BEGINNERS EDGE SPORTS TRAINING, LLC (3)

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INFORMATION PAGE (Continued) Policy Number: 6 WEG B❑3❑P❑ 3. A. Workers Compensation Insurance: Part one of t❑e policy applies to tie Wor ers Compensation Law of tie states listed ere❑T❑ SEE E❑DORSEME❑T - WC 99 03 6❑ B. Employers Liability Insurance: Part Two of t❑e policy applies to wor❑in eac❑ state listed in Item 3.A. T❑e limits of o-r liaJlity Ender Part Two are[] Bodily injury by Accident ❑1,000,000 each accident Bodily injury by Disease ❑1,000,000 policy limit Bodily injury by Disease ❑1,000,000 each employee C. Other States Insurance: Part TJee of t❑e policy applies to t❑e states, if any , listed ere❑ ALL STATES E❑CEPT ❑ORT❑ DA❑OTA, 0❑10, WAS11111GTO❑, WYOMI❑G, ❑.S.TERRITORIES A❑D STATES DESIG❑ATED I❑ ITEM 3.A. OF T❑E 111FORMATIO❑ PAGE. D. This policy includes these endorsements and schedule: SEE E❑DORSEME❑T-WC 99 03 68 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium Total Standard Premi-n Premi-n Disco-nt E-pense Constant Terrorism Ris❑Instance Program Rea❑t❑briEotion Act Disclos-re Endorsement Catastrope COt❑er T❑an Certified Acts Of Terrorism[] Estimated Ann❑al PremiErn ❑efore Siic❑arges❑ Total Estimated S❑c❑arges FSee to attac❑ed Sc❑edde[SEof Operations for Location and State Le el Premi-n Information Total Estimated Annual Premium: ❑y 83 Deposit Premium: Policy Minimum Premium: ❑600 CA [Encl❑des Increased Limit Min. Prem.- Interstate/intrastate Identification Number: Refer to Sc❑edde of Operations Labor Contractors Policy Number: ❑AICS 111113940 SIC: ❑991 Form WC 00 00 01 A (1) Printed in O.S.A. Page 2 Process Date: 11 /04/2 ❑ Policy Expiration Date: 11 /04/26