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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> ARIZONA ALCOHOL- AND DRUG-FREE WORKPLACE PREMIUM CREDIT <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 /> This endorsement applies only to the insurance provided c. Comply with the alcohol and drug testing policy <br /> by the policy because Arizona is shown in Item 3.A. of requirements in accordance with Title 23, <br /> the Policy Information Page. Chapter 2, Article 14. <br /> This endorsement provides notice that premium for your d. Conduct alcohol and drug testing of prospective <br /> policy may be affected by the Arizona Alcohol-and Drug- employees. <br /> Free Workplace Premium Credit Program. e. Conduct alcohol and drug testing of an <br /> You may qualify for a 5% premium credit if you have employee after the employee has been injured. <br /> established and maintain a qualifying alcohol- and drug- f. Allow us to have access to the alcohol and drug <br /> free workplace program in accordance with Title 23, testing results under d. and e. above. <br /> Chapter 2, Article 14 of Arizona Statutes. 3. The determination that you have established and <br /> We will determine your eligibility for this premium credit maintain a qualifying program must be made during <br /> after total premium has been paid for the policy period each policy term that you receive the premium <br /> and may be revised at the time your final premium audit credit. <br /> is processed. 4. Your certification and any other information relied <br /> The determination that you have a qualifying program upon by the insurer in granting the premium credit <br /> must be made each year that you receive the premium must be kept in the insurer's underwriting files and <br /> credit. To implement a premium credit program, the made available to the Department of Insurance upon <br /> following guidelines must be established: request. <br /> 1. Insurers offering the premium credit program may 5. The premium credit may be applied after total <br /> apply a 5% premium credit to qualifying employers. premium has been paid for the policy period and <br /> 2. To receive the premium credit, you must: may be revised at final audit to the employer's <br /> a. Provide a written statement to the insurer prior policy. The credit is applicable as a supplement to <br /> to or within 30 days after the beginning of the deviated rates and is applied in a multiplicative <br /> policy effective date each year, certifying that manner, after the application of the experience <br /> the business has implemented a program modification, and before the application of the <br /> meeting the requirements of Title 23, Chapter 2, premium discount and expense constant. <br /> Article 14. 6. You must reimburse the premium credit if it is <br /> b. At any time during the term of the policy, provide determined that you were not in compliance with the <br /> additional information to the insurer, as required, provisions of the program. <br /> to confirm that a qualifying program has been 7. Minimum premium policies are eligible for this <br /> established and is being maintained. premium credit. <br /> 8. Residual market employers are eligible to apply for <br /> this premium credit. <br /> Form WC 02 04 01 C Printed in U.S.A <br /> Process Date: 11/04/25 Policy Expiration Date: 11/04/26 <br />