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THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. <br />POLICY AMENDATORY ENDORSEMENT - CALIFORNIA <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 />Itisagreedthat,anythinginthepolicytothecontraryandwillreimburseusforanyincreaseinindemnity <br />notwithstanding,suchinsuranceasisaffordedbythispaymentnotcoveredunderthepolicywhenthe <br />policybyreasonofthedesignationofCaliforniainItemaggregatetotalamountofthereimbursement <br />3oftheInformationPageissubjecttothefollowingpaymentspaidinapolicyyearexceedsone <br />provisions:hundred dollars ($100). <br />Ifwenotifyyouinwriting,within30daysofthe <br />payment,thatyouareobligatedtoreimburseus,we <br />1.MinorsIllegallyEmployed-NotInsured.This <br />willbillyoufortheamountofincreaseinindemnity <br />policydoesnotcoverliabilityforadditional <br />paymentandcollectitnolaterthanthefinalaudit. <br />compensationimposedonyouunderSection4557, <br />Youwillhave60days,followingnoticeofthe <br />DivisionIV,LaborCodeoftheStateofCalifornia, <br />obligationtoreimburse,toappealthedecisionofthe <br />byreasonofinjurytoanemployeeundersixteen <br />insurer to the Department of Insurance. <br />yearsofageandillegallyemployedatthetimeof <br />injury.4.ApplicationofPolicy.PartOne,"Workers <br />CompensationInsurance",A,"HowThisInsurance <br />2.PunitiveorExemplaryDamages-Uninsurable. <br />Applies", is amended to read as follows: <br />Thispolicydoesnotcoverpunitiveorexemplary <br />damageswhereinsuranceofliabilitythereforisThisworkerscompensationinsuranceappliesto <br />prohibited by law or contrary to public policy.bodilyinjurybyaccidentordisease,includingdeath <br />resultingtherefrom.Bodilyinjurybyaccidentmust <br />3.IncreaseinIndemnityPayment- <br />occurduringthepolicyperiod.Bodilyinjuryby <br />Reimbursement.Youareobligatedtoreimburse <br />diseasemustbecausedoraggravatedbythe <br />usfortheamountofincreaseinindemnity <br />conditionsofyouremployment.Youremployee's <br />paymentsmadepursuanttoSubdivision(d)of <br />exposuretothoseconditionscausingoraggravating <br />Section4650oftheCaliforniaLaborCode,ifthe <br />suchbodilyinjurybydiseasemustoccurduringthe <br />lateindemnitypaymentwhichgivesrisetothe <br />policy period. <br />increaseintheamountofpaymentisdueless <br />thanseven(7)daysafterwereceivethe5.RateChanges.Thepremiumandrateswith <br />completedclaimformfromyou.Youarerespecttotheinsuranceprovidedbythis <br />obligatedtoreimburseusforanyincreaseinpolicy by reason of the designation ofCalifornia in <br />indemnity payments not covered under this policy <br />Form WC 04 03 01 BBPrinted in U.S.A.Page1 of2 <br />Process Date:08/17/24Policy Expiration Date:09/26/25 <br /> <br />