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UIJT!FOEPSTFNFOU!DIBOHFT!UIF!QPMJDZ/QMFBTF!SFBE!JU!DBSFGVMMZ/ <br />BVEJU!OPODPNQMJBODF!DIBSHF!FOEPSTFNFOU <br />Qpmjdz!Ovncfs;6WEGB3PFoepstfnfou!Ovncfs; <br />Fggfdujwf!Ebuf;11/04/2Effectie or is te same as stated on te Information Page of te policy. <br />Obnfe!Jotvsfe!boe!Beesftt;Beginners Edge Sports Training <br />432 E TIERRA BEA L <br />SCOTTSDALEA8260 <br />PartFie-Premim,SectionG.AditofteWorersCompensationandEmployersLiailityInsrancePolicyisreised <br />y adding te following <br />Ifyodonotallowstoeamineandaditallofyorrecordstatrelatetotispolicy,and/ordonotproideadit <br />informationasreested,wemayapplyanAditoncomplianceCarge.TemetodfordeterminingteAdit <br />oncompliance Carge y state, were applicale, is sown in te Scedle elow. <br />IfyoallowstoeamineandaditallofyorrecordsafterweaeappliedanAditoncomplianceCarge,wewill <br />reise yor premim in accordance wit or manals and Part  - Premim, E. Final Premim of tis policy. <br />Failretocooperatewittispolicyproisionmayresltintecancellationofyorinsrancecoerage,asspecified <br />nder te policy. <br />Tdifevmf <br />Cbtjt!pg!Bveju!OpodpnqmjbodfNbyjnvn!Bveju!Opodpnqmjbodf <br />Tubuf)t* <br />DibshfDibshf!Nvmujqmjfs <br />AL,AR,CO,CT,DC,DE,GA,IA,ID,Estimated Annal Premimp to two times <br />IL,Y,MD,ME,MI,M,MS,E,, <br />M,OR,RI,SC,SD,T,T,A,T, <br />W <br />A, I, S, OEstimated Annal PremimTwo times <br />CEstimated Annal Premimp to tree times <br />Estimated Annal Premimp to one times <br />WIEstimated Annal PremimOne time <br />Gpsn!XD!11!15!35 Printed in .S.A. <br />Qspdftt!Ebuf;11/04/2Qpmjdz!Fyqjsbujpo!Ebuf;11/04/26 <br /> <br />