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EXTENSION OF THE INFORMATION PAGE - ITEM 1 - OTHER <br /> WORKPLACES <br /> Policy Number: 76 WEG BX3ZPJ Endorsement Number: <br /> Effective Date: 11/04/25 Effective hour is the same as stated on the Information Page of the policy. <br /> Named Insured and Address: Beginners Edge Sports Training <br /> 7432 E TIERRA BUENA LN <br /> SCOTTSDALE AZ 85260 <br /> Item 1 of the Information Page is completed to include other workplaces of the named insured: <br /> 7432 E TIERRA BUENA LN, SCOTTSDALE,AZ 85260 <br /> 5900 Balcones Dr., Austin, TX 78731 <br /> 8300 SANTA MONICA BLVD, WEST HOLLYWOOD, CA 90069-6216 <br /> NO SPECIFIC LOCATION IN STATE OF COSTA MESA, CA 92626 <br /> Form WC 99 03 66 Printed in U.S.A. <br /> Process Date: 11/04/25 Policy Expiration Date: 11/04/26 <br />