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THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. <br />WORKERS’ COMPENSATION BROAD FORM 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 />Section I of this endorsement expands coverage provided under WC 00 00 00. <br />Section II of this endorsement provides additional coverage usually only provided by endorsement. <br />Section III of this endorsement is a Schedule of Covered States. <br />You may use the index to locate these coverage features quickly: <br />INDEX <br />SUBJECTPAGE <br />SECTION I2 <br />PARTS ONE and TWO2 <br />01We Will Also Pay2 <br />PART - THREE2 <br />02How This Insurance Works2 <br />PART - SIX2 <br />03Transfer of Your Rights and Duties2 <br />04Liberalization2 <br />SECTION II2 <br />VOLUNTARY COMPENSATION INSURANCE2 <br />05Voluntary Compensation Insurance2 <br />A.How This Insurance Applies2 <br />B.We will Pay3 <br />C.Exclusions3 <br />D.Before We Pay3 <br />E.Recovery From Others3 <br />F.Employers’ Liability Insurance3 <br />EMPLOYERS’ LIABILITY STOP GAP COVERAGE3 <br />06Employers’ Liability Stop Gap Coverage3 <br />A.Stop Gap Coverage Limited Montana, North Dakota, Ohio, Washington, West3 <br />Virginia and Wyoming <br />B.Part One does not Apply3 <br />C.Application of Coverage3 <br />D.Additional Exclusions3 <br />E.West Virginia3 <br />SECTION III4 <br />07Schedule of Covered States4 <br />Form WC 99 03 02 BPrinted in U.S.A. (Ed. 8/00)Page 1 of 4 <br />Process Date:08/17/24Policy Expiration Date:09/26/25 <br />© 2000, The Hartford <br /> <br />