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TDIFEVMF!PG!PQFSBUJPOT <br />Tis Scedle of Operations forms a part of te policy effectie on te inception date of te policy nless anoter date is <br />indicated elow <br />JOTVSFS;ARTFORD CASALTY ISRACE COMPAY <br />Dpnqboz!Dpef;3 <br />Qpmjdz!Ovncfs;6WEGB3PTdifevmf!Ovncfs;01-04-04 <br />Fggfdujwf!Ebuf;11/04/2Effectie or is te same as stated on te Information Page of te policy. <br />Obnfe!Jotvsfe!boe!Mpdbujpo!Beesftt!pg!pqfsbujpot!dpwfsfe!cz!uijt!tdifevmf; <br />Beginners Edge Sports Training <br />O SPECIFIC LOCATIO <br />COSTA MESA CA 92626 <br />AICS 13940 <br />GFJO;26-2932264SIC 991O. OF EMPL 2 <br />5/UifqsfnjvngpsuijtqpmjdzxjmmcfefufsnjofeczpvsNbovbmtpgSvmft-Dmbttjgjdbujpot-SbuftboeSbujoh <br />Qmbot/Bmm!jogpsnbujpo!sfrvjsfe!cfmpx!jt!tvckfdu!up!wfsjgjdbujpo!boe!dibohf!cz!bveju/ <br />Qsfnjvn!Cbtjt <br />DmbttjgjdbujpotUpubm!FtujnbufeSbuft!QfsFtujnbufe <br />Dpef!Ovncfs!boeBoovbm%211!pgBoovbm <br />EftdsjqujpoSfnvofsbujpoSfnvofsbujpoQsfnjvn <br />880180,141.001.4900002,684 <br />FITESS ISTRCTIO PROGRAMS OR STDIOS - ALL <br />EMPLOYEES - ICLDIG RECEPTIOISTS <br />Upubm!Tubuf!Tvnnbsz <br />Total Class Premim2,14 <br />CA Territorial Differential1.030009 <br />Waier of Srogation1,000 <br />Total Estimated Annal Standard Premim3,809 <br />Premim discont0.001000-4 <br />Epense constant200 <br />Terrorism Ris Insrance Program Reatoriation Act182,141.000.02000036 <br />Disclosre Endorsement <br />CA ser Fnd1.230000 <br />CA Frad0.4096001 <br />CA ninsred Employers Benefit Trst Fnd0.0818003 <br />CA Sseent Inries Benefit Trst Fnd Assessments3.014800122 <br />CA Occpational Safety  ealt Fnd0.188008 <br />CA Laor Enforcement  Compliance Fnd0.108004 <br />Total Estimated Annal Premim4,24 <br />Contersigned y <br />Atoried Representatie <br />Gpsn!XD!::!11!161 Printed in .S.A. <br />Qspdftt!Ebuf;11/04/2Qpmjdz!Fyqjsbujpo!Ebuf;11/04/26 <br /> <br />