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tuy <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, <br /> 90-DAY REPORTING REQUIREMENT - <br /> NOTIFICATION OF CHANGE IN OWNERSHIP <br /> ENDORSEMENT <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 /> You must report any change in ownership to us in writing within 90 days of the date of the change. Change in ownership <br /> includes sales, purchases, other transfers, mergers, consolidations, dissolutions, formations of a new entity and other <br /> changes provided for in the applicable experience rating plan. Experience rating is mandatory for all eligible insureds. The <br /> experience rating modification factor, if any, applicable to this policy, may change if there is a change in your ownership or <br /> in that of one or more of the entities eligible to be combined with you for experience rating purposes. <br /> Failure to report any change in ownership, regardless of whether the change is reported within 90 days of such change, <br /> may result in revision of the experience rating modification factor used to determine your premium. <br /> This reporting requirement applies regardless of whether an experience rating modification is currently applicable to this <br /> policy. <br /> Form WC 00 04 14 A Printed in U.S.A. <br /> Process Date: 11/04/25 Policy Expiration Date: 11/04/26 <br />