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EXTENSION OF THE INFORMATION PAGE - ITEM 1 - OTHER <br />WORKPLACES <br />Policy Number: 6 WEG B❑3❑P❑ Endorsement Number: <br />Effective Date: 11/04/211 Effecti❑e Eolir is t0e same as stated on tie Information Page of t❑e policy. <br />Named Insured and Address: Beginners Edge Sports Training <br />❑432 E TIERRA B❑E❑A L❑ <br />SCOTTSDALE All 8E260 <br />Item 1 of tie Information Page is completed to incl❑de otier wor-places of t❑e named insEired❑ <br />❑432 E TIERRA B❑E❑A L❑, SCOTTSDALE, All 8E260 <br />❑900 Balcones Dr., A❑stin, TO ❑81131 <br />8300 SA❑TA MO❑ICA BL❑D, WEST ❑OLLYWOOD, CA 90069-6216 <br />O SPECIFIC LOCATIO❑ I❑ STATE OF COSTA MESA, CA 92626 <br />Form WC 99 03 66 Printed in ❑.S.A. <br />Process Date: 11 /04/2 ❑ Policy Expiration Date: 11 /04/26 <br />