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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> AMENDMENT TO WORKERS' COMPENSATION BROAD FORM <br /> ENDORSEMENT- EMPLOYERS' LIABILITY STOP GAP COVERAGE <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 changes the Workers' A. This coverage only applies in North Dakota, <br /> Compensation Broad Form Endorsement — Ohio, Washington, and Wyoming <br /> Employers' Liability Stop Gap Coverage <br /> 6. Employers' Liability Stop Gap Coverage E. This paragraph is removed. <br /> Form WC 99 03 58 B Printed in U.S.A(Ed. 7108) <br /> Process Date: 11/04/25 Policy Expiration Date: 11/04/26 <br />