BEGINNERS EDGE SPORTS TRAINING, LLC (3)

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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY AMENDATORY ENDORSEMENT - CALIFORNIA Policy Number: F-6 WEG B❑3❑P❑ Endorsement Number: Effective Date: 11/04/2❑ Effectie ieDr is t!e same as stated on tle Information Page of to policy. Named Insured and Address: Beginners Edge Sports Training 432 E TIERRA B❑E❑A L❑ SCOTTSDALE A❑ 8E260 It is agreed tet, anytEJng in to policy to t❑e contrary notwitetanding, s❑c❑ ins❑rance as is afforded ❑y tEJs policy ❑y reason of t❑e designation of California in Item 3 of to Information Page is s❑❑iect to t❑e following prodsions❑ 1. Minors Illegally Employed - Not Insured. Tus policy does not coer liai�lity for additional compensation imposed on yo❑ Ender Section 4❑❑❑, DiJsion I❑, La!er Code of to State of California, y reason of inilry to an employee ceder si::teen years of age and illegally employed at to time of inEry. 2. Punitive or Exemplary Damages - Uninsurable. T!❑is policy does not co -:Or pEnitie or eemplary damages were instance of lia::Jlity t!erefor is pro!JJted y law or contrary to p❑tic policy. 3. Increase in Indemnity Payment - Reimbursement. Yo❑ are o:ligated to reim❑--se s for tie amo—nt of increase in indemnity payments made p—rsent to S❑❑di:jsion -d—of Section 46 0 of tie California La or Code, if tie late indemnity payment wJc❑ gies rise to tie increase in tie amo—nt of payment is d❑e less ten seen ❑ days after we receie tie completed claim form from yo❑. Yo❑ are o:ligated to reim❑--se e for any increase in indemnity payments not coered —nder toms policy and will reim❑use E8 for any increase in indemnity payment not coered Ender to policy wen to aggregate total amoEnt of to reim❑lirsement payments paid in a policy year eC(,eeds one ❑Endred dollars Fill00❑ If we notify yo❑ in writing, witEJn 30 days of to payment, tat yo❑are odigated to reim❑use e, we will EJII yo❑ for to amoLjit of increase in indemnity payment and collect it no later ten t❑e final aLdit. Yo❑ will ❑ae 60 days, following notice of to oEligation to reim❑use, to appeal to decision of t a insilrer to to Department of Instance. 4. Application of Policy. Part One, "Worers Compensation Instance", A, "Dow T❑is Inssance Applies", is amended to read as follows❑ T❑is worers compensation ins!-irance applies to edily inlory y accident or disease, incl-ling deat❑ resElting terefrom. Bodily inEflry y accident meet occ!-ir d!-iring to policy period. Bodily inky ❑y disease meet !e caeed or aggra::8ted y t!e conditions of yo!j employment. YoOr employee's eiEposi-1re to t❑ose conditions caging or aggrai-:8ting s❑ ic❑ edily in❑ry y disease meet occOr ding t❑ e policy period. :1 Rate Changes. Tle premiiE n and rates wit❑ respect to tle instance pro:jded ❑y toms policy ❑y reason of tie designation of California in Form WC 04 03 01 BB Printed in O.S.A. Process Date: 11/04/2❑ Page 1 of 2 Policy Expiration Date: 11/04/26