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/nt/ Workers' Compensation /nsurance <br />Schedu /e of Forms <br />Po /icy Period APRIL 16, 2012 TO APRIL 16, 2013 <br />Effective Date SEPTEMBER 18, 2012 <br />Policy Number 3587 -79 -16 NBO <br />Insured ACTIVE NETWORK INC <br />Name of Company FEDERAL INSURANCE COMPANY <br />Date /ssued SEPTEMBER 18, 2012 <br />The following is a schedule of forms issued as of the date shown above: <br />Edition <br />Ei`fecfive <br />Date <br />Form Number Date <br />Form Name <br />Date <br />/ssued <br />80 -02 -0129 12 -99 <br />INTL WORKERS' COMPENSATION DECLARATION <br />04/16/12 <br />04/26/12 <br />80 -02 -2053 7 -10 <br />INTERNATIONAL WORKERS' COMPENSATION INSURANCE <br />04/16/12 <br />04/26/12 <br />Reference Copy /ast page <br />Form 80 -02 -4799 (ED. � -00) Schedu /e of Forms Page 1 <br />