BEGINNERS EDGE SPORTS TRAINING, LLC. (2)

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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY AMENDATORY ENDORSEMENT - CALIFORNIA Policy Number: 76 WEG BX3ZPJ Endorsement Number: Effective Date: 11/04/25 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: Beginners Edge Sports Training 7432 E TIERRA BUENA LN SCOTTSDALE AZ 85260 It is agreed that, anything in the policy to the contrary and will reimburse us for any increase in indemnity notwithstanding, such insurance as is afforded by this payment not covered under the policy when the policy by reason of the designation of California in Item aggregate total amount of the reimbursement 3 of the Information Page is subject to the following payments paid in a policy year exceeds one provisions: hundred dollars($100). If we notify you in writing, within 30 days of the 1. Minors Illegally Employed - Not Insured. This payment, that you are obligated to reimburse us, we policy does not cover liability for additional will bill you for the amount of increase in indemnity compensation imposed on you under Section 4557, payment and collect it no later than the final audit. Division IV, Labor Code of the State of California, You will have 60 days, following notice of the by reason of injury to an employee under sixteen obligation to reimburse, to appeal the decision of the years of age and illegally employed at the time of insurer to the Department of Insurance. injury. 4. Application of Policy. Part One, "Workers 2. Punitive or Exemplary Damages - Uninsurable. Compensation Insurance", A, "How This Insurance This policy does not cover punitive or exemplary Applies", is amended to read as follows: damages where insurance of liability therefor is This workers compensation insurance applies to prohibited by law or contrary to public policy. bodily injury by accident or disease, including death 3. Increase in Indemnity Payment - resulting therefrom. Bodily injury by accident must Reimbursement. You are obligated to reimburse occur during the policy period. Bodily injury by us for the amount of increase in indemnity disease must be caused or aggravated by the payments made pursuant to Subdivision (d) of conditions of your employment. Your employee's Section 4650 of the California Labor Code, if the exposure to those conditions causing or aggravating late indemnity payment which gives rise to the such bodily injury by disease must occur during the increase in the amount of payment is due less policy period. than seven (7) days after we receive the 5. Rate Changes. The premium and rates with completed claim form from you. You are respect to the insurance provided by this obligated to reimburse us for any increase in policy by reason of the designation of California in indemnity payments not covered under this policy Form WC 04 03 01 BB Printed in U.S.A. Page 1 of 2 Process Date: 11/04/25 Policy Expiration Date: 11/04/26