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III i:IRI4kiIBiel :4.1- 4 M14kikI[s]:/_1ki It] 4•'19:I:11e7lill[WMJIIIIIIIA-l"ANA-1111kIDEA N411111111MA <br />WORKERS' COMPENSATION BROAD FORM ENDORSEMENT <br />Policy Number: 6 WEG B❑3❑P❑ Endorsement Number: <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 Address: Beginners Edge Sports Training <br />432 E TIERRA B❑E❑A L❑ <br />SCOTTSDALE All 8E260 <br />Section I of t!Eis endorsement e-pands coerage prodded Ader WC 00 00 00. <br />Section II of tEJs endorsement proddes additional coerage C:80aIIy only proEJded ❑y endorsement. <br />Section III of t❑is endorsement is a Sc❑edde of Coered States. <br />Yo❑ may Cie t❑e inde❑to locate tese coerage featilres ❑EJcdy❑ <br />INDEX <br />SUBJECT <br />SECTION I <br />PARTS ONE and TWO <br />01 We Will Also Pay <br />PART -THREE <br />02 [low TCis Instance Wor-s <br />PART - SIX <br />03 Transfer of Yoh Rig is and D ties <br />04 Li❑eraliE:ition <br />SECTION II <br />VOLUNTARY COMPENSATION INSURANCE <br />0❑ ❑olEntary Compensation Ins-rance <br />A. [low TCis Ins-rance Applies <br />B. We will Pay <br />C. EelC:8ions <br />D. Before We Pay <br />E. Recoery From Ot❑ers <br />F. Employers ElLiaE lity Ins-rance <br />EMPLOYERS' LIABILITY STOP GAP COVERAGE <br />06 Employers::Lia:jlity Stop Gap Coerage <br />A. Stop Gap Coerage Limited Montana, ❑ort❑Da❑bta, OEJo, WasJngton, West <br />❑irginia and Wyoming <br />B. Part One does not Apply <br />C. Application of Coerage <br />D. Additional EelC:8ions <br />E. West ❑irginia <br />SECTION III <br />0❑ Sc❑edde of Co Bred States <br />Form WC 99 03 02 B Printed in O.S.A. EEd. 8/0011 <br />Process Date: 11 /04/2 ❑ <br />PAGE <br />2 <br />2 <br />2 <br />2 <br />2 <br />2 <br />2 <br />2 <br />2 <br />2 <br />2 <br />2 <br />3 <br />3 <br />3 <br />3 <br />3 <br />3 <br />3 <br />3 <br />Page 1 of 4 <br />Policy Expiration Date: 11/04/26 <br />112000, T❑e ❑artford <br />