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BEGINNERS EDGE SPORTS TRAINING, LLC. (2)
INSURANCE NOT ON FILE WORK MAY NOT PROCEED N-202fi-068 CITY CLERK( DATE; MAR 2 0 2026 4nsA RECREATION SERVICES AGREEMENT WITH BEGINNERS EDGE SPORTS D4,,s;4reeSdY;anUCU ) TRAINING, LLC FOR MULTI-SPORT PROGRAMMING THIS AGREEMENT is made and entered into on this 17th day of February 2026 by and between Beginners Edge Sports Training, LLC, a California limited liability company ("Provider"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). City and Provider may be collectively referred to as the "Parties"or individually as a"Party." RECITALS A. The City desires to retain a recreation service provider having special skills, resources and knowledge to provide multi-sport programming in its recreation class program. B. Provider represents that it is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Provider represents that it is knowledgeable in their field and that any services performed by Provider under this Agreement will be performed in compliance with such standards as may reasonably be expected. D. The Parties acknowledge that the City intends to provide recreational activities to the public but must balance the need to comply with all COVID-19 guidance and restrictions. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the Parties agree as follows: 1. SCOPE OF SERVICES a. Provider shall perform those services as set forth in Exhibit A to this Agreement. b. All classes operated pursuant to this Agreement for conducting recreation classes at City facilities, including parks, will comply with all applicable guidance and public health orders, including those from the Centers for Disease Control ("CDC"), California Department of Public Health ("CDPH"), the Orange County Health Care Agency("OCHCA")and the City itself for as long as those orders and guidance remain in place. Provider will remind participants of these guidelines. To the extent that Provider needs assistance with enforcing any rules or requirements, Provider will contact a City Parks' employee or City security for assistance. c. Provider shall not attend a class or teach any class if Provider is sick or has any symptom(s)associated with COVID-19 including but not limited to,fever above 100.4, chills, cough, shortness of breath, loss of taste or smell, nausea, muscle or body aches, vomiting, headache, sore throat or diarrhea. Page 1 of 8 d. Provider will not attend class or teach a class if Provider or any member of Provider's household has been asked to quarantine or self-isolate due to symptoms of COVID-19 or a positive test result for COVID-19. e. Provider acknowledges that, to the extent that City is able to and chooses to conduct classes indoors, this Agreement will also cover classes conducted at one of City's recreational centers during the term of this Agreement. f. City reserves the right to change the location(s) at which the services contemplated by this Agreement are provided. g. Provider shall comply with the City's recreation class policy manual and any other City rules and regulations regarding the operation of recreation classes. 2. COMPENSATION a. In consideration for the provision of the programs set forth in Exhibit A, City agrees to pay, and Provider agrees to accept as total payment for their services for the City, seventy percent (70%)of all gross revenue received from program participants. Total annual revenue to Provider shall not exceed Fifteen Thousand Dollars and Zero cents ($15,000.00). b. Payment to Provider shall be made monthly within thirty (30) days following completion of the last class taught by Provider the prior month. City shall be responsible for collecting all fees from program participants. Provider shall not collect fees but will refer all interested participants to City for registration information. Provider agrees that City shall retain thirty percent(30%)of all gross revenue received from program participants as an administrative fee. 3. TERM This Agreement shall commence on April 1, 2026 and end on March 31, 2027 unless terminated earlier in accordance with Section 14 below. The term of this Agreement may be extended by a writing executed by the City Manager and the City Attorney. 4. INDEPENDENT CONTRACTOR Provider shall,during the entire term of this Agreement,be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer-employee relationship, a joint venture relationship,or to allow the City to exercise discretion or control over the manner in which Provider performs the services which are the subject matter of this Agreement; however, the services to be provided by Provider shall be provided in a manner consistent with all applicable standards and regulations governing such services. Provider shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all Page 2 of 8 applicable withholding taxes. Provider is not an agent, representative or employee of City and Provider shall have no authority to act on behalf of the City. 5. INSURANCE Insurance requirements attached hereto as Exhibit B. 6. INDEMNIFICATION Provider agrees to and shall indemnify, defend and hold harmless the City, its officers, agents, employees,consultants, special counsel, and representatives from liability: (1)for personal injury, damages,just compensation,restitution,judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Provider or its contractors, subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages,just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement, to the extent that the injury, damages,just compensation, restitution,judicial or equitable relief is caused by the negligence of the Provider. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. In no case will Provider be required to indemnify or hold harmless the City from injury,damages,just compensation, restitution,judicial or equitable relief caused by the negligence of the City. 7. CONFIDENTIALITY If Provider receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary,Provider agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own infonmation of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information, including but not limited to student records. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either Party by any subsidiary and/or agent of the other Party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Provider disclosed in a publicly available source; (c) is in rightful possession. of the Provider without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or(e)is independently developed by the Provider without reference to information disclosed by the City. Page 3 of 8 8. COVID-19 ASSUMPTION OF RISK AND WAIVER Provider acknowledges that Provider could be exposed to persons that may have COVID- 19 providing services pursuant to this Agreement, Provider understands that interacting with any person currently comes with the inherent risk of exposure to COVID-19 and that COVID-19 is highly contagious. Provider assumes the risks associated with providing services pursuant to this Agreement, namely potential exposure to COVID-19. Provider acknowledges that while some people have no symptoms or mild symptoms from COVID-19,some people have become seriously ill requiring hospitalization and that some people have died from COVID-19. Provider acknowledges that persons over the age of 65 and persons with underlying health conditions are at greater risk of contracting COVID-19 and are potentially risking serious injury or death. Provider is agreeing to provide classes pursuant to this Agreement and does so of Provider's own free will. Provider intends to be legally bound by this assumption of risk, release and waiver and to bind Provider's heirs, personal representatives, next of kin and anyone who may make a claim on Provider's behalf. Provider knowingly releases and waives any and all claims that Provider may have or could have in the future and includes any claims resulting from potential exposure or actual exposure to COVID-19, this includes claims for personal injury, transmittal of COVID-19 to others, and/or wrongful death. Provider agrees to hold harmless, defend and indemnify the City, its public officials, officers, employees,volunteers, and agents from any and all claims for liability or damages, including those for exposure to or diagnosis with COVID-19 as a result of providing services pursuant to this Agreement. 9. CONFLICT OF INTEREST a. Provider covenants that it presently has no interests and shall not have interests, direct or indirect,which would conflict in any manner with performance of services specified under this Agreement. bo No immediate family members of either the Mayor, City Council Member, or any appointed City Official, including appointed board and commission members, as defined under the City's Municipal Code, whose position with the City shall award or influence the award of this Agreement, or any competing contract or amendment thereof, shall be employed in any capacity by the Provider or have any other direct or indirect financial benefit or interest in this Agreement. c. The section also prohibits the awarding of any agreement, contract, grant, or any amendment to those awards, to any former full-time employee for one-year from date of employee separation except for any CalPERS retiree as authorized by City Council resolution d. Provider must comply with all conflict of interest laws, ordinances, and regulations now in effect or hereafter to be enacted during the term of this Agreement.The Provider warrants that it is not now aware of any facts which conflict with the prohibitions defined above. If Provider hereafter becomes aware of any facts that might reasonably Page 4 of 8 be expected to create a conflict of interest, it must immediately make full written disclosure of such facts to the City. Full written disclosure must include, but is not limited to, identification of all persons implicated and a complete description of all relevant circumstances. Failure to comply with the provisions of this paragraph will be a ma.terial breach of this Agreement. e. Provider covenants that none of its directors, officers, employees, or agents shall participate in selecting or administrating any subcontract supported(in whole or in part) by City funds stemming from the Agreement where the awarding of the subcontract has any direct or indirect financial benefit or interest to any individual, as defined in subsections (b) and (c) above. 10. BACKGROUND CHECK Provider shall ensure that all employees, subcontractors, and any volunteers are fingerprinted and background checked prior to conducting any work pursuant to this Agreement. Provider shall not assign any employee, agent, subcontractor,volunteer or the Provider personally to provide services pursuant to this Agreement, if that employee, agent, subcontractor, volunteer, or the Provider personally are required to register as a sex offender under California Penal Code Section 290 et seq, have a conviction for any crime of moral turpitude, have a conviction for a sexual based crime, have a conviction for a violent felony as defined in California Penal Code Section 667.5(c), or has a conviction for a serious felony as defined in California Penal Code Section 1192.7(c).Disqualifying convictions include but arc not limited to,violations of California Penal Code Sections 37, 128, 136.1 with Section 186.22, 187, 190-190.4 and 1.92(a), 205, 206, 207-209.5, 211, 212, 212.5, 213, 214, 215, 218-219, 220, 236.1(b) or 236.1(c), 243.4, 261, 261.5, 273.5, 262, 264.1, 266, 266c, 266h, 266i, 266j, 267, 269, 272, 273a, 273ab, 273d, 285, 286, 288, 288a, 288.2,288.'),288.4,288.5,288.7,289,290,31 l.l, ')11.2, 311.3,311.4, 311.10,311.11,314, 347(a), 368,417(b),451(a),518 with 186.22, 647.6, 653f(c), 664 and 187, 667.5(c), 18745, 18750, or 18755, 12022.53, 11.418(b)(1) or(b)(2); Business and Professions Code Section 729. 11. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail,postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: City Clerk City of Santa Ana 20 Civic Center Plaza(M-30) P.D. Box 1988 Santa Ana, CA 92702-1988 Fax (714) 647-6956 With copy to: Executive Director of Parks, Recreation and Community Services Page 5 of 8 City of Santa Ana 20 Civic Center Plaza(M-23) P.O. Box 1988 Santa Ana, California 92702 Fax(714) 571-4211 To Provider: Beginners Edge Sports Training, LLC Attn: Mitchell Goldberg, Owner 24654 N. Lake Pleasant Pkwy. Ste. 103-405 Peoria,Arizona 85383 A Party may change its address by giving notice in writing to the other Party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four (24)hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 12. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Provider regarding the subject matter herein, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Provider. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Provider or the City. Each Party to this Agreement acknowledges that no representations, inducements,promises or agreements,orally or otherwise,have been made by any Parry,or anyone acting on behalf of any Party, which is not embodied herein. 13. ASSIGNMENT The experience, knowledge, capability and reputation of Provider were a substantial inducement for City to enter into this Agreement. Therefore, Provider may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. 14. TERMINATION a. This Agreement may be terminated by the City upon thirty (30) days written notice of termination. Page 6 of 8 b. Termination or cancellation of classes by the Provider must be given to the City, in writing, at least thirty (30) days prior to termination/cancellation. Failure to provide adequate cancellation notice to the City may put future contracting of business with the City at risk. 15. RECORDS Provider shall use attendance sheets generated and supplied by the City to record attendance in each class. Provider shall keep these and any other records in connection with the work to be performed under this Agreement and shall permit City, upon request, to review such records for a period of three (3) years from the date of final payment to Provider under this Agreement. 16. NON-DISCRIMINATION Provider shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, gender identity, gender expression, gender, medical conditions, genetic information, or military and veteran status, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion, termination or other employment related activities or any services provided under this Agreement. Provider affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 17. JURISDICTION—VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both Parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 18. LICENSES Provider shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals,waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. 19. SEVERABILITY In the event that one or more of the phrases, sentences, clauses, paragraphs or sections contained in this Agreement shall be declared invalid or unenforceable by valid judgment or decree of a court of competent jurisdiction, such invalidity or unenforceability shall not affect any of the remaining phrases, sentences, clauses, paragraphs or sections of this Agreement, which shall be interpreted to carry out the intent of the Parties hereunder. Page 7 of 8 20. EXHIBITS All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 21. AUTHORITY The person(s) executing this Agreement on behalf of the Parties hereto warrant that they are duly authorized to execute this Agreement on behalf of said Parties and that by so executing this A-•eement, the Parties hereto are formally bound to the provisions of this Agreement. IN WITNESS WHEREOF, the Parties hereto have executed this Agreement the date and year first above written, ATTEST: CITY ' SANTA A7NA a Vu J Ater L. t,all :, ';"`" Alvaro Nunez::.- City Clerk, City Manager APPROVED AS TO FORM: SONIA R. CARVALHO PROVIDER: City Attorney ' - Jonathan T. Marticeeez Yfitchell Goldberg Assistant City Attorney Owner RECOMMENDED FOR APPROVAL: Ha4 co .. Executive o Parks, Recreation and Community Services Agency Palle 8 ot'8 EXHIBIT A SCOPE OF SERVICES Scone of Services Program Overview: This Scope of Services outlines the responsibilities and expectations for engagement of Provider to provide sports classes for ages 1 - 17 years at City recreation facilities and parks, as defined below. The aim is to promote health and wellness in the community by offering affordable recreation opportunities that encourage creative activity and teamwork. A. Program and Class Offerings: i. Seasonal programs and class offerings may include, but are not limited to the following class options: i. Soccer ii. Multi-sport ii. Provider shall teach such or similar classes at available City facilities to be designated by the City on a schedule agreed upon by the parties, in writing, for each class session or term, including the location, specific days and hours when classes will be held,and holidays to be observed,in accordance with City's needs. Provider and City agree that class locations and/or scheduling are subject to change due to unforeseen events or needs beneficial to the class participants. The Parties agree that changes to scheduling or location of classes shall be agreed upon, in writing, prior to the allowance of said change(s). iii. Class Size i. At the City's discretion and upon mutual agreement, the minimum and maximum number of participants required for each class will be determined to ensure the quality and safety of the class participants. ii. Class ratio of participants to instruetior(s)will be set for each class to ensure effective instruction and safety based on statewide standards. iii. If the minimum registration has not been reached by the second class, it is Lip to the discretion of the City upon mutual agreement with Provider, that the class shall be cancelled. Provider will be under no obligation to provide services for the cancelled classes, and the City will have no further obligations to pay Provider compensation for the remaining classes that were cancelled in that session. iv. Class Fees i. Class pricing is dependent on session length per season and subject to City staff approval. Class pricing is limited to no more than a 5% increase annually. ii. Each participant shall pay class registration fees as established by City. Provider may not waive class participation/registration fees.Only registered participants paid in full may participate in class. iii. Any refunds to participants will be made in accordance with City policy. B. Provider Responsibilities: i. Planning and delivering engaging and age-appropriate sports classes as defined by class curriculum.and description to be approved by City staff. ii. Ensuring the safety and wellbeing of all participants during class sessions. • Provider will immediately report to City staff, by phone or email, any injuries as a result of class participation, damages to the facility that could cause potential injury to a class participant and/ or require facility repairs. ■ Provider will notify parent/guardian of minors under the age of 18 and city staff regarding any injuries experienced during class. iii. Submitting seasonal program proposals to City staff for seasonal approval of class descriptions, details,and schedules. Proposals must be submitted in writing by way of the provided City form(s) to City staff for review and approval at least 60 days prior to the start of the new season, unless otherwise specified by City staff. City staff will review and approve written proposals based on community needs, facility availability, and alignment with City goals. iv. Adhering to all City policies and procedures related to the use of facilities and interaction.with participants. V. Adhering to all City deadlines for required documentation. vi. The Provider's organization is responsible for fingerprinting, monitoring, and managing all staff that will be instructing. vii. Promotion of class(es) with City approved marketing materials outside of City managed platforms. Publicizing on additional channels and networks outside of City platforms is the sole responsibility of the Provider. viii. Provider shall provide all materials, supplies, equipment, records and personnel. Provider shall be responsible for repairing and maintaining all equipment and supplies, and ensuring that it is in good working condition. Provider shall ensure clean-up of the facilities and materials to ensure the safety and effectiveness of instruction. The City will not responsible for any damage, repairs, misplaced, or stolen supplies or equipment, and will not be responsible for storing supplies or equipment. C. City Responsibilities: i. City shall manage participant registration and class information through registration.software.Provider shall be granted access to the class roster on the City registration system and is responsible for tracking attendance. ii. City shall collect all enrollment fees through the registration software. Provider shall not accept enrollment fees directly from a participant, and shall only collect materials fees that are pre-approved by City and published in advance as a part of the program marketing. Such material fees shall be collected by Provider at the first scheduled class meeting. No additional fees shall be collected for materials, uniforms, awards, etc. without written approval and advanced advertising. iii. City shall provide publicity for class(es) seasonally in the City's recreation magazine(published seasonally). City shall have the sole discretion to decide what information will be included in the recreation magazine about the class and Provider. Publicity may also include flyers created by City. Provider created flyers are encouraged, but must be finalized by City to include use of City logos before distribution. iv. City shall provide a location for the class(es). Provider will request dates and times for the cia.ss(es)seasonally, in writing, The City will confirm the class(es) schedule seasonally. Location selection is based on need, size of class, type of activity and availability, and is reserved at the discretion of the City. V. City shall provide refunds to participants when: ■ The participant formally requests to drop the class before the second schedule class meeting. • The class is canceled by City or Provider. EXHIBIT B INSURANCE REQUIREMENTS Insurance Requirements Prior to undertaking performance of work under this Agreement, Provider shall maintain and shall require subcontractors, if any, to obtain and maintain insurance; as described below, for the entire Term of this Agreement, against claims for injuries to persons or damage to property which may arise from or in connection with services,products and materials supplied. Total cost of such insurance shall be borne by Provider. MINIMUM SCOPE AND LIMIT OF INSURANCE 1. Commercial General Liability (CGL): Insurance Services Office Form CG 00 01covering CGL on an"occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence and $2,000,000 aggregate. Required policy limits can be met with primary and umbrella/excess insurance policies. 2, Automobile Liability (AL): Insurance Services Office Form CA 00 01 covering Code I (any auto), with limits no less than $1,000,000 per accident for bodily injury and property damage. In the event Provider does not maintain commercial automobile liability insurance, City will accept evidence of personal automobile insurance,provided that such policy is endorsed for business use and provides coverage with a minimum limit of $1,000,000. Required policy limits can be met with primary and umbrella/excess insurance policies. 3. Workers' Compensation(WC): As required by the State of California, with Statutory Limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident, policy or employee, for bodily injury or disease. Coverage is not required if Provider has no employees and signs request to waive such insurance. 4. Sexual.Abuse or Molestation Liability (SAML): If the work will include contact with minors, and the CGL policy referenced above is not endorsed to include affirmative coverage for sexual abuse or molestation,Provider shall obtain and maintain a policy covering Sexual. Abuse and Molestation with a limit of no less than$1,000,000 per occurrence or claim. If Provider maintains broader coverage and/or higher limits than the minimum requirements for each line of coverage shown above, City requires and shall be entitled to the broader coverage and/or the higher limits maintained by Provider. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to City. Other Insurance Provisions The above required insurance policies are to contain or be endorsed to contain the following provisions: 1. City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers arc to be covered as additional insureds on Provider's CGL,AL, and SAML policies with respect to liability arising out of work or operations performed by or on behalf of the Provider including materials, parts, equipment, and personnel furnished in connection with such work or operations. 2. Provider's Insurance company(ies) agrees to waive all rights of subrogation against City, its City Council, its officers, officials, employees, agents, and volunteers for losses paid under the terms of Provider's CGL, AL, and WC policies which arise from work performed by Provider under this Agreement. 3. For any claims related to this contract, Provider's insurance coverage shall be primary and any insurance maintained by City, its City Council, its officers, officials, employees, agents, or volunteers shall not contribute with it. 4. A severability of interest provision must apply for all the additional insureds, ensuring that Provider's insurance shall apply separately to each insured against whom a claim is made or suit is brought, except with respect to the insurer's limits of liability. 5. Insurance policy(ies) required herein shall provide that coverage shall not be canceled, suspended, voided, reduced in coverage or in limits, non-renewed by the carrier, or materially changed except after thirty (30)days prior written notice has been given to City. Ten (10) days prior written notice shall be provided to City for policy cancellation or non-renewal due to non-payment. 6. Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa Ana, Attention: Parks, Recreation, and Community Services Agency, M-23, Santa Ana, CA 92701. The name and location of project must be included in the Description of Operations section of each certificate. Acceptability of insurers Insurance is to be placed with insurers authorized to conduct business in the State of California with a current A.M. Best rating of no less than A:VII, unless otherwise acceptable to City. Verification of Coverage Provider shall furnish City with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage required by this clause) and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive Provider's obligation to provide them. City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. Special Events Coverage Special events coverage is available and can be purchased by Provider. Use this link to learn more: https://2sparta.com/selip application.php. Special Risks or Circumstances City reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. AC o) '1 2712 CERTIFICATE ©F LIABILITY INSURANCE r ATE27/20fYYYY)026 ill THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone: (904)354-9020 CONTACT Fax: {sbG)352-1401 NAME: Loritsringhausen The Monument Sports Group P"CN o E t (SO4)256-&335,301 (A IC.No 1365 Overbrook Road E-MAIL Lori@monumentsports.com ADOREss: Suite#i 1 ENSURERS AFFORDING COVERAGE Richmond,Virginia 23220 INSURER A: LIO Insurance Company 020918 INSURED INSURER B Beginners Edge Sports Training LLC INSURER C 29634 North Lake Pleasant Parkway INSURER D Suite 103-405 — Peoria,AZ 85383 INSURER E ----- -- INSURER F COVERAGES CERTIFICATE NUMBER:5043 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE ADDL SUER POLICY I I POLICY EX? LTR POLICY NUMBER MMfDOfYYYY r, MMIDINYYYY LIMITS COMMERCIAL GENERAL LIABILITY L101100084183-00 11/5/2025 11/5/2026 1,000,000 EACH OCCURRENCE 5 A CLAIMS-MADE 7 OCCUR DAMAGE TO RENTS❑ 101000 PREMISES Ea or S ✓ Inel Participants �/ y MED EXP(Any one person) 5 5,000 PERSONAL SADV INJURY S 1,000+000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 3,000,000 ` IPOLICY❑ ❑PRO- 2,000,QOO JECT LOC PRODUCTS-COMPIOPAGG 5 OTHER: Abuse/Mol $ 1,000,000 AUTOMOBILE LIAB ILdTY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED P BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS I HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE DE❑ RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETCRfPARTNEPJEXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFiCERIMEMBER EXCLUDED? NIA (Mandatory in i E.L.DISEASE-EA EMPLOYEE $ If yes,describe under - -- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Participant Accident L101 100084189-00 11/5/2025 1115/2026 Med me 25,000 $500 Ded DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) ity of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers. are included as additional insured per form CG 001 01 04 13. giver of Subrogation provided if required by written contract per form CC 20 01 04 13. his certificate is issued in reference to the named insureds operations and subject to the terms, conditions, and ther provisions of the policies, CERTIFICATE HOLDER CANCELLATION APPROVED By To Tran Nguyen at 11:43 am,filar 18;21J26 Holder's Nature of Interest:Additional Insured SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Santa Ana:Attn:Parks,Recreation,and Community THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Services Agency 20 Civic Center Plaza AUTHORIZED REP RESENTATIVE Santa Ana,CA 92701 O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER;L101 1 000841 83-00 COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organ ixation(s): City of Santa Ana, its City Council,officers,officials, employees,agents,and volunteers. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV— Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 OO Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: LIO 1100084163-00 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): City of SantaAna ,its City Council, its officers,employees,agents,and,volunteers ATTN: Parks, Recreation,and Community Services Agency 20 Civic Center Plaza SantaAna,CA 92701 Information required to complete this Schedule if not shown above will be shown in the Declarations. A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III - Limits Of Insurance: with respect to liability for"bodily injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury" required by a contract or agreement, the most we caused, in whole or in part, by your acts or omis- will pay on behalf of the additional insured is the sions or the acts or omissions of those acting on amount of insurance: your behalf: 1. In the performance of your ongoing opera- 1. Required by the contract or agreement; or tons; or 2. Available under the applicable Limits of Insur- 2. In connection with your premises owned by or ance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the applica- 1. The insurance afforded to such additional in- ble Limits of Insurance shown in the Declarations. sured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the in- surance afforded to such additional insured will not be broader than that which you are re- quired by the contract or agreement to pro- vide for such additional insured. CG 20 26 04 13 Copyright, Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER:L101100084183-00 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Con- (2) You have agreed in writing in a contract or dition and supersedes any provision to the con- agreement that this insurance would be trary: primary and would not seek contribution from any other insurance available to the Primary And Noncontributory Insurance additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy pro- vided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 Copyright, Insurance Services Office, Inc., 2012 Page 1 of 1 THE HARTFORD BUSINESS SERVICE CENTER THE A>. °'" 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 February 19, 2026 City of Santa Ana parks, Recreation,and Community 20 CIVIC CENTER PLZ SANTA ANA CA 92701-4058 Account Information: Contact Us Policy Holder Details : Beginners Edge Sports Training Need Help? Chat online or call us at (866)467-8730. We're here Monday- Friday. Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team WLTRO05 [�OT21191AE(MMIDDlYYYY) CERTIFICATE OF LIABILITY INSURANCE 2o26 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: INSURANCETRAK SERVICESIPAC 76251042 PHONE (585)282-0934 Fax (877)871-7137 4515 CULVER RD SUITE 206 (Arc,No,Ext): (A/C,Na): ROCHESTER NY 14622 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAICX INSURER A: Hartford Fire and Its P&C Affiliates 00914 INSURED INSURER B: BEGINNERS EDGE SPORTS TRAINING INSURERC: 7432 E TIERRA BUENA LN SCOTTSDALE AZ 85260-1646 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS TYPE OF INSURANCE ADDL POLICY NUMBER SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD DIYYYY !Y YYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) MED EXP(Any one person) PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY❑PRO- ❑LOC PRODUCTS-COMPfOP AGG _ JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ZA accident ANY AUTO BODILY INJURY(Per person) ALL OWNED q SCHEDULED Per accident AUTOS AUTOS BODILY INJURY( ) HIRED NON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Peraccident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- MADE AGGREGATE DED RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY X STATUTE ER ANY YIN E.L EACH ACCIDENT $1,000,000 A PROPRIETORrPARTNERIFXECUTIVF N/A X. 76 WEG BX3ZPJ 11/04/2025 11/04/2026 OFFICEWMEMBER EXCLUDED? F.L-DISEASE-EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT S1,000,000 DESCRIPTION OF OPERATIONS below LCDRf7I0PN OP OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) seusual to the Insured's Operations.Bfanket Waiver of Subrogation applies in favor of the Certficate Holder per the Waiver of Our Right to over from Others Endorsement WC040306,attached to this policy.State job is performed in:AZ Payroll for job to support waiver(Work Comp):350 CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED parks,Recreation,and Community BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 20 CIVIC CENTER PLZ IN ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA CA 92701-4058 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Workers' Compensation and Employers' Liability Business Insurance Policy THE HARTFORD Form WC 99 00 02 (03114) Page 1 of 1 (Policy Provisions: WCOOOOOOC) INFORMATION PACE WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INSURER: SEE ATTACHED ENDORSEMENT uTHE NCC[ Company Number: 20621 fE iTFOR.D Company Code: 9 Suffix LARS RENEWAL POLICY NUMBER: 76 WEG BX3ZPJ Previous Policy Number: 76 WEG AZ6AMU 1, Named Insured and Mailing Address: BEGINNERS EDGE SPORTS TRAINING (No., Street, Town, State, Zip Code) 7432 E TIERRA BUENA LN SCOTTSDALE AZ 85260 FEIN Number: 26-2932264 State Identification Number(s): Refer to the EXTENSION OF THE INFORMATION PAGE—WC990365. The Named Insured is: LLC Business of Named Insured: Fitness and Recreational Sports Centers Other workplaces not shown above: See Endorsement-WC990366 2. Policy Period: From 11/04/25 To 11/04/26 ANNUAL 12:01 a.m., Standard time at the insured's mailing address. Producer's Name: INSURANCETRAK SERVICES/PAC 4515 CULVER RD SUITE 206 ROCHESTER NY 14622 Producer's Code: 76251042 Issuing Office: THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 (877) 287-1316 Total Estimated Annual Premium: $5,583 Deposit Premium: Policy Minimum Premium: $600 CA (Includes Increased Limit Min. Prem.) Audit Period: ANNUAL Installment Term: The policy is not binding unless countersigned by our authorized representative. Countersigned by �` �'�I�C 11/04/25 Authorized Representative Date Form WC 00 00 01 A (1) Printed in U.S.A. Page 1 (Continued on next page) Process Date: 11/04/25 Policy Expiration Date: 11/04/26 INFORMATION PAGE (Continued) Policy Number: 76 WEG BX3ZPJ 3.A.Workers Compensation Insurance: Part one of the policy applies to the Workers Compensation Law of the states listed here: TX SEE ENDORSEMENT-WC 99 03 67 B. Employers Liability Insurance: Park Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily injury by Accident $1,000,000 each accident Bodily injury by Disease $1,000,000 policy limit Bodily injury by Disease $1,000,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any , listed here: ALL STATES EXCEPT NORTH DAKOTA, OHIO, WASHINGTON, WYOMING, U.S.TERRITORIES AND STATES DESIGNATED IN ITEM 3.A. OF THE INFORMATION PAGE. D. This policy includes these endorsements and schedule: SEE ENDORSEMENT-WC 99 03 68 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. _ Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium Total Standard Premium $5,084 Premium Discount _$4 Expense Constant $200 Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement $68 Catastrophe (Other Than Certified Acts Of Terrorism) $31 Estimated Annual Premium (before Surcharges) $5,379 Total Estimated Surcharges $204 *See the attached Schedule(s) of Operations for Location and State Level Premium Information Total Estimated Annual Premium: $5,583 Deposit Premium: Policy Minimum Premium: $600 CA(Includes Increased Limit Min. Prem.) Interstatellntrastate Identification Number: Refer to Schedule of Operations NAICS: 713940 Labor Contractors Policy Number: SIC: 7991 Form WC 00 00 01 A (1) Printed in U.S.A. Page 2 Process Date: 11/04/25 Policy Expiration Date: 11/04/26 EXTENSION OF THE INFORMATION PAGE - ITEM 1 - OTHER WORKPLACES 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 Item 1 of the Information Page is completed to include other workplaces of the named insured: 7432 E TIERRA BUENA LN, SCOTTSDALE,AZ 85260 5900 Balcones Dr., Austin, TX 78731 8300 SANTA MONICA BLVD, WEST HOLLYWOOD, CA 90069-6216 NO SPECIFIC LOCATION IN STATE OF COSTA MESA, CA 92626 Form WC 99 03 66 Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 it EXTENSION OF THE INFORMATION PAGE - ITEM 3.A - STATES COVERED 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 Item 3.A. of the Information Page is completed to include the following states: Texas TX California CA Arizona AZ Form WC 99 03 67 Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 EXTENSION OF THE INFORMATION PACE - ITEM 3.13 - ENDORSEMENTS 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 Item 3.D, of the Information Page is completed to include the following endorsements G-4119-0 POLICYHOLDER NOTICE-PAYROLL BILLING PN049901 J POLICYHOLDER NOTICE -YOUR RIGHT TO RATING AND DIVIDEND INFORMATION WC000000C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC000001A.1 INFORMATION PAGE WC000001A,2 INFORMATION PAGE WC000313 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT WC000403 EXPERIENCE RATING MODIFICATION FACTOR ENDORSEMENT WC000406 Premium Discount Endorsement WC000414A 90-DAY REPORTING REQUIREMENT-NOTIFICATION OF CHANGE IN OWNERSHIP ENDORSEMENT WC000419A PART FIVE- PREMIUM AMENDATORY ENDORSEMENT WC000421 F CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUM ENDORSEMENT WC000422C TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT WC000424 AUDIT NONCOMPLIANCE CHARGE ENDORSEMENT WCO20401 C ARIZONA ALCOHOL AND DRUG-FREE WORKPLACE PREMIUM CREDIT ENDORSEMENT WCO20601C Arizona Cancellation and Nonrenewal Endorsement WCO20603A ARIZONA AMENDATORY ENDORSEMENT WC040301 BB POLICY AMENDATORY ENDORSEMENT-CALIFORNIA Form WC 99 03 68 Printed in U:S.A. Process Date: 11/04/25 Policy Expiration Date. 11/04/26 tuy EXTENSION OF THE INFORMATION PAGE - ITEM 3.D - ENDORSEMENTS 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 Item 3.D. of the Information Page is completed to include the following endorsements: WC040306 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA WC0403606 EMPLOYERS LIABILITY COVERAGE AMENDATORY ENDORSEMENT-CALIFORNIA WC040421 OPTIONAL PREMIUM INCREASE ENDORSEMENT-CALIFORNIA WC040601 B CALIFORNIA CANCELATION ENDORSEMENT WC420301L TEXAS AMENDATORY ENDORSEMENT WC550011D Employees Claim for Workers compensation Benefits WC550022A NOTICE TO WORKERS' COMPENSATION POLICYHOLDERS IN TEXAS LETTER WC880400J Notice to Employees- Injuries Caused By Work(TITLE IN SPANISH) WC880401 J Notice to Employees- Injuries Caused By Work VVC990001 K Signature/Copyright WC990002 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY BUSINESS INSURANCE POLICY WC990005 SCHEDULE OF OPERATIONS WC990302B WORKERS COMPENSATION BROAD FORM ENDORSEMENT WC990358B AMENDMENT TO WORKERS COMPENSATION BROAD FORM ENDORSEMENT- EMPLOYERS LIABILITY STOP GAP COVERAGE WC990366 EXTENSION OF THE INFORMATION PAGE - ITEM 1 - OTHER WORKPLACES WC990367 EXTENSION OF THE INFORMATION PAGE- ITEM 3.A-STATES COVERED WC990363 EXTENSION OF THE INFORMATION PAGE- ITEM 3.D. - ENDORSEMENTS Form WC 99 03 68 Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 EXTENSION OF THE INFORMATION PAGE - ITEM 3.13 - ENDORSEMENTS 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 Item 3.Dn of the Information Page is completed to include the following endorsements: WC990371A ARIZONA COUNTERSIGNATURE EXCLUSION ENDORSEMENT WC990375 CALIFORNIA INSTALLMENT FEE DISCLOSURE ENDORSEMENT WC990689 GOODS AND SERVICES ENDORSEMENT WC990694 GOODS AND SERVICES ENDORSEMENT Form WC 99 03 68 Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 POLICY INSURER LIST BY JURISDICTION INSURER NAIC JURISDICTION Hartford Casualty Insurance Company 29424 CA ONE HARTFORD PLAZA HARTFORD CT 06155 Hartford Insurance Company of the Southeast 38261 AZ ONE HARTFORD PLAZA HARTFORD CT 06155 Hartford Insurance Company of Illinois 38288 TX ONE HARTFORD PLAZA HARTFORD CT 06155 THE COVERAGE PROVIDED IN EACH JURISDICTION IS WITH RESPECT TO THE LOCATIONS OF THE NAMED INSURED IN THAT JURISDICTION IN ACCORDANCE WITH THE WORKERS' COMPENSATION LAW OF THAT JURISDICTION. AS USED IN THIS POLICY, "COMPANY", "WE", "US"AND "OURS" MEAN THE MEMBER INSURANCE COMPANIES OF THE HARTFORD INSURANCE GROUP COLLECTIVELY PROVIDING THIS INSURANCE. Nothing herein, contained shall be held to vary, waive, alter or extend any of the terms, conditions, agreements or information of the policy, other than as herein stated. Form WC 66 04 40 Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 tay SCHEDULE OF OPERATIONS it This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: HARTFORD INSURANCE COMPANY OF THE SOUTHEAST Company Code: J Policy Number: 76 WEG BX3,ZPJ Schedule Number: 01-02-01 Effective Date: 11/04/25 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Location Address of operations covered by this schedule: Beginners Edge Sports Training 7432 E TIERRA BUENA LN SCOTTSDALE AZ 85260 NAICS: 713940 FEIN: 26-2932264 SIC: 7991 N0, OF EMPL: 5 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium 9063 306,811.00 0,300000 920 HEALTH OR EXERCISE INSTITUTE & CLERICAL Total State Summary Total Class Premium 920 Waiver of Subrogation 250 Emp liab increased limits 0.011000 10 Total Estimated Annual Standard Premium 1,180 Terrorism Risk Insurance Program Reauthorization Act 306,811.00 0.010000 31 Disclosure Endorsement Catastrophe (other than certified acts of terrorism) 306,811.00 0.010000 31 Total Estimated Annual Premium 1,242 Countersigned by Authorized Representative Form WC 99 00 05 (1) Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: HARTFORD CASUALTY INSURANCE COMPANY Company Code: 3 Policy Number: 76 WEG BX3ZPJ Schedule Number: 01-04-03 Effective Date. 11/04/25 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Location Address of operations covered by this schedule: Beginners Edge Sports Training 8300 SANTA MONICA BLVD WEST HOLLYWOOD CA 90069 NAICS: 713940 FEIN: 26-2932264 SIC: 7991 NO, OF EMPL: 1 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. m Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium 8870 2,000.00 1.490000 30 FITNESS INSTRUCTION PROGRAMS OR STUDIOS -ALL EMPLOYEES -INCLUDING RECEPTIONISTS Countersigned by Authorized Representative Form WC 99 00 05 (1) Printed in U.S.A. Process Date: 11/04/25 Policy (Expiration Date: 11/04/26 SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: HARTFORD CASUALTY INSURANCE COMPANY Company Code: 3 Policy Number: 76 WEG BX3ZPJ Schedule Number: 01-04-04 Effective Date: 11/04/25 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Location Address of operations covered by this schedule: Beginners Edge Sports Training NO SPECIFIC LOCATION COSTA MESA CA 92626 NAICS: 713940 FEIN: 26-2932264 SIC: 7991 NO. OF EMPL: 2 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium 8870 180,141.00 1.490000 2,684 FITNESS INSTRUCTION PROGRAMS OR STUDIOS-ALL EMPLOYEES - INCLUDING RECEPTIONISTS Total State Summary Total Class Premium 2,714 CA Territorial Differential 1.036000 95 Waiver of Subrogation 1,000 Total Estimated Annual Standard Premium 3,809 Premium discount 0.001000 -4 Expense constant 200 Terrorism Risk Insurance Program Reauthorization Act 182,141,00 0.020000 36 Disclosure Endorsement CA User Fund 1.237000 50 CA Fraud 0.409600 17 CA Uninsured Employers Benefit Trust Fund 0.081800 3 CA Subsequent Injuries Benefit Trust Fund Assessments 3.014800 122 CA Occupational Safety &Health Fund 0.188500 8 CA Labor Enforcement& Compliance Fund 0.105800 4 Total Estimated Annual Premium 4,245 Countersigned by Authorized Representative Form WC 99 00 05 (1) Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: HARTFORD INSURANCE COMPANY OF ILLINOIS Company Code: F Policy Number: 76 WEG BX3ZPJ Schedule Number: 01-42-02 Effective Date: 11/04/25 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Location Address of operations covered by this schedule: Beginners Edge Sports Training 5900 Balcones Dr. Austin TX 78731 NAICS: 713940 FEIN: 26-2932264 SIC: 7991 NO. OF EMPL: 1 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium 9063 25,734.00 0.180000 46 HEALTH OR EXERCISE INSTITUTE & DRIVERS Total State Summary Total Class Premium 46 Emp liab increased limits 0.014000 1 Employer Liability Increase Limits balance to Minimum 139 Premium Premium Incentive For Small Employers 0.850000 -28 Schedule Rating Factor 0.600000 -63 Total Estimated Annual Standard Premium 95 Terrorism Risk Insurance Program Reauthorization Act 25,734.00 0.005000 1 Disclosure Endorsement Catastrophe (other than certified acts of terrorism) 26,734.00 0 Total Estimated Annual Premium 96 Countersigned by Authorized Representative Form WC 99 00 05 (1) Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 THElf HAR.TFORD THIS LETTER CONTAINS IMPORTANT INFORMATION, Texas Regional Office 450 Gears Road,Suite 500 PLEASE READ CAREFULLY AND RETAIN THIS LETTER Houston,TX 77067-4585 FOR FUTURE USE. P.O.Box 4611 Houston,TX 77210-4511 Telephone(281)874-9600 TO: WORKERS' COMPENSATION POLICYHOLDERS IN TEXAS Thank you for choosing The Hartford as your workers' compensation carrier. We ask that you take a minute to familiarize yourself with the forms and reporting requirements for the State of Texas which we have included in this packet. 1. Each employer should maintain a record of all injuries reported or made known to the employer. The Texas Department of Insurance, Division of Workers' Compensation (DWC) may at times request these records for review. 2. If the injury causes an employee to be off work more than one day OR involve a claim for an occupational disease you must immediately report the loss. 3. Please refer to Form WC 66 02 51 for LossConnect loss reporting instructions. 4. LossConnect will file all necessary state reports. 5. THE CLAIM MUST BE REPORTED NO LATER THAN THE EIGHTH DAY AFTER THE LOSS. OF ONE DAY OF WORK OR THE FIRST NOTICE OF AN OCCUPATIONAL DISEASE. FAILURE TO COMPLY MAY RESULT IN AN ADMINISTRATIVE VIOLATION WHICH COULD INCLUDE UP TO A$500.00 FINE. 6. The FROI must be filed even on a doubtful or disputed claim. Your lack of knowledge of the claim details should be reflected on the report. COMPLETION OF A FROI IS NOT CONSIDERED AN ADMISSION OF OR EVIDENCE OF A COMPENSARLE INJURY IF THE FACTS CONTAINED THEREIN ARE LATER CONTRADICTED. 7. The Employer's Wage Statement (DWC-3) should be provided to the carrier, employee, and DWC if you know or expect 8 days of disability. 8. The Supplemental Report of Injury (DWC-6) should be filed with the carrier whenever you (as the employer) are aware of any change in work status or earnings due to the injury. DO NOT SEND TO THE DWC. We, as the carrier, cannot act quickly and efficiently in your interest unless immediate notice of an injury is received. Your cooperation is imperative and we stand to assist you in any way we can. Form WC 55 00 22 A Printed in U.S.A. The Hartford Insurance Group Hartford Fire Insurance Company and its Affiliates Hartford Plaza,Hartford,Connecticut 06115 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY QUICK REFERENCE Beginning Beginning on Page on Page INFORMATION PAGE PART TWO -Continued 1 G. Limits of Liability .............................................. 4 General Section.............................................................. 1 H. Recovery From Others..................................... 4 A. The Policy............................................................... 1 I. Actions Against Us........................................... 4 B. Who Is Insured....................................................... 1 C. Workers Compensation Law.................................. 1 PART THREE-OTHER STATES INSURANCE 4 ........ 1 A. How This Insurance Applies...................... . E. Locations................................................................ 1 B. Notice............................................................... 5 PART ONE-WORKERS COMPENSATION INSURANCE... 1 PART FOUR-YOUR DUTIES IF INJURY OCCURS..... 5 A. How This Insurance Applies................................... 1 B. We Will Pay............................................................ 1 PART FIVE - PREMIUM............................................... 5 C. We Will Defend....................................................... 1 A. Our Manuals..................................................... 5 D. We Will Also Pay.................................................... 1 B. Classifications.................................................. 5 E. Other Insurance...................................................... 2 C. Remuneration................................................... 5 F. Payments You Must Make...................................... 2 D. Premium Payments.......................................... 5 G. Recovery From Others........................................... 2 E. Final Premium.................................................. 5 H. Statutory Provisions................................................ 2 F. Records............................................................ 6 G. Audit................................................................. 6 PART TWO - EMPLOYERS LIABILITY INSURANCE...... 2 A. How This Insurance Applies................................... 2 PART SIX-CONDITIONS.................................... 6 B. We will Pay............................................................. 3 A. Inspection....................... 6 C. Exclusions..................................................I........... 3 B. Long Term Policy............................................. 6 D. We Will Defend...................................................... 3 C. Transfer of Your Rights and Duties.................. 6 E. We Will Also Pay.................................................... 4 D. Cancellation..................................................... 6 F. Other Insurance...................................................... 4 E. Sole Representative......................................... 6 IMPORTANT: This Quick Reference is not part of the Workers Compensation and Employers Liability Policy and does not provide coverage. Refer to the Workers Compensation and Employers Liability Policy itself for actual contractual provisions. PLEASE READ THE WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY CAREFULLY. Form WC 66 01 56 B Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY In return for the payment of the premium and subject to all terms of this policy, we agree with you as follows: GENERAL SECTION A. The Policy law of each state or territory named in Item 3.A. of the This policy includes at its effective date the Information Page. It includes any amendments to Information Page and all endorsements and schedules that law which are in effect during the policy period. It listed there. It is a contract of insurance between you does not include any federal workers or workmen's (the employer named in Item 1 of the Information compensation law, any federal occupational disease Page) and us (the insurer named on the Information law or the provisions of any law that provide Page). 'The only agreements relating to this insurance nonoccupational disability benefits. are stated in this policy. The terms of this policy may D. State not be changed or waived except by endorsement State means any state of the United States of issued by us to be part of this policy. America, and the District of Columbia. B. Who Is Insured E. Locations You are insured if you are an employer named in Item This policy covers all of your workplaces listed in 1 of the Information Page. If that employer is a Items 1 or 4 of the Information Page; and it covers all partnership, and if you are one of its partners, you are other workplaces in Item 3.A. states unless you have insured, but only in your capacity as an employer of other insurance or are self-insured for such the partnership's employees. workplaces. C. Workers Compensation Law Workers Compensation Law means the workers or workmen's compensation law and occupational disease PART ONE -WORKERS COMPENSATION INSURANCE A. Flow This Insurance Applies C. We Will Defend This workers compensation insurance applies to We have the right and duty to defend at our expense bodily injury by accident or bodily injury by disease. any claim, proceeding or suit against you for benefits Bodily injury includes resulting death. payable by this insurance. We have the right to 1. Bodily injury by accident must occur during the investigate and settle these claims, proceedings or policy period. suits. 2. Bodily injury by disease must be caused or We have no duty to defend a claim, proceeding or aggravated by the conditions of your employment. suit that is not covered by this insurance. The employee's last day of last exposure to the D. We Will Also Pay conditions causing or aggravating such bodily We will also pay these costs, in addition to other injury by disease must occur during the policy amounts payable under this insurance, as part of any period. claim, proceeding or suit we defend: B. We Will Pay 1. reasonable expenses incurred at our request, but We will pay promptly when due the benefits required not loss of earnings; of you by the workers compensation law. Form WC 00 00 00 C Printed in U.S.A. Page 1 of 6 Process Date: 11/04/26 Policy Expiration Date: 11/04/26 2. premiums for bonds to release attachments and You will do everything necessary to protect those for appeal bonds in bond amounts up to the rights for us and to help us enforce them. amount payable under this insurance; H. Statutory Provisions 3. litigation costs taxed against you; These statements apply where they are required by 4. interest on a judgment as required by law until we law. offer the amount due under this insurance; and 1. As between an injured worker and us, we have 5. expenses we incur. notice of the injury when you have notice. E. Other Insurance 2. Your default or the bankruptcy or insolvency of We will not pay more than our share of benefits and you or your estate will not relieve us of our duties costs covered by this insurance and other insurance under this insurance after an injury occurs. or self-insurance. Subject to any limits of liability that 3. We are directly and primarily liable to any person may apply, all shares will be equal until the loss is entitled to the benefits payable by this insurance. paid. If any insurance or self-insurance is exhausted, Those persons may enforce our duties; so may the shares of all remaining insurance will be equal an agency authorized by law. Enforcement may until the loss is paid. be against you and us. F. Payments You Must Make 4. Jurisdiction over you is jurisdiction over us for You are responsible for any payments in excess of the purposes of the workers compensation law. We benefits regularly provided by the workers are bound by decisions against you under that compensation law including those required because: law, subject to the provisions of this policy that 1. of your serious and willful misconduct; are not in conflict with that law. 5. This insurance conforms to the parts of the 2. you knowingly employ an employee in violation of workers compensation law that apply to: aw; 3. you fail to comply with a health or safety law or a. benefits payable by this insurance; regulation; or b. special taxes, payments into security or other 4. you discharge, coerce or otherwise discriminate special funds, and assessments payable byus under that law, against any employee in violation of the workers compensation law. 6. Terms of this insurance that conflict with the If we make any payments in excess of the benefits workers compensation law are changed by thisstatement to conform to that law. regularly provided by the workers compensation law on your behalf, you will reimburse us promptly. Nothing in these paragraphs relieves you of your duties G. Recovery From Others under this policy. We have your rights, and the rights of persons entitled to the benefits of this insurance, to recover our payments from anyone liable for the injury. PART TWO - EMPLOYERS LIABILITY INSURANCE A. How This Insurance Applies 2. The employment must be necessary or incidental This employers liability insurance applies to bodily to your work in a state or territory listed in Item injury by accident or bodily injury by disease. Bodily 3.A. of the Information Page. injury includes resulting death. 3. Bodily injury by accident must occur during the 1. The bodily injury must arise out of and in the policy period. course of the injured employee's employment by 4. Bodily injury by disease must be caused or you. aggravated by the conditions of your employment. The employee's last day of last Form WC 00 00 00 C Printed in U.S.A. Page 2 of 6 exposure to the conditions causing or aggravating This exclusion does not apply to bodily injury to a such bodily injury by disease must occur during citizen or resident of the United States of America the policy period. or Canada who is temporarily outside these 5. If you are sued, the original suit and any related countries; legal actions for damages for bodily injury by 7. Damages arising out of coercion, criticism, accident or by disease must be brought in the demotion, evaluation, reassignment, discipline, United States of America, its territories or defamation, harassment, humiliation, dis- possessions, or Canada. crimination against or termination of any B. We Will Pay employee, or any personnel practices, policies, We will pay all sums that you legally must pay as acts or omissions; damages because of bodily injury to your employees, 8. Bodily injury to any person in work subject to the provided the bodily injury is covered by this Employers Longshore and Harbor Workers' Compensation Liability Insurance. Act (33 U.S.C. Sections 901 et seq.), the The damages we will pay, where recovery is permitted Noappropriated Fund Instrumentalities Act (5 U.S.C. Sections 8171 et seq.), the Outer by law, include damages: Continental Shelf Lands Act (43 U.S.C. Sections 1. For which you are liable to a third party by reason 1331 et seq.), the Defense Base Act (42 U.S.C. of a claim or suit against you by that third party to Sections 1651-1654), the Federal Mine Safety recover the damages claimed against such third and Health Act (30 U.S.C. Sections 801 et seq. party as a result of injury to your employee; and 901-944) any other federal workers or 2. For care and loss of services; and workmen's compensation law or other federal 3. For consequential bodily injury to a spouse, child, occupational disease law, or any amendments to parent, brother or sister of the injured employee; these laws; provided that these damages are the direct 9. Bodily injury to any person in work subject to the consequence of bodily injury that arises out of and Federal Employers' Liability Act (45 U.S.C. in the course of the injured employee's Sections 51 et seq.), any other federal laws employment by you; and obligating an employer to pay damages to an employee due to bodily injury arising out of or in 4. Because of bodily injury to your employee that the course of employment, or any amendments arises out of and in the course of employment, to those laws; claimed against you in a capacity other than as employer. 10. Bodily injury to a master or member of the crew of any vessel, and does not cover punitive C. Exclusions damages related to your duty or obligation to This insurance does not cover: provide transportation, wages, maintenance, and 1. Liability assumed under a contract. This exclusion cure under any applicable maritime law; does not apply to a warranty that your work will be 11. Fines or penalties imposed for violation of federal done in a workmanlike manner; or state law; and 2. Punitive or exemplary damages because of bodily 12. Damages payable under the Migrant and injury to an employee employed in violation of law; Seasonal Agricultural Worker Protection Act (29 3. Bodily injury to an employee while employed in U.S.C. Sections 1801 et seq.) and under any violation of law with your actual knowledge or the other federal law awarding damages for violation actual knowledge of any of your executive officers; of those laws or regulations issued thereunder, 4. Any obligation imposed by a workers com- and any amendments to those laws. pensation, occupational disease, unemployment D. We Will Defend compensation, or disability benefits law, or any We have the right and duty to defend, at our expense, similar law; any claim, proceeding or suit against you for damages 5. Bodily injury intentionally caused or aggravated by payable by this insurance. We have the right to you; investigate and settle these claims, proceedings and 6. Bodily injury occurring outside the United States of suits. America, its territories or possessions, and Canada. Form WC 00 00 00 C Printed in U.S.A. Page 3 of 6 We have no duty to defend a claim, proceeding or suit A disease is not bodily injury by accident unless it that is not covered by this insurance. We have no results directly from bodily injury by accident. duty to defend or continue defending after we have 2. Bodily Injury by Disease. The limit shown for paid our applicable limit of liability under this "bodily injury by disease policy limit" is the most insurance. we will pay for all damages covered by this E. We Will Also Pay insurance and arising out of bodily injury by We will also pay these costs, in addition to other disease, regardless of the number of employees amounts payable under this insurance, as part of any who sustain bodily injury by disease. The limit claim, proceeding or suit we defend: shown for "bodily injury by disease each 1. Reasonable expenses incurred at our request, but employee" is the most we will pay for alldamages because of bodily injury by disease to not loss of earnings; any one employee. 2. Premiums for bonds to release attachments and Bodily injury by disease does not include disease for appeal bonds in bond amounts up to the limit that results directly from a bodily injury by of our liability under this insurance; accident. 3. Litigation costs taxed against you; 3. We will not pay any claims for damages after we 4. Interest on a judgment as required by law until we have paid the applicable limit of our liability under offer the amount due under this insurance; and this insurance. 5. Expenses we incur. H. Recovery From Others F. Other Insurance We have your rights to recover our payment from We will not pay more than our share of damages and anyone liable for an injury covered by this insurance. costs covered by this insurance and other insurance You will do everything necessary to protect those or self-insurance. Subject to any limits of liability that rights for us and to help us enforce them. apply, all shares will be equal until the loss is paid. If I. Actions Against Us any insurance or self-insurance is exhausted, the There will be no right of action against us under this shares of all remaining insurance and self-insurance insurance unless: will be equal until the loss is paid. 1. You have complied with all the terms of this G. Limits of Liability policy; and Our liability to pay for damages is limited. Our limits of 2. The amount you owe has been determined with liability are shown in Item 3.B. of the Information Page. our consent or by actual trial and final judgment. They apply as explained below. This insurance does not give anyone the right to add 1. Bodily Injury by Accident. The limit shown for us as a defendant in an action against you to "bodily injury by accident each accident" is the determine your liability. The bankruptcy or most we will pay for all damages covered by this insolvency of you or your estate will not relieve us of insurance because of bodily injury to one or more our obligations under this Part. employees in any one accident. PART THREE - OTHER STATES INSURANCE A. How This Insurance Applies listed in Item 3.A. of the Information Page. 1. This other states insurance applies only if one or 3. We will reimburse you for the benefits required by more states are shown in Item 3.C. of the the workers compensation law of that state if we Information Page. are not permitted to pay the benefits directly to 2. If you begin work in any one of those states after persons entitled to them. the effective date of this policy and are not insured 4. If you have work on the effective date of this or are not self-insured for such work, all provisions policy in any state not listed in Item 3.A. of the of the policy will apply as though that state were Form WC 00 00 00 C Printed in U.S.A. Page 4 of 6 Information Page, coverage will not be afforded for B. Notice that state unless we are notified within thirty days. Tell us at once if you begin work in any state listed in Item 3.C. of the Information Page. PART FOUR -YOUR DUTIES IF INJURY OCCURS Tell us at once if injury occurs that may be covered by 4. Cooperate with us and assist us, as we may this policy. Your other duties are listed here. request, in the investigation, settlement or 1 Provide for immediate medical and other services defense of any claim, proceeding or suit. required by the workers compensation law. 5. Do nothing after an injury occurs that would 2. Give us or our agent the names and addresses of interfere with our right to recover from others. the injured persons and of witnesses, and other 6. Do not voluntarily make payments, assume information we may need. obligations or incur expenses, except at your own 3. Promptly give us all notices, demands and legal cost. papers related to the injury, claim, proceeding or suit. PART FIVE v PREMIUM A. Our Manuals 2. all other persons engaged in work that could All premium for this policy will be determined by our make us liable under Part One (Workers manuals of rules, rates, rating plans and Compensation Insurance) of this policy. If you do classifications. We may change our manuals and not have payroll records for these persons, the apply the changes to this policy if authorized by law or contract price for their services and materials a governmental agency regulating this insurance. may be used as the premium basis. This paragraph 2 will not apply if you give us proof B. Classifications that the employers of these persons lawfully Item 4 of the Information Page shows the rate and secured their workers compensation obligations. premium basis for certain business or work D. Premium Payments classifications. These classifications were assigned based on an estimate of the exposures you would You will pay all premium when due. You will pay the have during the policy period. If your actual premium even if part or all of a workers exposures are not properly described by those compensation law is not valid. classifications, we will assign proper classifications, E. Final Premium rates and premium basis by endorsement to this The premium shown on the Information Page, policy. schedules, and endorsements is an estimate. The C. Remuneration final premium will be determined after this policy ends Premium for each work classification is determined by by using the actual, not the estimated, premium basis multiplying a rate times a premium basis. and the proper classifications and rates that lawfully Remuneration is the most common premium basis. apply to the business and work covered by this This premium basis includes payroll and all other policy. If the final premium is more than the premium you paid to us, you must pay us the balance. If it is remuneration paid or payable during the policy period less, we will refund the balance to you. The final for the services of: premium will not be less than the highest minimum 1. All your officers and employees engaged in work premium for the classifications covered by this policy. covered by this policy; and Form WC 00 00 00 C Printed in U.S.A. Page 5 of 6 If this policy is cancelled, final premium will be G. Audit determined in the following way unless our manuals You will let us examine and audit all your records that provide otherwise: relate to this policy. These records include ledgers, 1. If we cancel, final premium will be calculated pro journals, registers, vouchers, contracts, tax reports, rata based on the time this policy was in force. payroll and disbursement records, and programs for Final premium will not be less than the pro rata storing and retrieving data. We may conduct the share of the minimum premium. audits during regular business hours during the policy 2. If you cancel, final premium will be more than pro period and within three years after the policy period rata; it will be based on the time this policy was in ends. Information developed by audit will be used to force, and increased by our short rate cancellation determine final premium. Insurance rate service table and procedure. Final premium will not be organizations have the same rights we have under less than the minimum premium. this provision. F. Records You will keep records of information needed to compute premium. You will provide us with copies of those records when we ask for them. PART SIX. W CONDITIONS A. Inspection D. Cancellation We have the right, but are not obligated to inspect 1. You may cancel this policy. You must mail or your workplaces at any time. Our inspections are not deliver advance written notice to us stating when safety inspections. They relate only to the insurability the cancellation is to take effect. of the workplaces and the premiums to be charged. 2. We may cancel this policy. We must mail or We may give you reports on the conditions we find. deliver to you not less than ten days advance We may also recommend changes. While they may written notice stating when the cancellation is to help reduce losses, we do not undertake to perform the duty of any person to provide for the health or take effect. Mailing that notice to you at your safety of your employees or the public. We do not mailing address shown in Item 1 of the Information Page will be sufficient to prove warrant that your workplaces are safe or healthful or notice. that they comply with laws, regulations, codes or standards. Insurance rate service organizations have 3. The policy period will end on the day and hour the same rights we have under this provision. stated in the cancellation notice. D. Long Term Policy 4. Any of these provisions that conflict with a law that controls the cancellation of the insurance in If the policy period is longer than one year and sixteen this policy is changed by this statement to comply days, all provisions of this policy will apply as though a with that law. new policy were issued on each annual anniversary that this policy is in force. . Sole Representative C. Transfer of Your Rights and Duties The insured first named in Item 1 of the Information Page will act on behalf of all insureds to change this Your rights or duties under this policy may not be policy, receive return premium, and give or receive transferred without our written consent. notice of cancellation. If you die and we receive notice within thirty days after your death, we will cover your legal representative as insured. Form WC 00 00 00 C Printed in U.S.A. Page 6 of 6 POLICYHOLDER NOTICE CALIFORNIA WORKERS' COMPENSATION INSURANCE RATING LAWS Pursuant to Section 11752.8 of the California Insurance premium to reflect your claim history. A better claim Code, we are providing you with an explanation of the history generally results in a lower experience rating California workers' compensation rating laws. modification; more claims, or more expensive claims, generally result in a higher experience rating 1, We establish our own rates for workers' modification. The uniform experience rating plan, compensation. Our rates, rating plans, and related which is developed by the insurance rating information are filed with the insurance organization designated by the insurance commissioner and are open for public inspection. commissioner, is subject to approval by the insurance commissioner. 2, The insurance commissioner can disapprove our rates, rating plans, or classifications only if he or she 5. A standard classification system, developed by the has determined after public hearing that our rates insurance rating organization designated by the might jeopardize our ability to pay claims or create a insurance commissioner, is subject to approval by monopoly in the market. A monopoly is defined by the insurance commissioner. The standard law as a market where one insurer writes 20% or classification system is a method of recognizing and more of that part of the California workers' separating policyholders into industry or compensation insurance that is not written by the occupational groups according to their similarities State Compensation Insurance Fund. If the and/or differences. We can adopt and apply the insurance commissioner disapproves our rates, standard classification system or develop and apply rating plans, or classifications, he or she may order our own classification system, provided we can an increase in the rates applicable to outstanding report the payroll, expenses, and other costs of policies. claims in a way that is consistent with the uniform statistical plan or the standard classification system. 3. Rating organizations may develop pure premium rates that are subject to the insurance 6. Our rates and classifications may not violate the commissioner's approval. A pure premium rate Unruh Civil Rights Act or be unfairly discriminatory. reflects the anticipated cost and expenses of claims per $100 of payroll for a given classification. Pure 7. We will provide an appeal process for you to appeal premium rates are advisory only, as we are not the way we rate your insurance policy. The process required to use the pure premium rates developed by requires us to respond to your written appeal within any rating organization in establishing our own rates. 30 days. If you are not satisfied with the result of your appeal, you may appeal our decision to the 4. We must adhere to a single, uniform experience insurance commissioner. rating plan. If you are eligible for experience rating under the plan, we will be required to adjust your Form PN 04 99 02 B(Ed. 5-02) Printed in U.S.A. Page 1 of 2 CALIFORNIA WORKERS' COMPENSATION INSURANCE NOTICE OF NONRENEWAL Section 11664 of the California Insurance Code requires 4. The policy is for a period of no more than 60 days us, in most instances, to provide you with a notice of and you were notified at the time of issuance that it nonrenewal. Except as specified in paragraphs 1 may not be renewed. through 6 below, if we elect to nonrenew your policy, we 5. You requested a change in the terms or conditions are required to deliver or mail to you a written notice or risks covered by the policy within 60 days prior to stating the reason or reasons for the nonrenewal of the the end of the policy period. policy. The notice is required to be sent to you no earlier than 120 days before the end of the policy period 6. We made a written offer to you to renew the policy and no later than 30 days before the end of the policy at a premium rate increase of less than 25 percent. period. If we fail to provide you the required notice, we are required to continue the coverage under the policy (A) If the premium rate in your governing with no change in the premium rate until 60 days after classification is to be increased 25 percent or we provide you with the required notice. greater and we intend to renew the policy, we shall provide a written notice of a renewal offer We are not required to provide you with a notice of not less than 30 days prior to the policy renewal nonrenewal in any of the following situations: date. The governing classification shall be determined by the rules and regulations 1. Your policy was transferred or renewed without a established in accordance with California change in its terms or conditions or the rate on Insurance Code 11750.3(c). which the premium is based to another insurer or other insurers who are members of the same (B) For purposes of this Notice, "premium rate" insurance group as us. means the cost of insurance per unit of exposure prior to the application of individual 2. The policy was extended for 90 days or less and the risk variations based on loss or expense required notice was given prior to the extension. considerations such as scheduled rating and experience rating. 3. You obtained replacement coverage or agreed, in writing, within 60 days of the termination of the This notice does not change the policy to which it is policy, to obtain that coverage. attached. Form PN 04 99 02 B (Ed. 5-02) Printed in U.S.A. Page 2 of 2 THE HARTFORD POLICY HOLDER NOTICE - PAYROLL BILLING Thank you for choosing The Hartford. Your policy is on our payroll billing method. The payroll billing method uses actual payrolls received throughout the policy period and a blended rate(s) to determine premiums due during the policy period. To learn more about how your premium is calculated on the payroll billing method please visit: htti)s://www.thehartford.com/blended Below are the blended rate(s) being used for each state and classification code on your policy: State Class Code Blended Rate Effective 2: 5900 Balcones Dr., Austin, 9063 0.380000 11/04/2025 TX 4: COSTA MESA, CA 8870 2220000 11/04/2025 3: WOS: 8300 SANTA 8870 2.220000 11/04/2025 MONICA BLVD, WEST HOLLYWOOD, CA 1: 7432 E TIERRA BUENA 9063 0.400000 11/04/2025 LN, SCOTTSDALE, AZ Form G-4119-0 Printed in U.S.A. ©2017, The Hartford 1-The Hartford POLICYHOLDER NOTICE YOUR RIGHT TO RATING AND DIVIDEND INFORMATION I. Information Available to You A. Information Available from Us - Hartford Casualty Insurance Company (1) General questions regarding your policy should be directed to your Hartford Agent or Hartford Casualty Insurance Company 3600 Wiseman Blvd San Antonio,TX 78251 Telephone: (877) 287-1316 agency.services@thehartford.com www.thehartford.com (2) Dividend Calculation. If this is a participating policy (a policy on which a dividend may be paid), upon payment or non-payment of a dividend, we shall provide a written explanation to you that sets forth the basis of the dividend calculation. The explanation will be in clear, understandable language and will express the dividend as a dollar amount and as a percentage of the earned premium for the policy year on which the dividend is calculated. (3) Claims Information. Pursuant to Sections 3761 and 3762 of the California Labor Code, you are entitled to receive information in our claim files that affects your premium. Copies of documents will be supplied at your expense during reasonable business hours. For claims covered under this policy, we will estimate the ultimate cost of unsettled claims for statistical purposes eighteen months after the policy becomes effective and will report those estimates to the Workers' Compensation Insurance Rating Bureau of California (WCIRB) no later than twenty months after the policy becomes effective. The cost of any settled claims will also be reported at that time. At twelve- month intervals thereafter, we will update and report to the WCIRB the estimated cost of any unsettled claims and the actual final cost of any claims settled in the interim. The amounts we report will be used by the WCIRB to compute your experience modification if you are eligible for experience rating. B. Information Available from the Workers'Compensation Insurance Rating Bureau of California (1) The WCIRB is a licensed rating organization and the California Insurance Commissioner's designated statistical agent. As such, the WCIRB is responsible for administering the California Workers' Compensation Uniform Statistical Reporting Plan-1995 (USRP) and the California Workers' Compensation Experience Rating Plan-1995 (ERP). WCIRB contact information is: WCIRB, One Montgomery Street, Suite 400, San Francisco, CA 94104, Attn: Customer Service; 888,229.2472 (phone); 415.773.7272 (fax); and customerservice wcirb.com (email). The regulations contained in the USRP and ERP are available for public viewing through the WCIRB's website at wcirb.com, (2) Policyholder Information. Pursuant to California Insurance Code (CIC) Section 11752.6, upon written request, you are entitled to information relating to loss experience, claims, classification assignments, and policy contracts as well as rating plans, rating systems, manual rules, or other information impacting your premium that is maintained in the records of the WCIRB. Complaints and Requests for Action requesting policyholder information should be forwarded to: WCIRB, One Montgomery Street, Suite 400, San Francisco, CA 94104, Attn: Custodian of Records. The Custodian of Records can be reached at 415.777.0777 (phone)and 415.778.7272 (fax). (3) Experience Rating Form. Each experience rated risk may receive a single copy of its current Experience Rating FormlWorksheet free of charge by completing a Policyholder Experience Rating Worksheet Request Form on the WCIRB's website at wcirb.com/ratesheet. The Experience Rating Form/worksheet will include a Loss-Free Rating, which is the experience modification that would have been calculated if Form PN 04 99 01 J (06/25) Printed in U.S.A. Page 1 of 3 Process Date: 11/04/25 Policy Expiration Date: 11/04/26 $0 (zero) actual losses were incurred during the experience period. This hypothetical rating calculation is provided for informational purposes only. II. Dispute Process You may dispute our actions or the actions of the WCIRB pursuant to CIC Sections 11737 and 11753.1. A. Our Dispute Resolution Process. You may send us a written Complaint and Request for Action requesting that we reconsider a change in a classification assignment that results in an increased premium and/or requesting that we review the manner in which our rating system has been applied in connection with the insurance afforded or offered you. Written Complaints and Requests for Action should be forwarded to= Hartford Casualty Insurance Company One Pointe Drive, Suite 200, Brea, CA 92821; Telephone(800)451-6944; Fax(860) 7234289. After you send your Complaint and Request for Action, we have 30 days to send you a written notice indicating whether your written request will be reviewed. If we agree to review your request, we must conduct the review and issue a decision granting or rejecting your request within 60 days after sending you the written notice granting review. If we decline to review your request, if you are dissatisfied with the decision upon review, or if we fail to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner as described in paragraph II.C., below. B. Disputing the Actions of the WCIRB. If you have been aggrieved by any decision, action, or omission to act of the WCIRB, you may request, in writing, that the WCIRB reconsider its decision, action, or omission to act. You may also request, in writing, that the WCIRB review the manner in which its rating system has been applied in connection with the insurance afforded or offered you. For requests related to classification disputes, the reporting of experience, or coverage issues, your initial request for review must be received by the WCIRB within 12 months after the expiration date of the policy to which the request for review pertains, except if the request involves the application of the Revision of Losses rule. For requests related to your experience modification, your initial request for review must be received by the WCIRB within 6 months after the issuance, or 12 months after the expiration date, of the experience modification to which the request for review pertains, whichever is later, except if the request for review involves the application of the Revision of Losses rule. If the request involves the Revision of Losses rule, the time to state your appeal may be longer. (See Section VI, Rule 7 of the ERP). You may commence the review process by sending the WCIRB a written Inquiry. Written Inquiries should be sent to: WCIRB, One Montgomery Street, Suite 400, San Francisco, CA 94104, Attn: Customer Service. Customer Service can be reached at 888.229.2472 (phone), 415.778.7272 (fax) and customerservice@wcirb.com (email). If you are dissatisfied with the WCIRB's decision upon an Inquiry, or if the WCIRB fails to respond within 90 days after receipt of the Inquiry, you may pursue the subject of the Inquiry by sending the WCIRB a written Complaint and Request for Action. After you send your Complaint and Request for Action, the WCIRB has 30 days to send you written notice indicating whether your written request will be reviewed. If the WCIRB agrees to review your request, it must conduct the review and issue a decision granting or rejecting your request within 60 days after sending you the written notice granting review. If the WCIRB declines to review your request, if you are dissatisfied with the decision upon review, or if the WCIRB fails to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner as described in paragraph II.C., below. Written Complaints and Requests for Action should be forwarded to: WCIRB, One Montgomery Street, Suite 400, San Francisco, CA 94104, Attn: Complaints and Reconsideration. The WCIRB's contact information is 888.229.2472 (phone), 415.371.5204 (fax) and customerservice@wcirb.com (email). C. California Department of Insurance - Appeals to the Insurance Commissioner. After you follow the appropriate dispute resolution process described above, if (1) we or the WCIRB decline to review your request, (2) you are dissatisfied with the decision upon review, or (3) we or the WCIRB fail to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner pursuant to CIC Sections 11737, 11752.6, 11753.1 and Title 10, California Code of Regulations, Section 2509.40 et seq. You must file your appeal within 30 days after we or the WCIRB send you the notice rejecting review of your Complaint and Request for Action or the decision upon your Complaint and Request for Action. If no written decision regarding your Complaint and Request for Action is sent, your appeal must be filed within 120 days after you sent your Complaint and Request for Action to us or to the WCIRB. The filing address for all appeals to the Insurance Commissioner is: Form PN 04 99 01 J (06/25) Printed in U.S.A. Page 2 of 3 Administrative Hearing Bureau California Department of Insurance 1901 Harrison Street, 3rd Floor Mailroom Oakland, CA 94612 415.538.4243 You have the right to a hearing before the Insurance Commissioner, and our action, or the action of the WCIRB, may be affirmed, modified or reversed. III. Resources Available to You in Obtaining Information and Pursuing Disputes A. Policyholder Ombudsman. Pursuant to California Insurance Code Section 11752.6, a policyholder ombudsman is available at the WCIRB to assist you in obtaining and evaluating the rating, policy, and claims information referenced in I.A. and I.B., above. The ombudsman may advise you on any dispute with us, the WCIRB, or on an appeal to the Insurance Commissioner pursuant to Section 11737 of the Insurance Code. The address of the policyholder ombudsman is WCIRB, One Montgomery Street, Suite 400, San Francisco, CA 94104, Attn: Policyholder Ombudsman. The policyholder ombudsman can be reached at 415.778,7159 (phone), 415.371.5288 (fax) and ombudsman wcirb.com (email). B. California Department of Insurance - Information and Assistance. Information and assistance on policy questions can be obtained from the Department of Insurance Consumer HOTLINE, 800.927.HELP (4357) or insurance.ca.gov. For questions and correspondence regarding appeals to the Administrative Hearing Bureau, seethe contact information in paragraph II.C. This notice does not change the policy to which it is attached. Form PN 04 99 01 J (06/25) Printed in U.S.A. Page 3 of 3 tLy - AL THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE City of Scottsdale, 9191 E SAN SALVADOR DR, 1 SCOTTSDALE, AZ, 85258 Countersigned by Authorized Representative Form WC 00 03 13 Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXPERIENCE RATING MODIFICATION FACTOR ENDORSEMENT 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 The premium for the policy will be adjusted by an experience rating modification factor. The Factor was not available when the policy was issued. The factor, if any, shown on the Information Page is an estimate. We will issue an endorsement to show the proper factor, if different from the factor shown, when it is calculated. Countersigned by Authorized Representative Form WC 00 04 03 Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PREMIUM DISCOUNT ENDORSEMENT 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 The premium for this policy and the policies, if any, listed in Item 3 of the Schedule may be eligible for a discount. This endorsement shows your estimated discount in Item 1 or 2 of the Schedule. The final calculation of premium discount will be determined by our manuals and your premium basis as determined by audit. Premium subject to retrospective rating is not subject to premium discount. SCHEDULE 1. Table of States California or any other State that has approved the premium discount plan applicable to the total policy premium on an interstate basis at the effective date of the policy. 2. Average percentage discount: 0.10 % 3. Other policies: 4. If there are no entries in Items 1, 2 and 3 of the Schedule, see the Premium Discount Endorsement attached to your policy number: Countersigned by Authorized Representative Form WC 00 04 06 Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 tuy THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, 90-DAY REPORTING REQUIREMENT - NOTIFICATION OF CHANGE IN OWNERSHIP ENDORSEMENT 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 You must report any change in ownership to us in writing within 90 days of the date of the change. Change in ownership includes sales, purchases, other transfers, mergers, consolidations, dissolutions, formations of a new entity and other changes provided for in the applicable experience rating plan. Experience rating is mandatory for all eligible insureds. The experience rating modification factor, if any, applicable to this policy, may change if there is a change in your ownership or in that of one or more of the entities eligible to be combined with you for experience rating purposes. Failure to report any change in ownership, regardless of whether the change is reported within 90 days of such change, may result in revision of the experience rating modification factor used to determine your premium. This reporting requirement applies regardless of whether an experience rating modification is currently applicable to this policy. Form WC 00 04 14 A Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PART FIVE - PREMIUM AMENDATORY ENDORSEMENT 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 This endorsement amends Part Five-Premium of the policy as follows: Part Five- Premium, Section A. (Our Manuals) is replaced by the following provision: A. Our Manuals All premium for this policy will be determined by our manuals of rules, rates and loss costs (as applicable), rating plans, forms, endorsements, and classifications, and such manuals are expressly incorporated by reference into, and apply to, this policy and any renewals (our manuals). As used in this policy and any renewals, our manuals means manuals that have been: 1. Developed in any format and filed by the state-designated workers compensation rating or advisory organization on our behalf with the appropriate state insurance regulatory authority; or 2. Developed in any format and filed by the respective state rating bureau on our behalf with the appropriate state insurance regulatory authority, or 3. Developed in any format and filed by us with the appropriate state insurance regulatory authority; and 4. For each or any of the three scenarios above, the manuals also must be approved for use by the appropriate state insurance regulatory authority, or as otherwise authorized by law as applicable. We may change our manuals and apply the changes to this policy and any renewals if such manual changes are approved for use by the appropriate state insurance regulatory authority, or an otherwise authorized by law as applicable. Part Five- Premium, Section D. (Premium Payments) is replaced by the following provision: D. Premium Payments You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid. The due date for audit and retrospective premiums is the due date specified in the billing for the policy. Form WC 00 04 19 A Printed in U.S.A. Process Date: 1 1/0412 02 5 Policy Expiration Date: 11/04/2026 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUM ENDORSEMENT 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 This endorsement is notification that we are charging For purposes of this endorsement, Catastrophe (Other premium to cover the losses that may occur in the Than Certified Acts of Terrorism) is defined as: A single event of a Catastrophe (Other Than Certified Acts of event or peril resulting in a group of claims with Terrorism) as that term is defined below. Your policy aggregate workers compensation losses in excess of provides coverage for workers compensation losses $50 million. This $50 million threshold applies per caused by a Catastrophe (Other Than Certified Acts occurrence, across all states for which claims arise from of Terrorism). Coverage for such losses is subject to a single event or peril. all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. This premium charge does The premium charge for the coverage your policy not provide funding for Certified Acts of Terrorism Provides for workers compensation losses caused by a contemplated under the Terrorism Risk insurance Catastrophe (Other Than Certified Acts of Terrorism) is Program Reauthorization Act Disclosure Endorsement shown in Item 4 of the Information Page or in the attached to this policy. Schedule below, Schedule State Bate Premium See Attached Schedule Form WC 00 04 21 F Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 le LLY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUDIT NONCOMPLIANCE CHARGE ENDORSEMENT 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 Part Five - Premium, Section G. (Audit) of the Workers Compensation and Employers Liability Insurance Policy is revised by adding the following: 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 information as requested, we may apply an Audit Noncompliance Charge. The method for determining the Audit Noncompliance Charge by state, where applicable, is shown in the Schedule below. If you allow us to examine and audit all of your records after we have applied an Audit Noncompliance Charge, we will revise your premium in accordance with our manuals and Part 5-Premium, E. (Final Premium) of this policy. Failure to cooperate with this policy provision may result in the cancellation of your insurance coverage, as specified under the policy. Schedule State(s) Basis of Audit Noncompliance Maximum Audit Noncompliance Charge Charge Multiplier AL, AR, CO, CT, DC, DE, GA, IA, ID, Estimated Annual Premium Up to two times IL, KY, MD, ME, MI, MN, MS, NE, NJ, NM, OR, RI, SC, SD, TN, UT, VA, VT, WV AZ, HI, KS, OK Estimated Annual Premium Two times NC Estimated Annual Premium Up to three times NV Estimated Annual Premium Up to one times Wl Estimated Annual Premium One time Form WC 00 04 24 Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ARIZONA ALCOHOL- AND DRUG-FREE WORKPLACE PREMIUM CREDIT ENDORSEMENT 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 This endorsement applies only to the insurance provided c. Comply with the alcohol and drug testing policy by the policy because Arizona is shown in Item 3.A. of requirements in accordance with Title 23, the Policy Information Page. Chapter 2, Article 14. This endorsement provides notice that premium for your d. Conduct alcohol and drug testing of prospective policy may be affected by the Arizona Alcohol-and Drug- employees. Free Workplace Premium Credit Program. e. Conduct alcohol and drug testing of an You may qualify for a 5% premium credit if you have employee after the employee has been injured. established and maintain a qualifying alcohol- and drug- f. Allow us to have access to the alcohol and drug free workplace program in accordance with Title 23, testing results under d. and e. above. Chapter 2, Article 14 of Arizona Statutes. 3. The determination that you have established and We will determine your eligibility for this premium credit maintain a qualifying program must be made during after total premium has been paid for the policy period each policy term that you receive the premium and may be revised at the time your final premium audit credit. is processed. 4. Your certification and any other information relied The determination that you have a qualifying program upon by the insurer in granting the premium credit must be made each year that you receive the premium must be kept in the insurer's underwriting files and credit. To implement a premium credit program, the made available to the Department of Insurance upon following guidelines must be established: request. 1. Insurers offering the premium credit program may 5. The premium credit may be applied after total apply a 5% premium credit to qualifying employers. premium has been paid for the policy period and 2. To receive the premium credit, you must: may be revised at final audit to the employer's a. Provide a written statement to the insurer prior policy. The credit is applicable as a supplement to to or within 30 days after the beginning of the deviated rates and is applied in a multiplicative policy effective date each year, certifying that manner, after the application of the experience the business has implemented a program modification, and before the application of the meeting the requirements of Title 23, Chapter 2, premium discount and expense constant. Article 14. 6. You must reimburse the premium credit if it is b. At any time during the term of the policy, provide determined that you were not in compliance with the additional information to the insurer, as required, provisions of the program. to confirm that a qualifying program has been 7. Minimum premium policies are eligible for this established and is being maintained. premium credit. 8. Residual market employers are eligible to apply for this premium credit. Form WC 02 04 01 C Printed in U.S.A Process Date: 11/04/25 Policy Expiration Date: 11/04/26 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ARIZONA CANCELLATION AND NONRENEWAL ENDORSEMENT 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 This endorsement applies because Arizona is shown in Item 3.A. of the Information Page. Part Six-Conditions, Section D. (Cancellation) of the policy is replaced by the following: D. Cancellation and Nonrenewal 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancellation is to take effect. 2. If you cancel or fail to renew this policy, we must promptly notify the Industrial Commission of Arizona. 3. We may cancel this policy if you fail to pay premium when due, or when one or both of the parties to a professional employer agreement terminate the agreement. o If we cancel or nonrenew this policy, we must provide to you and the Industrial Commission of Arizona at least 30 days' notice of the cancellation or nonrenewal. o Notice to you may be sent via mail or delivered by electronic means as follows: o Mailing that notice to you at your last-known mailing address on file with us will be sufficient proof of notice. o Delivery to an email address at which you have consented to receive notices or documents. o Posting on a portal, secure website, electronic network or site accessible via the Internet or a mobile application, computer, mobile device, tablet, or other electronic device, together with a separate notice that includes a description of the document or notice that was posted and that was provided by email to the email address at which you consented to receive notice, or by any other delivery method to which you consented. o If you consented to have the notice emailed in accordance with Arizona law, emailing that notice to you at your last-known email address as provided by you to us will be sufficient proof of notice. o If the email notice is: (1) rejected for delivery; (2) returned to us; or (3) we become aware that the email address provided by you is no longer valid, then we will also mail that notice to you by US Postal Service certified mail, certificate of mailing, or first-class mail using intelligent mail barcode, or another similar tracking method used or approved by the US Postal Service. o If we nonrenew this policy and fail to give you notice of nonrenewal, coverage will not extend beyond the policy period. 4. The policy period will end on the date and time stated in the cancellation or nonrenewal notice, 5. Any of these provisions that conflict with a law that controls the cancellation of the insurance in this policy is changed by this statement to comply with the law. Form WC 02 06 01 C Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 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 Item 3 of the Information Page are subject to covered by this policy. If the final premium is more change if ordered by the Insurance Commissioner than the premium you paid to us, you must pay us of the State of California pursuant to Section 11737 the balance. If it is less, we will refund the balance of the California Insurance Code. to you. The final premium will not be less than the 6. Long Term Policy. If this policy is written for a highest minimum premium for the classifications period longer than one year, all the provisions of covered by this policy. this policy shall apply separately to each If this policy is canceled, final premium will be consecutive twelve-month period or, if the first or determined in the following way unless our manuals last consecutive period is less than twelve months, provide otherwise: to such period of less than twelve months, in the a. If we cancel, final premium will be calculated pro same manner as if a separate policy had been rata based on the time this policy was in force. written for each consecutive period. Final premium will not be less than the pro rata 7. Statutory Provision. Your employee has a first share of the minimum premium. lien upon any amount which becomes owing to you b. If you cancel, final premium may be more than by us on account of this policy, and in the case of pro rata; it will be based on the time this policy your legal incapacity or inability to receive the was in force, and may be increased by our money and pay it to the claimant, we will pay it short-rate cancelation table and procedure. directly to the claimant. Final premium will not be less than the pro rata 8. Part Five, "Premium", F, "Final Premium", is share of the minimum premium. amended to read as follows: It is further agreed that this policy, including all The premium shown on the Information Page, endorsements forming a part thereof, constitutes the schedules, and endorsements is an estimate. The entire contract of insurance. No condition, provision, final premium will be determined after this policy agreement, or understanding not set forth in this policy or ends by using the actual, not the estimated, such endorsements shall affect such contract or any premium basis and the proper classifications and rights, duties, or privileges arising therefrom. rates that lawfully apply to the business and work Form WC 04 03 01 BB Printed in U.S.A. Page 2 of 2 AL THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS 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 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 5 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description The City of Mission Viejo 01 Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS 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 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 5 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Beginners Edge Sports Training, LLC7432 East Tierra 02 Buena Suite 102 Scottsdale AZ 8526 Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS 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 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 5 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description City of West Hollywood, 8300 Santa Monica Blvd, West 003 Hollywood, CA 90069. Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS 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 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 5 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description City of Riverside, 3900 Main St Riverside, CA 2 Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ARIZONA AMENDATORY ENDORSEMENT 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 This endorsement applies because Arizona is shown in Item 3.A. of the Information Page. Item 2. of the Information Page is replaced by the following: 2. The policy period is from 11/04/25 to 11/04/26 12:01 a.m. in the time zone of the insured's mailing address. For endorsements issued during the policy period, the effective date is in the time zone of the insured's mailing address. Form WC 02 06 03 A Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EMPLOYERS' LIABILITY COVERAGE 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 The insurance afforded by Part Two (Employers' Liability C. The "Exclusions" section is modified as follows (all Insurance) by reason of designation of California in Item 3 other exclusions in the "Exclusions" section remain of the Information Page is subject to the following as is): provisions: 1. Exclusion 1 is amended to read as follows: A. "How This Insurance Applies," is amended to read 1. liability assumed under a contract. as follows: 2. Exclusion 2 is deleted. A. How This Insurance Applies 3. Exclusion 7 is amended to read as follows: This employers' liability insurance applies to bodily 7. damages arising out of coercion, criticism, injury by accident or bodily injury by disease. demotion, evaluation, reassignment, Bodily injury means a physical injury, including discipline, defamation, harassment, resulting death. humiliation, discrimination against or 1. The bodily injury must arise out of and in the termination of any employee, termination of course of the injured employee's employment employment, or any personnel practices, by you. policies, acts or omissions. 2. The employment must be necessary or 4• The following exclusions are added: incidental to your work in California. 1. bodily injury to any member of the flying crew 3. Bodily injury by accident must occur during of any aircraft. the policy period. 2. bodily injury to an employee when you are 4. Bodily injury by disease must be caused or deprived of statutory or common law aggravated by the conditions of your defenses or are subject to penalty because employment. The employee's last day of last of your failure to secure your obligations exposure to the conditions causing or under the workers' compensation law(s) aggravating such bodily injury by disease applicable to you or otherwise fail to comply must occur during the policy period. with that law. 5. If you are sued, the original suit and any 3. liability arising from California Labor Code related legal actions for damages for bodily Section 2810.3 which relates to labor injury by accident or by disease must be contracting. brought in the United States of America, its territories or possessions, or Canada. Countersigned by Authorized Representative Form WC 04 03 60 B Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 it THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OPTIONAL PREMIUM INCREASE 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 You must provide us, or our authorized representative, We will notify you of your failure to provide access by access to records necessary to perform a payroll mailing a certified, return-receipt document stating the verification audit. If you fail to provide access within 90 increased premium and the total amount of our costs days after expiration of the policy, you are liable to pay a incurred in our attempt(s)to perform an audit. In addition total premium equal to 3 times our current estimate of to any other obligations under this contract, 30 days the annual premium for your policy. In addition, if you fail after you receive the notification, you will be obligated to to provide access after our third request within a 90 day pay the total premium and costs referenced above. If, or longer period, you are also liable for our costs in thereafter, you provide access to your records within attempting to perform the audit unless you provide a three years after the policy expires, or within another compelling business reason for your failure. mutually agreed upon time, and we succeed in performing the audit to our satisfaction, we will revise We will contact you to schedule appointments during your total premium and the costs due to reflect the normal business hours. results of the audit. Form WC 04 04 21 Printed in U.S.A. Page 1 of 1 Process Date: 11/04/26 Policy Expiration Date: 11/04/26 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CANCELATION ENDORSEMENT 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 Name of California Insurer: Hartford Casualty Insurance Company This endorsement applies only to the insurance provided j. The occurrence of any change in your business by the policy because California is shown in item 3.A. of or operation that requires additional or different the Information Page. classification for premium calculation; The cancelation condition in Part Six (Conditions) of the k. The occurrence of any change in your business policy is replaced by these conditions: or operation which contemplates an activity Cancelation excluded by our reinsurance treaties. 1. You may cancel this policy. You must mail or deliver 3. If we cancel your policy for any of the reasons listed advance written notice to us stating when the in (a) through (f), we will give you 10 days advance cancelation is to take effect. written notice, stating when the cancelation is to take 2. We may cancel this policy for one or more of the effect. Mailing that notice to you at your mailing following reasons: address shown in Item 1 of the Information Page will be sufficient to prove notice. If we cancel your policy a. Non-payment of premium; for any of the reasons listed in Items (g)through (k), b. Failure to report payroll; we will give you 30 days advance written notice; c. Failure to permit us to audit payroll as required however, we agree that in the event of cancelation by the terms of this policy or of a previous policy and reissuance of a policy effective upon a material issued by us; change in ownership or operations, notice will not be d. Failure to pay any additional premium resulting provided. from an audit of payroll required by the terms of 4. If we mail the notice to you, the stated periods of this policy or any previous policy issued by us; notice and your right to remedy the condition will be e. Material misrepresentation made by you or your extended by 5 days if the place of mailing and your mailing address is within California, 10 days if the agent; place of mailing or your mailing address is outside of f, Failure to cooperate with us in the investigation California and 20 days if the place of mailing or your of a claim; mailing address is outside of the United States. g. Material failure to comply with federal or state 5. The policy period will end on the day and hour safety orders or written recommendations of our stated in the cancelation notice. designated loss control representatives; h. The occurrence of a material change in the ownership of your business; i. The occurrence of any change in your business or operations that materially increases the hazard for frequency or severity of loss; Form WC 04 06 01 B (01/22) Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 it THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TEXAS AMENDATORY ENDORSEMENT 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 This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. GENERAL SECTION B. Who Is Insured is amended to read: You are insured if you are an employer named in Item 1 of the Information Page. If that employer is a partnership or joint venture, and if you are one of its partners or members, you are insured, but only in your capacity as an employer of the partnership's or joint venture's employees. D. State is amended to read: State means any state or territory of the United States of America, and the District of Columbia. PART ONE-WORKERS COMPENSATION INSURANCE E. Other Insurance is amended by adding this sentence: This Section only applies if you have other insurance or are self-insured for the same loss. F. Payments You Must Make This Section is amended by deleting the words"workers compensation"from number 4. H. Statutory Provisions This Section is amended by deleting the words "after an injury occurs"from number 2. PART TWO - EMPLOYERS LIABILITY INSURANCE C. Exclusions Sections 2 and 3 are amended to add: This exclusion does not apply unless the violation of law caused or contributed to the bodily injury. Section 6 is amended to read: 6. bodily injury occurring outside the United States of America, its territories or possessions, and Canada. This exclusion does not apply to bodily injury to a citizen or resident of the United States of America, Mexico or Canada who is temporarily outside these countries. D. We Will Defend This Section is amended by deleting the last sentence. PART FOUR-YOUR DUTIES IF INJURY OCCURS Number 6 of this part is amended to read: 6. Texas law allows you to make weekly payments to an injured employee in certain instances. Unless authorized by law, do not voluntarily make payments, assume obligations or incur expenses, except at your own cost. Form WC 42 03 01 L Printed in U.S.A. Page 1 of 3 Process Date: 11/04/25 Policy Expiration Date: 11/04/26 PART FIVE -PREMIUM A. Our Manuals is amended by adding this sentence: In this part, "our manuals" means manuals approved or prescribed by the Texas Department of Insurance. C. Remuneration Number 2 is amended to read: 2. All other persons engaged in work that would make us liable under Part One (Workers Compensation Insurance) of this policy. This paragraph 2 will not apply if you give us proof that the employers of these persons lawfully secured workers compensation insurance. D. Premium Payments is amended by adding this sentence: The billing statement or invoice for audit additional premiums and/or retrospective additional premiums establishes the date the premium is due. E. Final Premium Number 2 is amended to read: 2. If you cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. PART SIX -CONDITIONS A. Inspection is amended by adding this sentence: Your failure to comply with the safety recommendations made as a result of an inspection may cause the policy to be canceled by us. C. Transfer of Your Rights and Duties is amended to read: Your rights and duties under this policy may not be transferred without our written consent. If you die, coverage will be provided for your surviving spouse or your legal representative. This applies only with respect to their acting in the capacity as an employer and only for the workplaces listed in Items 1 and 4 on the Information Page. D. Cancellation is amended to read: 1. You may cancel this policy. You must mail or deliver advance notice to us stating when the cancellation is to take effect. 2. We may cancel this policy. We may also decline to renew it. We must give you written notice of cancellation or nonrenewal. That notice will be sent certified mail or delivered to you in person. A copy of the written notice will be sent to the Texas Department of Insurance-Division of Workers' Compensation. 3. Notice of cancellation or nonrenewal must be sent to you not later than the 30th day before the date on which the cancellation or nonrenewal becomes effective, except that we may send the notice not later than the 10th day before the date on which the cancellation or nonrenewal becomes effective if we cancel or do not renew because of: a. Fraud in obtaining coverage; b. Misrepresentation of the amount of payroll for purposes of premium calculation; c. Failure to pay a premium when payment was due; d. An increase in the hazard for which you seek coverage that results from an action or omission and that would produce an increase in the rate, including an increase because of failure to comply with reasonable recommendations for loss control or to comply within a reasonable period with recommendations designed to reduce a hazard that is under your control; e. A determination by the Commissioner of Insurance that the continuation of the policy would place us in violation of the law, or would be hazardous to the interests of subscribers, creditors, or the general public. 4. If another insurance company notifies the Texas Department of Insurance-Division of Workers' Compensation that it is insuring you as an employer, such notice must be a cancellation of this policy effective when the other policy starts. Add the following to the policy: PART SEVEN -OUR DUTY TO YOU FOR CLAIM NOTIFICATION A. Claims Notification We are required to notify you of any claim that is filed against your policy. Thereafter we must notify you of any proposal to settle a claim or, on receipt of a written request from you, of any administrative or judicial proceeding relating to the resolution of a claim, including a benefit review conference conducted by the Texas Department of Insurance-Division of Workers' Compensation. You may, in writing, elect to waive this notification requirement. We must, on the written request from you, provide you with a list of claims charged against your policy, payments made and reserves established on each claim, and a statement explaining the effect of claims on your premium rates. We must furnish the requested information to you in writing no later than the 30th day after the date we receive your request. The information is considered to be provided on the date the information is received by the United States Postal Service or is personally delivered. Form WC 42 03 01 L Printed in U.S.A, Page 2 of 3 COMPLAINT NOTICE: DISPUTE RESOLUTION SERVICES NCCI'S DISPUTE RESOLUTION PROCESS DOES NOT APPLY TO WORKERS COMPENSATION CLAIMS. For workers compensation claim disputes, see "CLAIM COMPLAINT" below. For issues related to a violation of law related to your policy,see "VIOLATIONS OF LAW" below. Important Note: The dispute resolution services provided through the Dispute Resolution Process (Process) of the National Council on Compensation Insurance (NCCI) are voluntary. The Process is not an administrative remedy that must be exhausted before you pursue relief in court. Using the Process does not prevent you or the carrier that issued the policy from pursuing any available legal remedies at any time. NCCI can assist in the resolution of a dispute regarding your policy that is related to any of the following matters: o The application or interpretation of rules contained in the various NCCI manuals (including, but not limited to, classification codes and experience rating modifications) o Rating programs o Endorsements o Forms Contact the carrier that issued the policy and attempt to resolve the dispute directly. If you and the carrier cannot agree, then contact NCCI to ask for assistance. NCCI's Basic Manua! rule, Dispute Resolution Process, addresses disputes. You may obtain dispute resolution services only after you have made a reasonable attempt to first resolve the dispute directly with the carrier and after you have paid any undisputed premium due to the carrier. Send your request for assistance by mail to NCCI, Dispute Resolution Services, 901 Peninsula Corporate Circle, Boca Raton, FL 33487-1362; or by fax to 561-893-5043; or by email to disputeresolution@ncci.com. THIS NOTICE OF THE DISPUTE RESOLUTION PROCESS IS FOR INFORMATION ONLY AND DOES NOT BECOME A PART,TERM, OR CONDITION OF THIS POLICY. VIOLATIONS OF LAW: If you believe there has been a violation of law related to your policy, file a complaint with the Texas Department of Insurance: Phone: 1-800-252-3439 Online:tdi.texas.gov Email: ConsumerProtection@tdi.texas.gov Mail: MC CO-CP, PO Box 12030, Austin, TX 78711-2030 CLAIM COMPLAINT: If there is a workers compensation claim complaint involving one of your employees, then contact the Texas Department of Insurance - Division of Workers' Compensation, Compliance and Investigations by mail to MC: Cl, PO Box 12050, Austin, TX 78711-2050; or by fax to 512-490-1030; or by email to DWCCOMPLAINTS@tdi.texas.gov. THIS NOTICE IS FOR INFORMATION ONLY AND DOES NOT BECOME A PART, TERM, OR CONDITION OF THIS POLICY. Form WC 42 03 01 L Printed in U.S.A. Page 3 of 3 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WORKERS' COMPENSATION BROAD FORM ENDORSEMENT 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 Section I of this endorsement expands coverage provided under WC 00 00 00. Section II of this endorsement provides additional coverage usually only provided by endorsement. Section III of this endorsement is a Schedule of Covered States. You may use the index to locate these coverage features quickly: INDEX SUBJECT PAGE SECTION 1 2 PARTS ONE and TWO 2 01 We Will Also Pay 2 PART-THREE 2 02 How This Insurance Works 2 PART-SIX 2 03 Transfer of Your Rights and Duties 2 04 Liberalization 2 SECTION II 2 VOLUNTARY COMPENSATION INSURANCE 2 05 Voluntary Compensation Insurance 2 A. How This Insurance Applies 2 B. We will Pay 3 C. Exclusions 3 D. Before We Pay 3 E. Recovery From Others 3 F. Employers' Liability Insurance 3 EMPLOYERS' LIABILITY STOP GAP COVERAGE 3 06 Employers' Liability Stop Gap Coverage 3 A. Stop Gap Coverage Limited Montana, North Dakota, Ohio, Washington, West 3 Virginia and Wyoming B. Part One does not Apply 3 C. Application of Coverage 3 D. Additional Exclusions 3 E. West Virginia 3 SECTION III 4 07 Schedule of Covered States 4 Form WC 99 03 02 B Printed in U.S.A. (Ed. 8100) Page 1 of 4 Process Date: 11/04/25 Policy Expiration Date: 11/04/26 0 2000, The Hartford SECTION I PARTS ONE and TWO PART THREE 1, WE WILL ALSO PAY 2. How This Insurance Applies D. We Will Also Pay of Part One (WORKERS' Paragraph 4. of A. How This Insurance COMPENSATION INSURANCE); and Applies of Part 3 (Other States Insurance) is E. We Will Also Pay of Part Two replaced by the following: (EMPLOYERS' LIABILITY INSURANCE) is 4. If you have work on the effective date of this replaced by the following: policy in any state not listed in Item 3.A. of the We Will Also Pay Information Page, coverage will not be afforded We will also pay these costs, in addition to for that state unless we are notified within sixty other amounts payable under this insurance, days, as part of any claim, proceeding, or suit we defend: PART SIX 1. reasonable expenses incurred at our 3. Transfer Of Your Rights and Duties request, INCLUDING loss of earnings; C. Transfer Of Your Rights and Duties of Part 6 2. premiums for bonds to release (Conditions) is replaced by the following: attachments and for appeal bonds in Your rights or duties under this policy may not be bond amounts up to the limit of our transferred without our written consent. liability under this insurance; If you die and we receive notice within sixty 3. litigation costs taxed against you; days after your death, we will cover your legal 4. interest on a judgment as required by representative as insured. law until we offer the amount due under 4. Liberalization this law; and If we adopt a change in this form that would broaden 5. expenses we incur. the coverage of this form without extra charge, the broader coverage will apply to this policy. It will apply when the change becomes effective in your state. SECTION II VOLUNTARY COMPENSATION AND EMPLOYERS' to work in a state shown in Item 3.A. of the LIABILITY COVERAGE Information Page. 5. Voluntary Compensation Insurance 3. The bodily injury must occur in the United A. How This Insurance Applies States of America, its territories or This insurance applies to bodily injury by possessions, or Canada, and may occur elsewhere if the employee is a United States accident or bodily injury by disease. Bodily or Canadian citizen, or otherwise legal injury includes resulting death. resident, and legally employed, in the United 1. The bodily injury must be sustained by States or Canada and temporarily away from any officer or employee not subject to those places. the workers' compensation law of any 4. Bodily injury by accident must occur during state shown in Item 3.A. of the the policy period. Information Page. 2. The bodily injury must arise out of and in 5. Bodily injury by disease must be caused or the course of employment or incidental aggravated by the conditions of the officer's or employee's employment. Form WC 99 03 02 B Printed in U.S.A. (Ed. 8100) Page 2 of 4 The officer's or employee's last day of If the persons entitled to the benefits of this last exposure to the conditions causing insurance make a recovery from others, they or aggravating such bodily injury by must reimburse us for the benefits we paid them. disease must occur during the policy F. Employers' Liability Insurance period. Part Two (Employers' Liability Insurance) applies B. We Will Pay to bodily injury covered by this endorsement as We will pay an amount equal to the benefits though the State of Employment was shown in that would be required of you as if you and Item 3.A. of the Information Page. your employees were subject to the workers' This provision 5. does not apply in New Jersey or compensation law of any state shown in Item Wisconsin. 3.A. of the Information Page. will pay EMPLOYERS' LIABILITY STOP GAP COVERAGE those amounts to the persons whoho would be entitled to them under the law. 6. Employers' Liability Stop Gap Coverage C. Exclusion A. This coverage only applies in Montana, North This insurance does not cover: Dakota, Ohio, Washington, West Virginia and 1. any obligation imposed by workers' Wyoming. compensation or occupational disease B. Part One (Workers' Compensation Insurance) law or any similar law. does not apply to work in states shown in 2. bodily injury intentionally caused or Paragraph A above. aggravated by you. C. Part Two (Employers' Liability Insurance) applies in the states, shown in Paragraph A., as though 3. officers or employees who have elected they were shown in Item 3.A, of the Information not to be subject to the state workers' Page. compensation law. D. Part Two, Section C. Exclusions is changed by 4. partners or sole proprietors not covered adding these exclusions. under the Standard Sole Proprietors, Partners, Officers and Others Coverage This insurance does not cover; Endorsement. 5. bodily injury intentionally caused or D. Before We Pay aggravated by you or in Ohio bodily injury resulting from an act which is determined by Before we pay benefits to the persons an Ohio court of law to have been committed entitled to them, they must: by you with the belief than an injury is 1. Release you and us, in writing, of all substantially certain to occur. However, the responsibility for the injury or death. cost of defending such claims or suits in Ohio 2. Transfer to us their right to recover from is covered. others who may be responsible for the 13. bodily injury sustained by any member of the injury or death. flying crew of any aircraft. 3. Cooperate with us and do everything 14. any claim for bodily injury with respect to necessary to enable us to enforce the which you are deprived of any defense or right to recover from others. defenses or are otherwise subject to penalty If the persons entitled to the benefits of this because of default in premium under the insurance fail to do those things, our duty to provisions of the workers' compensation law pay ends at once. If they claim damages or laws of a state shown in Paragraph A. from you or from us for the injury or death, E. This insurance applies to damages for which you our duty to pay ends at once. are liable under West Virginia Code Annot. S 23- E. Recovery From Others 4-2. if we make a recovery from others, we will keep an amount equal to our expenses of recovery and the benefits we paid. We will pay the balance to the persons entitled to it. Form WC 99 03 02 8 Printed in U.S.A. (Ed. 8100) Page 3 of 4 SECTION III 7. SCHEDULE OF COVERED STATES B. If a state, shown in Item 3.A. of the Information A. This endorsement only applies in the states Page, approves this endorsement after the listed in this Schedule of Covered States. effective date of this policy, this endorsement will apply to this policy. The coverage will apply in the new state on the effective date of the state approval. C. Schedule of Covered States: CA Countersigned by Authorized Representative Form WC 99 03 02 B Printed in U.S.A. (Ed. 8/00) Page 4 of 4 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT TO WORKERS' COMPENSATION BROAD FORM ENDORSEMENT- EMPLOYERS' LIABILITY STOP GAP COVERAGE 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 This endorsement changes the Workers' A. This coverage only applies in North Dakota, Compensation Broad Form Endorsement — Ohio, Washington, and Wyoming Employers' Liability Stop Gap Coverage 6. Employers' Liability Stop Gap Coverage E. This paragraph is removed. Form WC 99 03 58 B Printed in U.S.A(Ed. 7108) Process Date: 11/04/25 Policy Expiration Date: 11/04/26 it THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ARIZONA COUNTERSIGNATURE EXCLUSION ENDORSEMENT 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 This endorsement applies only to the insurance "This endorsement shall not be binding unless provided by the policy because Arizona is shown in countersigned by a duly authorized agent of the Item 3.A. of the Information Page. company, provided that if this endorsement takes effect The following wording, as may be contained in this as of the effective date of the policy and, at issue of policy, does not apply in Arizona: said policy, forms a part thereof, countersigned on the "This policy is not binding unless countersigned Information Page of said policy by a duly authorized by our authorized representative. Agent of the company shall constitute valid countersignature of this endorsement." Form WC 99 03 71 A Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA INSTALLMENT FEE DISCLOSURE ENDORSEMENT 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 This endorsement applies only to the insurance provided when your premium is paid in installments. The service because California is shown in Item 3.A. of the fee is $5.00 per withdrawal when you select an Information Page. electronic fund transfer payment plan. The service fee A service fee of$7.00 is charged for each installment will be added to the premium amount shown on your premium billing statement. Form WC 99 03 75 Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ®®DS AND SERVICES ENDORSEMENT 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 Name of Insurer: Hartford Casualty Insurance Company This endorsement modifies insurance provided under all Coverage Parts of this Policy. We may offer or make "goods or services" available to you through this underwriting company, a non-insurer subsidiary, or unaffiliated third parties as a part of this policy. The "goods or services" may be provided for a charge, at a discount, on a subsidized basis, or free of charge. In some cases, we may receive a fee from the unaffiliated third parties that provide "goods or services". We do not warrant or guarantee the "goods or services" provided by third parties, and such third parties shall be solely liable and responsible for the"goods or services"they provide. The "goods or services" offered or made available by us may be modified or discontinued at any time. "Goods or services" means goods, products or services, including but not limited to risk mitigation, safety, and/or loss prevention services or equipment. Form WC 99 06 89 (02121) Printed in U.S.A. Page 1 of 1 Process Date: 11/04/25 Policy Expiration Date: 11/04/26 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GOODS AND SERVICES ENDORSEMENT 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 Name of Insurer; Hartford Insurance Company of Illinois We may offer or make "goods or services" available to you through this underwriting company, a non-insurer subsidiary, or unaffiliated third parties as a part of this policy. The "goods or services" are optional and may be provided for a charge, at a discount, on a subsidized basis, or free of charge. In some cases, we may receive a fee from the unaffiliated third parties that provide "goods or services". We do not warrant or guarantee the "goods or services" provided by third parties, and such third parties shall be solely liable and responsible for the "goods or services" they provide. The "goods or services" offered or made available by us may be modified or discontinued at any time. "Goods or services" means risk mitigation, safety, and/or loss prevention goods, products, services or equipment. Form WC 99 06 94(06121) Printed in U.S.A. Page 1 of 1 Process Date. 11/04/25 Policy Expiration Date: 11/04/26 JiThe Hartford MAINTAINING YOUR RECORDS FOR AUDIT PURPOSES WHAT IS A PREMIUM ADJUSTMENT? Remuneration does not include: a. Employer contributions to a group insurance or When your Workers' Compensation policy was issued you pension plan other than statutory plans of insurance. paid a deposit premium based on the nature of your b. Special awards for individual inventions or business and estimates of your payroll. At the end of the discoveries. policy period, we conduct an audit to compare the c. Overtime.* estimates against the actual figures and operations. Based on this comparison an adjustment is made. If the Subcontractors. In the absence of other insurance, most actual premium is less than what you already have paid, a state laws hold a contractor responsible for injuries to refund will be made. If it's more, you will be billed for the employees of subcontractors. At the time of audit difference. These adjustments are subject to any minimum Certificates of Insurance must be available for premiums that apply. subcontractors with employees, in order to avoid payment of premium. HOW WILL THE PREMIUM ADJUSTMENT BE MADE? Independent Contractors, without employees, whose On smaller, less complex operations we may e-mail you, duties closely resemble those of an employee, will be call you, or mail you a request to ask you to provide the considered your employee with the appropriate premium information via our online web-based portal, mail or charged. telephone. if we require this information, we will provide an electronic link to, or a paper copy of, the necessary The actual working relationship between you and the forms for you to complete. Independent Contractor is examined. Items such as, but not limited to: whether the work performed is an integral On larger, more complex operations one of our Premium part of your operations, whether you have the right to Auditors will contact you for an appointment. You will be control the details of the work, the method of payment, contacted either by e-mail, telephone or mail. If directed, who supplied the materials used, does the person the auditor will contact your accountant to obtain as much regularly work for others, whose regulatory authority did information as possible and contact you at a later time for person operate under, whether the person is involved in a additional information that may be needed. separate and distinct business offering the same services to the public. BASIS OF PREMIUM Remuneration (Payroll) in most states, includes: RECORDS As part of the policy conditions, we are allowed to Payment of: Wages, bonuses, commissions, examine your financial books and records to determine overtime,* sick pay, vacation pay,* tool actual exposures and operations. We would appreciate allowances, contributions to individual your cooperation in making the needed records available retirement accounts, employee for the auditor's inspection. contributions to employee benefit plans. Payments on What Records Will Be Needed? basis of: Piece work, incentive plans, profit sharing. The records needed will vary. In most cases, the Premium The value of: Housing furnished to employees,* meals Auditor will be able to obtain the necessary audit data furnished to employees,* store certificates, from two or more of the following records: Journals, merchandise and other dollar substitutes. Ledgers, State and Federal Tax Reports, Individual Earning Cards, Checkbooks and Contracts. Form 98456 5th Rev. 12-13 Printed in U.S.A. Page 1 of 2 How You Should Keep Your Records computation of premium. Their remuneration is assigned By maintaining your payroll records in accordance with the without division to the actual operation in which they are following guidelines, you might reduce your insurance engaged. If their duties are the same as those of a costs. worker, foreman or superintendent, their payroll is assigned to the classification that develops the highest Overtime. In most states, the amount paid in excess of payroll. Minimum and maximum payrolls apply to straight time pay can be deducted if it can be verified in executive officers. your records. You must maintain your records to show pay separately by employee and in summary by Automated Records. If your records are automated or classification of work. you plan to automate in the near future you can obtain maximum benefits by setting up your records to include *Division of an employee's payroll to more than one insurance requirements. Our Premium Auditor will be classification is not allowed in most states. pleased to assist you in setting up your records. Contact your Hartford Representative if you would like this Exception: For construction, erection or stevedoring assistance. operations the payroll of an employee may be allocated to each type of work performed if proper records are kept. (VOTE: The contents of this publication are not intended Your records must show the number of hours and amount to supersede any definitions or conditions of your policy, of payroll for each type of work. If you do not keep such a the Workers' Compensation Law or any legal rulings. breakdown, the full salary must be charged to the highest rated classification to which the employee is exposed. *Your state may have specific rules or exceptions. Please contact your Hartford Representative for details Executive Officers in most states are considered that may apply and answer questions you may have. employees of their corporation and included in the Form 98456 5th Rev. 12-13 Printed in U.S.A. Page 2 of 2 ItThe Hartford Customer Privacy Notice The Hartford Insurance Group, Inc. and Affiliates (herein called "we, our, and us") This Privacy Policy applies to our United States Operations We value your trust. We are committed to the c) insurance companies; responsible: d) administrators; and a) management; e) service providers; b) use; and who help us serve You and service our business. c) protection; When allowed by law, we may share certain Personal of Personal Information. Financial Information with other unaffiliated third parties This notice describes how we collect, disclose, and who assist us by performing services or functions such protect Personal Information. as: a) taking surveys; We collect Personal Information to: b) marketing our products or services; or a) service your Transactions with us; and c) offering financial products or services under a joint b) support our business functions, agreement between us and one or more financial We may obtain Personal Information from: institutions. a) You; We, and third parties we partner with, may track some of b) your Transactions with us; and the pages You visit through the use of: c) third parties such as a consumer-reporting agency. a) cookies; Based on the type of product or service You apply for or b) pixel tagging; or get from us, Personal Information such as: c) other technologies; a) your name; For more information, our Online Privacy Policy, which b) your address; governs information we collect on our website and our affiliate websites, is available at c) your income; https://www.thehartford.com/online-privacy-policy d) your payment; or e) your credit history; We will not sell or share your Personal Financial may be gathered from sources such as applications, Information with anyone for purposes unrelated to our Transactions, and consumer reports. business functions without offering You the opportunity to: To serve You and service our business, we may share a) "opt-out;" or certain Personal Information. We will share Personal b) "opt-in;" Information, only as allowed by law, with affiliates such as required by law. as: a) our insurance companies; We only disclose Personal Health Information with: b) our employee agents; a) your authorization; or c) our brokerage firms; and b) as otherwise allowed or required by law, d) our administrators. Our employees have access to Personal Information in As allowed by law, we may share Personal Financial the course of doing their jobs, such as: Information with our affiliates to: a) underwriting policies; a) market our products; or b) paying claims; b) market our services; c) developing new products; or to You without providing You with an option to prevent d) advising customers of our products and services. these disclosures. We may also share Personal Information, only as allowed by law, with unaffiliated third parties including: a) independent agents; b) brokerage firms; Form WC 66 03 30 R Printed in U.S.A. Page 1 of 2 We use manual and electronic security procedures to a) credit history; maintain: b) income; a) the confidentiality; and c) financial benefits; or b) the integrity of; d) policy or claim information. Personal Information that we have. We use these Personal Financial Information may include Social procedures to guard against unauthorized access. Security Numbers, Driver's license numbers, or other Some techniques we use to protect Personal government-issued identification numbers, or credit, debit Information include: card, or bank account numbers. a) secured files; Personal Health Information means health information b) user authentication; such as: c) encryption; a) your medical records; or d) firewall technology; and b) information about your illness, disability or injury. e) the use of detection software. Personal Information means information that identifies We are responsible for and must: You personally and is not otherwise available to the a) identify information to be protected; public. It includes: b) provide an adequate level of protection for that data; a) Personal Financial Information; and and b) Personal Health Information. c) grant access to protected data only to those people Transaction means your business dealings with us, such who must use it in the performance of their job- as: related duties. a) your Application; Employees who violate our privacy policies and b) your request for us to pay a claim; and procedures may be subject to discipline, which may c) your request for us to take an action on your account, include termination of their employment with us. You means an individual who has given us Personal We will continue to follow our Privacy Policy regarding Information in conjunction with: Personal Information even when a business a) asking about; relationship no longer exists between us. b) applying for; or As used in this Privacy Notice: c) obtaining; a financial product or service from us if the product or Application means your request for our product or service is used mainly for personal, family, or household service. purposes. Personal Financial Information means financial information such as: If you have any questions or comments about this privacy notice, please feel free to contact us at The Hartford - Consumer Rights and Privacy Compliance Unit,One Hartford Plaza,Mail Drop: HO1-09,Hartford,CT 06155,oratConsumerPrivac:ylnquiriesMailbox@thehartford.com. This Customer Privacy Notice is being provided on behalf of The Hartford Insurance Group, Inc. and its affiliates(including the following as of February 2025),to the extent required by the Gramm-Leach-Bliley Act and implementing regulations: 1stAGChoice, Inc.;Access CoverageCorp, Inc.;Access CoverageCorp Technologies, Inc.; Business Management Group, Inc.;Cervus Claim Solutions, LLC; First State insurance Company; FTC Resolution Company LLC; Hart Re Group L.L.C.; Hartford Accident and Indemnity Company; Hartford Administrative Services Company; Hartford Asia Limited; Hartford Casualty General Agency, Inc.; Hartford Casualty Insurance Company; Hartford Corporate Underwriters Limited; Hartford Fire General Agency, Inc.; Hartford Fire Insurance Company; Hartford Funds Distributors, LLC; Hartford Funds Management Company, LLC; Hartford Funds Management Group, Inc.; Hartford Holdings, Inc.; Hartford Insurance Company of Illinois; Hartford Insurance Company of the Midwest; Hartford Insurance Company of the Southeast; Hartford Insurance, Ltd.; Hartford Integrated Technologies, Inc.; Hartford Investment Management Company; Hartford Life and Accident Insurance Company; Hartford Lloyd's Corporation; Hartford Lloyd's Insurance Company; Hartford Management, Ltd.; Hartford Management(UK) Limited; Hartford Productivity Services LLC; Hartford Singapore Pte. Ltd; Hartford of the Southeast General Agency, Inc.; Hartford of Texas General Agency,Inc.; Hartford Residual Market, L.C.C.; Hartford Specialty Insurance Services of Texas, LLC; Hartford STAG Ventures LLC; Hartford Strategic Investments, LLC; Hartford Underwriters General Agency, Inc.; Hartford Underwriters Insurance Company; Hartford Underwritfng Agency Limited; Heritage Holdings, Inc.; Heritage Reinsurance Company, Ltd.; HLA LLC; Horizon Management Group, LLC; HRA Brokerage Services, Inc.; Lattice Strategies LLC; Maxum Casualty Insurance Company; Maxum Indemnity Company; Maxum Specialty Services Corporation; Millennium Underwriting Limited; MPC Resolution Company LLC; Navigators Holdings(UK)Limited; Navigators Insurance Company; Navigators Management Company, Inc.; Navigators Specialty Insurance Company;Navigators Underwriting Limited; New England Insurance Company;New England Reinsurance Corporation;Now Ocean Insurance Co.,Ltd.; NIC Investments(Chile)SpA;Nutmeg Insurance Agency, Inc.; Nutmeg Insurance Company; Pacific Insurance Company, Limited; Property and Casualty Insurance Company of Hartford; Sentinel Insurance Company, Ltd.;The Navigators Group, Inc.;Trumbull Flood Management, L.L.C.; Trumbull Insurance Company;Twin City Fire Insurance Company;Y- Risk,LLC. Form WC 66 03 30 R Printed in U.S.A. Page 2 of 2 POLICYHOLDER NOTICE PAYROLL RECORD AND AUDIT REQUIREMENTS FOR DUAL WAGE CONSTRUCTION OR ERECTION CLASSIFICATIONS Your policy includes one or more construction or erection classifications. Dual wage classifications are pairs of classifications that describe the same construction or erection operation yet are assigned based upon whether the employee's hourly wage is above or below a specified threshold. Each pair of dual wage classifications contains one"high wage" classification that is assignable to payrolls earned by employees whose regular hourly wage equals or exceeds a specified wage threshold and one "low wage" classification that is assignable to payrolls earned by employees whose regular hourly wage is less than the specified threshold. Payroll Record Requirements The assignment of a high wage classification is contingent on verifying that the employee's hourly wage equals or exceeds the specified wage threshold. The determination of the regular hourly wage for any non-salaried employee must be supported by one of the following sources: o Original time cards or time book entries for each employee. Original records must include the operations performed, the total hours worked each day and the times the employee started and ended each work period throughout the workday. At job locations where all of the employer's operations cease for a uniform unpaid meal period, recording the start and stop times of the uniform break period is not required. o A valid collective bargaining agreement that shows the regular hourly wage rate by job classification of a worker. If using a collective bargaining agreement, the records must include an employee roster by job classification that permits the reconciliation of individual employees to the job classifications set forth in the collective bargaining agreement. The non-salaried employee's regular hourly wage shall be determined by dividing that employee's total remuneration by the hours worked during the pay period, irrespective of whether the employee is paid on an hourly, piecework, production or commission basis. The payroll earned by any non-salaried employees for whom the records specified above are not maintained and/or made available will be assigned to the low wage classification that describes the operations performed. The regular hourly wage of salaried employees is determined by dividing the total annual remuneration by 2000 hours. If an employee is salaried for less than 12 months, the regular hourly wage for the salaried period is calculated on a prorated basis. ,Audit Requirements If your policy has an effective date on or after January 1, 2020 and produces a final premium of $10,500 or more, a physical audit is required at least once a year; if it produces a final premium of less than $10,500 and develops payroll in a high wage classification, a physical audit of the policy is required unless the policy is a renewal and a physical audit was completed for one of the two immediately preceding policy periods. A "physical audit" is defined as an audit of payroll, whether conducted at the policyholder's location or at a remote site, that is based upon an auditor's examination of the policyholder's books of accounts and original payroll records (in either electronic or hard copy form) as necessary to determine and verify the exposure amounts by classification. If you hold a C-39 Roofing Contractor license from the California Contractors State License Board, a physical audit is required on the complete policy period of each policy regardless of the amount of final premium. See California Insurance Code Section 11665(a)for additional requirements regarding the audit of C-39 license holders. Form PN 04 99 06 D Printed in U.S.A. The Hartford POLICYHOLDER NOTICE OF SHORT RATE CANCELLATION PROVISIONS If the policy is cancelled by the insured before the end of the policy term, except if the reason for cancellation is permanent closure or sale of the business, The Hartford will apply a short rate cancellation fee. This means that the final premium will be more than pro rata, as it will be increased by a short rate cancellation fee. The amount of the fee will.vary depending on how early the policy is cancelled or whether your policy is subject to an annual minimum premium. The range of the fee is 5% to 100% of the full premium, and the final premium will not be less than the minimum premium. The method for determining the short rate cancellation fee can vary by state; contact your agent or broker if more information is required. (Note: the Short Hate Cancellation rules do not apply in the state of TX.) Form WC 66 04 51 Printed in U.S.A. Page 1 of 1 MiElf H.ARTFORD PRODUCER COMPENSATION NOTICE You can review and obtain information on The Hartford's producer compensation practices at www.TheHartford.com or at 1-800-592-5717. Form G-341 S-4 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT 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 Name of California Insurer: This endorsement addresses the requirements of the "Act of Terrorism" means any act that is certified by the Terrorism Risk Insurance Act of 2002 as amended and Secretary of the Treasury, in consultation with the extended by the Terrorism Risk Insurance Program Secretary of Homeland Security, and the Attorney Reauthorization Act of 2019. It serves to notify you of General of the United States as meeting all of the certain limitations under the Act, and that your insurance following requirements: carrier is charging premium for losses that may occur in a. The act is an act of terrorism. the event of an Act of Terrorism. b. The act is violent or dangerous to human life, Your policy provides coverage for workers compensation property or infrastructure. losses caused by Acts of Terrorism, including workers compensation benefit obligations dictated by state law. c. The act resulted in damage within the United States, Coverage for such losses is still subject to all terms, or outside of the United States in the case of the definitions, exclusions, and conditions in your policy, and premises of United States missions or certain air any applicable federal and/or state laws, rules, or carriers or vessels. regulations. d. The act has been committed by an individual or Definitions individuals as part of an effort to coerce the civilian population of the United States or to influence the The definitions provided in this endorsement are based policy or affect the conduct of the United States on and have the same meaning as the definitions in the Government by coercion. Act. If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will "Insured Loss" means any loss resulting from an act of apply. terrorism (and, except for Pennsylvania, including an act of war, in the case of workers compensation) that is "Act" means the Terrorism Risk Insurance Act of 2002, covered by primary or excess property and casualty which took effect on November 26, 2002, and any insurance issued by an insurer if the loss occurs in the amendments thereto, including any amendments United States or at the premises of United States resulting from the Terrorism Risk Insurance Program missions or to certain air carriers or vessels. Reauthorization Act of 2019. "Insurer Deductible" means, for the period beginning on January 1, 2021, and ending on December 31, 2027, an amount equal to 20% of our direct earned premiums during the immediately preceding calendar year. Form WC 00 04 22 C (01/21) Printed in U.S.A. Page 1 of 2 Process Date: 11/04/25 Policy Expiration Date: 11/04/26 Limitation of Liability The Act limits our liability to you under this policy. If 2. Notwithstanding item 1 above, the United States aggregate Insured Losses exceed $100,000,000,000 in Government will not make any payment under the a calendar year and if we have met our Insurer Act for any portion of Insured Losses that exceed Deductible, we are not liable for the payment of any $100,000,000,000. portion of the amount of Insured Losses that exceeds 3. The premium charge for the coverage your policy $100,000,000,000; and for aggregate Insured Losses up provides for Insured Losses is included in the to$100,000,000,000, we will pay only a pro rata share of amount shown in Item 4 of the Information Page or such Insured Losses as determined by the Secretary of in the Schedule below. the Treasury. Policyholder Disclosure Notice 1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured Losses occurring in any calendar year exceed $200,000,000, the United States Government would pay 80% of our Insured Losses that exceed our Insurer Deductible. Schedule State Rate Premium See Attached Schedule Form WC 00 04 22 C (01/21) Printed in U.S.A. Page 2 of 2 IiThe Hartford ARIZONA NOTICE INDEPENDENT CONTRACTORS Section 23-902 of the Arizona statutes states that a contractor is deemed an employee of the "employer" for which they are working if: o The employer retains supervision or control over the contractor and o The work is ongoing, regular, ordinary, or routine in your operation and is routinely done by your own employees If the above conditions are met, we wig[treat the contractor as an employee and make the appropriate premium charge. Section 23-964, Section L of the Arizona statutes allows a contractor who is a sole proprietor to waive rights to Workers Compensation coverage. No additional premium charge will be made, if the sole proprietor completes form WC 66 02 35 "Arizona Sole Proprietor Waiver'. For further information, please contact your agent or broker. Form WC 66 02 48 Printed in U.S.A. li-The Hartford CALIFORNIA NOTICE CALIFORNIA LABOR CODE 3551 PROVIDES THAT EVERY EMPLOYER SUBJECT TO THE COMPENSATION PROVISIONS OF THIS CODE, EXCEPT EMPLOYERS OF EMPLOYEES DEFINED IN SUBDIVISION (d) OF SECTION 3351, SHALL GIVE EVERY NEW EMPLOYEE, EITHER AT THE TIME OF HIRE, OR BY THE END OF THE FIRST PAY PERIOD, WRITTEN NOTICE OF THE INFORMATION CONTAINED IN SECTION 3550. CALIFORNIA LABOR CODE 3550 PROVIDES THAT EVERY EMPLOYER SUBJECT TO THE COMPENSATION PROVISIONS OF THIS DIVISION SHALL POST AND KEEP POSTED IN A CONSPICUOUS LOCATION FREQUENTED BY EMPLOYEES, AND WHERE THE NOTICE MAY BE EASILY READ BY EMPLOYEES DURING THE HOURS OF THE WORKDAY, A NOTICE WHICH SHALL STATE THE NAME OF THE CURRENT COMPENSATION INSURANCE CARRIER OF THE EMPLOYER, OR WHEN SUCH IS THE FACT, THAT THE EMPLOYER IS SELF-INSURED, AND WHO IS RESPONSIBLE FOR CLAIMS ADJUSTMENT. Form WC 66 00 15 A Printed in U.S.A. ItThe Hartford NOTICE TO POLICYHOLDER CALIFORNIA WORKERS' COMPENSATION INSURANCE RATING LAWS Pursuant to Section 11752.8 of the California Insurance Code, we are providing you with an explanation of the California workers' compensation rating laws applicable to new and renewal policies with policy effective dates on and after January 1, 1995. 1. The laws requiring all insurers to charge the same minimum rate uniformly to all employers within a given classification has been repealed. Beginning January 1, 1995, we will establish our own rates for workers' compensation. Our rates will not be applicable prior to the first normal policy effective date of a policy incepting on or after January 1, 1995. Our rates, rating plans and related information are filed with the Insurance Commissioner and are open for public inspection. 2. The Insurance Commissioner can disapprove our rates, rating plans or classifications only if he has determined after public hearing that our rates might jeopardize our ability to pay claims or create a monopoly in the market. A monopoly is defined by law as a market where one insurer writes 20% or more of that part of the California workers' compensation insurance that is not written by the State Compensation Insurance Fund. If the insurance Commissioner disapproves our rates, rating plans or classification, he may order an increase in the rates applicable to outstanding policies. 3. Rating organizations may develop pure premium rates which are subject to the Insurance Commissioner's approval. A pure premium rate reflects the anticipated cost and expenses of claims per $100 of payroll for a given classification. Pure premium rates are advisory only, as we are not required to sue the pure premium rates developed by any rating organization in establishing our own rates. 4. We must adhere to a single, uniform experience rating plan. If you are eligible for experience rating under the plan, we will be required to adjust your premium to reflect your claim history. A better claim history generally results in a lower experience rating modification; more claims, or more expensive claims, generally result in a higher experience rating modification. The uniform experience rating plan developed by the insurance rating organization designated by the Insurance commissioner is subject to the approval of the Insurance Commissioner. 5. A standard classification system developed by the insurance rating organization designated by the Insurance Commissioner is subject to approval of the Insurance Commissioner. The standard classification system is a method of recognizing and separating policyholders into industry or occupational groups according to their similarities and/or differences. We can adopt and apply the standard classification system or develop and apply our own classification system, provided that we can report the payroll, expenses and other costs of claims in a way which is consistent with the standard classification system. 6. Our rates and classifications may not violate the Unruh Civil Rights Act or be unfairly discriminatory. 7. We will provide an appeal process for you to appeal the way we rate your insurance policy. The process will require us to respond to your written appeal within 30 days. If you are not satisfied with the result of your appeal, you may appeal our decision to the Insurance Commissioner. Form WC 66 02 05 A Printed in U.S.A. IkThe Hartford DEDUCTIBLE NOTICE OF ELECTION TO ACCEPT TEXAS WORKERS COMPENSATION BENEFITS Texas law permits an employer to obtain Workers' Compensation insurance with a deductible. The deductible applies to benefits payable under Texas Workers' Compensation Law. The insurance applies only to benefits in excess of the deductible amount. The deductible applies separately to each accident or disease regardless of the number of people who sustain injury by such accident or disease or claim or medical-only claim. The deductible plans have been explained to me. Premium reductions are determined based on the deductible selected, and the hazard group. The hazard group is determined by the classification that produces the largest amount of estimated Texas standard premium. You are not required to choose a deductible. If you do choose one, your insurance company will pay the deductible amount for you, but you must reimburse the insurance company within 30 days after they send you notice that payment is due. If you fail to reimburse the company, they may cancel the policy, upon ten days written notice, and any resulting premium may be applied to the deductible amount owed. If a deductible amount is desired, please indicate below. ( ) Yes, I want a deductible of: (select only one) 1 $ per accident 2. $ per claim 3. $ per medical-only claim applied to benefits payable under the Texas Workers' Compensation Law. I understand that the company will pay the deductible amount and seek reimbursement (monthly, quarterly or other) ( ) No, I do not want a deductible applied to benefits payable under the Texas Workers' Compensation Law ( ) Yes, I do want a deductible policy, but am unable to obtain for the following reason: Beginners Edge Sports Training Employer Name (print or type) Date 76 WEG BX3ZPJ Signature and Title Policy Number WC 66 01 25 A Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 POLICY NUMBER: 76 WEG BX3ZPJ NAME OF INSURER: Hartford Insurance Company of Illinois Our President and Secretary have signed this policy. Where required by law, the Information Page has been countersigned by our duly authorized representative. Kevin Barnett, Secretary A. Morris Tooker, President Includes copyright material of the National Council on Compensation Insurance, Inc. used with its permission. © 2000 National Council on Compensation Insurance, Inc. All Rights Reserved. DELAWARE: Delaware forms have been copyrighted by the Delaware Compensation Rating Bureau Inc. NEW YORK: Includes copyrighted material of the New York Compensation Insurance Rating Board, used with its permission. o 2021 New York Compensation Insurance Rating Board, all rights reserved. NORTH CAROLINA: Includes copyrighted material of the North Carolina Rate Bureau, used with its permission. PENNSYLVANIA: Pennsylvania forms have been copyrighted by the Pennsylvania Compensation Rating Bureau. Form WC 99 00 01 K Printed in U.S.A. Page 1 of 1 Process Date: 11/04/25 Policy Expiration Date: 11/04/26 THE HAR.TFORD INSTRUCTIONS EMPLOYEE'S CLAIM FOR WORKERS' COMPENSATION BENEFITS As of January 1, 1990, California employers are required by law to furnish a claim form to an injured worker within one working day of knowledge of a work-related injury or illness (other than First Aid). While it is mandatory for the employer to furnish the claim form to the employee, it is not mandatory for the employee to complete it. The employer should complete sections 9-17, with the exception of section 13 (which reads, "Date employer received claim form"). This is to be completed after the claimant has completed his or her portion of the claim form and returned it to you, at which time section 13 should be immediately filled out or date stamped. Penalties can be invoked if employers fail to provide an injured employee an EMPLOYEE'S CLAIM FOR COMPENSATION BENEFITS form or if employers fail to report the claim to the workers' compensation insurance carrier. DO NOT DELAY REPORTING A CLAIM TO THE HARTFORD: Whether or not the employee completes the EMPLOYEE'S CLAIM FOR WORKER'S COMPENSATION BENEFITS, please contact The Hartford's LossConnect (1-800-327-3636)to report every occupational injury or illness which results in lost time beyond the date of the incident or requires medical treatment beyond First Aid, Form WC 55 00 11 D Printed in U.S.A. JiThe Hartford Reporting a Work-Related Injury is Time Sensitive! Call The Hartford's LossConnect immediately to report a claim. 1 -800-327-3636 Available 24 hours a day, 365 days a year. The Benefits of Timely Loss Reporting: Research has shown that faster foss reporting significantly affects loss costs. The sooner we are notified, the sooner we can investigate the accident and coordinate with you, the injured employee, and the medical team to ensure the fastest possible return to health and work. The Effect of Timely Reporting on Controlling the Cost of Your Loss: Average Loss for Closed Claims (Accident Years 2002-2005) Report Lag in Days Percent Change in Loss Costs Compared to First Week Report Incident Da -6% Week 1 0% Week 2 13% Week 3 or 4 16% 1 Month or Later 24% Statutory requirements also necessitate the prompt initial reporting of the accident causing injury or death. Failure to comply may result in a fineable offense by the State. Information You'll Need Company Information Incident Information o Account Number o Type of injury (burn, cut, etc.)? o Location Code (if applicable) o Exact body part injured? o Parent Company (or program name) o What caused the accident? o Policy Number o Any reason to question the injury? o Any witnesses? Worker Information o Address where injury occurred? o Name, DOB, Address, Phone o Where was the injured employee treated? (Provide o Social Security Number name, address, phone of medical provider.) o Age, Gender o When was the accident reported to you and by o Marital Status, Number of Dependants whom (date, time)? o Hire Date, Years in Current Position o Wage Information Network Providers A listing of more than 400,000 network providers qualified to treat work-related injuries is available online at www.talispoint.com/hartext or by calling our Network Referral Unit at 1-800-327-3636 (select 4 at the prompt). Since network referrals are often impacted by state specific rules, please tali to learn how to maximize our network capabilities on behalf of your employees. Form WC 66 03 84 Printed in U.S.A. The Hartford DEDUCTIBLE NOTICE OF ELECTION TO ACCEPT TEXAS WORKERS COMPENSATION BENEFITS Texas law permits an employer to obtain Workers' Compensation insurance with a deductible. The deductible applies to benefits payable under Texas Workers' Compensation Law. The insurance applies only to benefits in excess of the deductible amount. The deductible applies separately to each accident or disease regardless of the number of people who sustain injury by such accident or disease or claim or medical-only claim. The deductible plans have been explained to me. Premium reductions are determined based on the deductible selected, and the hazard group. The hazard group is determined by the classification that produces the largest amount of estimated Texas standard premium. You are not required to choose a deductible. If you do choose one, your insurance company will pay the deductible amount for you, but you must reimburse the insurance company within 30 days after they send you notice that payment is due. If you fail to reimburse the company, they may cancel the policy, upon ten days written notice, and any resulting premium may be applied to the deductible amount owed. If a deductible amount is desired, please indicate below. ( } Yes, I want a deductible of: (select only one) 1 $ per accident 2. $ per claim 3. $ per medical-only claim applied to benefits payable under the Texas Workers' Compensation Law. I understand that the company will pay the deductible amount and seek reimbursement (monthly, quarterly or other) ( ) No, I do not want a deductible applied to benefits payable under the Texas Workers' Compensation Law ( ) Yes, I do want a deductible policy, but am unable to obtain for the following reason: Beginners Edge Sports Training Employer Name (print or type) Date 76 WEG BX3ZPJ Signature and Title Policy Number WC 66 01 25 A Printed in U.S.A. Process Date: 11/04/25 Policy Expiration Date: 11/04/26 ItThe Hartford THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 76 WEG BX3ZPJ Endorsement Number: 003 Effective Date: 03/12/26 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 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 5% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description City of Santa Ana, its City Council, officers, officials, 5 employees, agents and volunteers, 20 CIVIC CENTER PLZ, SANTA ANA, CA, 92701 Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 03/12/26 Policy Expiration Date: 11/04/26 CITY OF SANTA ANA ... Risk Management a division of Human Resources I. Managing Risk through Awareness and Action AFFIDAVIT OF EXEMPTION FOR AUTOMOBILE LIABILITY INSURANCE 1, Mitchell Goldberg ("Representative"),attest that I am an authorized (Name and Title of Vendor Representative) representative of Begnners Edge Sports Training ("Company"), and (Consultant/Company Name) possess the authority to legally bind Company. In my capacity as Representative of Company, I represent and confirm the following, as relates to the agreement between Company and City of Santa Ana, agreement number ("Agreement")to provide Youth Sports Classes and Sports Camps ("Services"): (Services to be provided under agreement/contract) During the course and scope of Company's agreement with the City of Santa Ana, Company employees, consultants, representatives, and agents will not use and/or drive any Company owned/rented/leased/borrowed vehicles to perform Services to, for, or on behalf of City of Santa Ana. If at any time it is found that Company is not adhering to any and/or all of the statements in this document and does not maintain the minimum automobile liability insurance coverage as required in the Agreement, it will be considered a breach of Agreement rendering the Agreement null and void and Company will be fully liable for any and all damages. 1/27/2026 Si ature Date Mitchell 1 Goldberg Print Name Owner Title 714-874-4737, mitch@best-sports-usa.com Contact Information,i.e.,Telephone Number and/or Email Address Affidavit of Exemption for Automobile Liability Insurance 11.12.2024