BEGINNERS EDGE SPORTS TRAINING, LLC (3)

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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ARIZONA ALCOHOL- AND DRUG -FREE WORKPLACE PREMIUM CREDIT ENDORSEMENT Policy Number: E6 WEG B❑3❑P❑ Endorsement Number: Effective Date: 11/04/2❑ Effecti—e ❑o r is te same as stated on ti❑e Information Page of t e policy. Named Insured and Address: Beginners Edge Sports Training ❑432 E TIERRA B❑E❑A L❑ SCOTTSDALE A❑ 8-160 Ti❑is endorsement applies only to tie insiiance pro:1ded ❑y tip policy iDecaE8e AriEona is sown in Item 3.A. of tEie Policy Information Page. T❑is endorsement proddes notice tit premiun for yoLir policy may ❑e affected ❑y tie AriFona Alco❑ol-and Dr❑g- Free WorEplace Premiun Credit Program. Yo❑ may ❑E81ify for a ❑❑ premiiun credit if yo❑ Fia::o esta:lis❑ed and maintain a ❑ilalifying alco❑ol- and driug- free worEplace program in accordance wit-] Title 23, Cif pter 2, Article 14 ofAriiEona Statues. We will determine yoij eligiiility for tics premiiun credit after total premiiun iEas !Feen paid for tip policy period and may Ele reused at tie time yoij final premii7n ai-lit is processed. Ti❑e determination tit yo❑ iDaLla a ❑Eialifying program m❑5t Lie made eac❑ year t-at yo❑ receiC:o t❑a premiun credit. To implement a premiun credit program, tip following gidelines m❑st ❑e estaiis❑ed❑ 1. Inssers offering t e premiiun credit program may apply a ❑i❑ premiErn credit to ❑Ealifying employers. 2. To recei::0 t❑e premiiun credit, yo❑ mi❑;t❑ a. Proide a written statement to t0a insuer prior to or witin 30 days after t0a ❑eginning of tDO policy effectiE0 date eac❑ year, certifying tLiat t❑e ❑Clsiness Elas implemented a program meeting tip re❑irements of Title 23, CF18pter 2, Article 14. At any time dimming tiDa term of tiDa policy, proiide additional information to t❑r insiier, as re❑fired, to confirm tiEat a ❑E81ifying program iDas iDeen estaiiisL]ed and is ring maintained. c. Comply wit❑ t%e alcoi❑oI and drug testing policy re❑EJrements in accordance wit❑ Title 23, CE18pter 2, Article 14. d. Cond❑ct alco❑ol and driig testing of prospectiE0 employees. e. Condit alco❑ol and dr❑g testing of an employee after tip employee iDas i-leen iniEred. f. Allow E8 to iDOiE0 access to t❑ e alco❑ol and drJg testing resits Finder d. and e. a❑o::O. 3. Tile determination t-at yo❑ LIOiEO estaiis❑ed and maintain a ❑Lialifying program m❑5t Lie made d0ring eac❑ policy term t et yo❑ receiC:o t0a premiun credit. 4. Yoij certification and any otDar information relied —pon ❑y tEie insiier in granting tip premiiun credit m—st ❑a Copt in t0a insierS Enderwriting files and made ai:ailaE]e to t0e Department of Ins ance Egon re ❑lest. a T❑e premiiun credit may !Da applied after total premiiun -as Deen paid for t!❑r policy period and may De reused at final ai—dit to tiDO employers policy. T❑e credit is applicaie as a s—pplement to deiated rates and is applied in a mitiplicatiEo manner, after ti❑r application of ti❑r ei-I)erience modification, and ❑✓fore ti❑r application of t❑a premiiun discoiEnt and eiEpense constant. 6. Yo❑ milt reim❑iJse tEla premiiun credit if it is determined tiDat yo❑were not in compliance wit❑t❑a proisions of tEla program. :1 Minimiun premiun policies are eligiie for tics premiiun credit. 8. Residi❑al mariEot employers are eligiie to apply for tics premiiun credit. Form WC 02 04 01 C Printed in ❑.S.A Process Date: 11/04/2❑ Policy Expiration Date: 11/04/26