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ENDORSEMENT AGREEMENT <br />COVID-19 REPORTING REQUIREMENT <br />ENDORSEMENT — CALIFORNIA <br />HOME OFFICE <br />SAN FRANCISCO EFFECTIVE JULY 10, 2021 AT 12.01 A.M. <br />ALL EFFECTIVE DATES ARE TO JULY 1, 2022 AT 12.01 A.M. <br />AT 12:01 AM PACIFIC <br />STANDARD TIME OR THE <br />TIME INDICATED AT <br />PACIFIC STANDARD TIME <br />FRIENDS OF SANTA ANA ZOO <br />1801 E CHESTNUT AVE <br />SANTA ANA, CA 92701 <br />REP D1 <br />9048876-21 <br />RENEWAL <br />SP <br />3-68-03-58 <br />PAGE 1 OF <br />IN ADDITION TO THE REQUIREMENTS UNDER PART 4, "YOUR DUTIES <br />IF INJURY OCCURS" OF YOUR POLICY, IF YOU HAVE FIVE OR MORE <br />EMPLOYEES AND AN EMPLOYEE THAT IS NOT DESCRIBED IN <br />CALIFORNIA LABOR CODE SECTION 3212.87 TESTS POSITIVE FOR <br />COVID-19, YOU ARE REQUIRED TO REPORT THE FOLLOWING <br />INFORMATION AS PROVIDED BELOW. <br />REPORTING COVID-19 POSITIVE TESTS FROM JULY 6, 2020 TO <br />SEPTEMBER 17. 2020 <br />PURSUANT TO CALIFORNIA LABOR CODE SECTION 3212.88(K)(2), IF <br />YOU ARE AWARE OF AN EMPLOYEE TESTING POSITIVE FOR COVID-19 <br />ON OR AFTER JULY 6, 2020 AND PRIOR TO SEPTEMBER 17, 2020, <br />YOU MUST REPORT TO YOUR CLAIMS ADMINISTRATOR IN WRITING VIA <br />ELECTRONIC MAIL OR FACSIMILE WITHIN 30 BUSINESS DAYS OF <br />SEPTEMBER 17, 2020, ALL OF THE FOLLOWING: <br />1. AN EMPLOYEE HAS TESTED POSITIVE. FOR PURPOSES OF THIS <br />REPORTING, DO NOT PROVIDE ANY PERSONALLY IDENTIFIABLE <br />INFORMATION REGARDING THE EMPLOYEE WHO TESTED POSITIVE <br />FOR COVID-19 UNLESS THE EMPLOYEE ASSERTS THE INFECTION <br />IS WORK RELATED OR HAS FILED A CLAIM FORM PURSUANT TO <br />CALIFORNIA LABOR CODE SECTION 5401. <br />2. THE DATE THAT THE EMPLOYEE TESTS POSITIVE, WHICH IS THE <br />DATE THE SPECIMEN WAS COLLECTED FOR TESTING. <br />3. THE SPECIFIC ADDRESS OR ADDRESSES OF THE EMPLOYEE'S <br />CONTINUED <br />NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND <br />ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY <br />OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE <br />HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR <br />LIMITATIONS IN THIS ENDORSEMENT. <br />COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: <br />1159 <br />AUTHORIZED REPRESENT IVE <br />SCIF FORM 10217 (REV.4-2018) <br />JUNE 25, 2021 <br />PRESIDENT AND <br />4 <br />�oRaN <br />RiskMmWmentDiAslnn <br />REVIEWED & APPROVED BY. - <br />Risk Management Analyst <br />