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(Policy Provisions: WCOOOOOOC) <br /> INFORMATION PACE <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY <br /> INSURER: SEE ATTACHED ENDORSEMENT <br /> uTHE <br /> NCC[ Company Number: 20621 fE iTFOR.D <br /> Company Code: 9 <br /> Suffix <br /> LARS RENEWAL <br /> POLICY NUMBER: 76 WEG BX3ZPJ <br /> Previous Policy Number: 76 WEG AZ6AMU <br /> 1, Named Insured and Mailing Address: BEGINNERS EDGE SPORTS TRAINING <br /> (No., Street, Town, State, Zip Code) 7432 E TIERRA BUENA LN <br /> SCOTTSDALE AZ 85260 <br /> FEIN Number: 26-2932264 <br /> State Identification Number(s): Refer to the EXTENSION OF THE INFORMATION PAGE—WC990365. <br /> The Named Insured is: LLC <br /> Business of Named Insured: Fitness and Recreational Sports Centers <br /> Other workplaces not shown above: See Endorsement-WC990366 <br /> 2. Policy Period: From 11/04/25 To 11/04/26 ANNUAL <br /> 12:01 a.m., Standard time at the insured's mailing address. <br /> Producer's Name: INSURANCETRAK SERVICES/PAC <br /> 4515 CULVER RD SUITE 206 <br /> ROCHESTER NY 14622 <br /> Producer's Code: 76251042 <br /> Issuing Office: THE HARTFORD BUSINESS SERVICE CENTER <br /> 3600 WISEMAN BLVD <br /> SAN ANTONIO TX 78251 <br /> (877) 287-1316 <br /> Total Estimated Annual Premium: $5,583 <br /> Deposit Premium: <br /> Policy Minimum Premium: $600 CA (Includes Increased Limit Min. Prem.) <br /> Audit Period: ANNUAL Installment Term: <br /> The policy is not binding unless countersigned by our authorized representative. <br /> Countersigned by �` �'�I�C 11/04/25 <br /> Authorized Representative Date <br /> Form WC 00 00 01 A (1) Printed in U.S.A. Page 1 (Continued on next page) <br /> Process Date: 11/04/25 Policy Expiration Date: 11/04/26 <br />