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111:IRI4kiIBiel :4.1- 4 M14ki III I[s]:/_1ki It] 4•'19:I:11s7ll![WMJIIIIIA-l"ANA-1117111IDEA N4111111111MA <br />OPTIONAL PREMIUM INCREASE ENDORSEMENT - CALIFORNIA <br />Policy Number: 6 WEG B❑3❑P❑ Endorsement Number: <br />Effective Date: 11/04/2❑ Effecti❑e Eolir is Cie same as stated on tile Information Page of tie policy. <br />Named Insured and Address: Beginners Edge Sports Training <br />❑432 E TIERRA B❑E❑A L❑ <br />SCOTTSDALE All 8E260 <br />Yo❑ m❑st prodde E8, or oEir aEtEori❑ed representatiE0, <br />access to records necessary to perform a payroll <br />❑erification a❑dit. If yo❑ fail to prodde access witEjn 90 <br />days after expiration of t❑e policy, yo❑are liade to pay a <br />total premiEn e❑❑al to 3 times olir ca-rent estimate of <br />t❑e ann❑al premiEn for yob policy. In addition, ifyo❑fail <br />to prodde access after olir tEJrd re❑❑est witEJn a 90 day <br />or longer period, yo❑ are also liade for olir costs in <br />attempting to perform t❑e a❑dit Ehless yo❑ prodde a <br />compelling ❑❑siness reason for yob faille. <br />We will contact yo❑ to sc❑edde appointments d-ring <br />normal ❑-siness ❑ohs. <br />We will notify yo❑ of yob fail -re to pro:jde access ❑y <br />mailing a certified, retlim-receipt docErnent stating t❑e <br />increased premiEn and t❑e total amooht of o-r costs <br />incEirred in olir attempt[SE]to perform an a❑dit. In addition <br />to any ot❑er odigations ❑nder tEJs contract, 30 days <br />after yo❑ recei❑e t❑e notification, yo❑will ❑e odigated to <br />pay t❑e total premiEin and costs referenced a❑b❑e. If, <br />t❑ereafter, yo❑ prodde access to yob records witEJn <br />tEree years after t❑e policy expires, or witEJn anot❑er <br />mCd❑ally agreed xpon time, and we s❑cceed in <br />performing t❑e a❑dit to oEir satisfaction, we will ruse <br />yo❑r total premiEn and t❑e costs d❑e to reflect t❑e <br />rests of t❑e a❑dit. <br />Form WC 04 04 21 Printed in ❑.S.A. <br />Process Date: 11 /04/2 ❑ <br />Page 1 of 1 <br />Policy Expiration Date: 11/04/26 <br />