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SCHEDULE OF OPERATIONS <br />T❑is Sc❑edde of Operations forms a part of t❑e policy effecti-e on t❑e inception date of tie policy -nless anot❑er date is <br />indicated ❑elow❑ <br />INSURER: ❑ARTFORD CAS❑ALTY I❑S❑RA❑CE COMPA❑Y <br />Company Code: 3 <br />Policy Number: ❑6 WEG B❑3❑P❑ Schedule Number: 01-04-04 <br />Effective Date: 11/04/2❑ Effecti❑e Eolir is t❑e same as stated on t❑e Information Page of tie policy. <br />Named Insured and Location Address of operations covered by this schedule: <br />Beginners Edge Sports Training <br />❑O SPECIFIC LOCATIO❑ <br />COSTA MESA CA 92626 <br />FEIN: 26-2932264 <br />❑AICS 11❑13940 <br />SIC❑❑991 ❑O. OF EMPL::2 <br />4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating <br />Plans. All information required below is subject to verification and change by audit. <br />Premium Basis <br />Classifications Total Estimated Rates Per Estimated <br />Code Number and Annual $100 of Annual <br />Description Remuneration Remuneration Premium <br />88EO 180,141.00 1.490000 2,684 <br />FIT❑ESS I ❑STR❑CTIO❑ PROGRAMS OR ST❑DIOS - ALL <br />EMPLOYEES - I❑CL❑DI❑G RECEPTIO❑ISTS <br />Total State Summary <br />Total Class Premi -n <br />2, ❑14 <br />CA Territorial Differential <br />1.03 000 <br />9❑ <br />Wai-er of S❑rogation <br />1,000 <br />Total Estimated Ann -al Standard PremiEn <br />3,809 <br />Premi-n discoEtit <br />0.001000 <br />-4 <br />E-pense constant <br />200 <br />Terrorism Ris❑Ins rance Program ReaEt❑briC:Ation Act <br />182,141.00 0.020000 <br />36 <br />Disclos-re Endorsement <br />CA ❑ser F-nd <br />1.23 000 <br />0 <br />CA Fra❑d <br />0.409600 <br />1 ❑ <br />CA ❑nins-red Employers Benefit Tr❑st Fed <br />0.081800 <br />3 <br />CA S❑Else❑❑ent Iniries Benefit Tr❑st F-nd Assessments <br />3.014800 <br />122 <br />CA OccEpational Safety ❑ ❑ealt❑ FEnd <br />0.188❑DO <br />8 <br />CA LaEor Enforcement ❑ Compliance F-nd <br />0.10❑800 <br />4 <br />Total Estimated Ann -al Premi-n <br />4,24❑ <br />Co-ntersigned y <br />A t❑ori-ed Representati e <br />Form WC 99 00 05 d ❑Printed in ❑.S.A. <br />Process Date: 11/04/20 Policy Expiration Date: 11/04/26 <br />