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le LLY <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> AUDIT NONCOMPLIANCE CHARGE 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 /> Part Five - Premium, Section G. (Audit) of the Workers Compensation and Employers Liability Insurance Policy is revised <br /> by adding the following: <br /> If you do not allow us to examine and audit all of your records that relate to this policy, and/or do not provide audit <br /> information as requested, we may apply an Audit Noncompliance Charge. The method for determining the Audit <br /> Noncompliance Charge by state, where applicable, is shown in the Schedule below. <br /> If you allow us to examine and audit all of your records after we have applied an Audit Noncompliance Charge, we will <br /> revise your premium in accordance with our manuals and Part 5-Premium, E. (Final Premium) of this policy. <br /> Failure to cooperate with this policy provision may result in the cancellation of your insurance coverage, as specified <br /> under the policy. <br /> Schedule <br /> State(s) Basis of Audit Noncompliance Maximum Audit Noncompliance <br /> Charge Charge Multiplier <br /> AL, AR, CO, CT, DC, DE, GA, IA, ID, Estimated Annual Premium Up to two times <br /> IL, KY, MD, ME, MI, MN, MS, NE, NJ, <br /> NM, OR, RI, SC, SD, TN, UT, VA, VT, <br /> WV <br /> AZ, HI, KS, OK Estimated Annual Premium Two times <br /> NC Estimated Annual Premium Up to three times <br /> NV Estimated Annual Premium Up to one times <br /> Wl Estimated Annual Premium One time <br /> Form WC 00 04 24 Printed in U.S.A. <br /> Process Date: 11/04/25 Policy Expiration Date: 11/04/26 <br />