OF OPERATIONS <br />WC990302BWORKERS COMPENSATION BROAD FORM ENDORSEMENT <br />WC990358BAMENDMENT TO WORKERS COMPENSATION BROAD FORM ENDORSEMENT - <br />EMPLOYERS LIABILITY STOP GAP COVERAGE <br />WC990366EXTENSION OF THE INFORMATION PAGE - ITEM 1 - OTHER WORKPLACES <br />WC990367EXTENSION OF THE INFORMATION PAGE - ITEM 3.A - STATES COVERED <br />WC990368EXTENSION OF THE INFORMATION PAGE - ITEM 3.D. - ENDORSEMENTS <br />Form WC 99 03 68Printed in U.S.A. <br />Process Date:08/17/24Policy Expiration Date:09/26/25 <br /> <br />