Laserfiche WebLink
ENDORSEMENT AGREEMENT <br />COVID-19 REPORTING REQUIREMENT <br />ENDORSEMENT — CALIFORNIA <br />HOME OFFICE <br />SAN FRANCISCO EFFECTIVE JULY 1, 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 />CONTINUED. <br />REP D1 <br />9048876-21 <br />RENEWAL <br />SP <br />3-68-03-58 <br />PAGE 2 OF <br />SPECIFIC PLACE OF EMPLOYMENT DURING THE 14—DAY PERIOD <br />PRECEDING DATE OF THE EMPLOYEE'S POSITIVE TEST. <br />4. THE HIGHEST NUMBER OF EMPLOYEES WHO REPORTED TO WORK AT <br />EACH OF THE EMPLOYEE'S SPECIFIC PLACES OF EMPLOYMENT ON <br />ANY GIVEN WORK DAY BETWEEN JULY 6, 2020 AND SEPTEMBER <br />17, 2020. <br />REPORTING COVID-19 POSITIVE TEST FROM SEPTEMBER 17, 2020 TO <br />JANUARY 1, 2023 <br />PURSUANT TO CALIFORNIA LABOR CODE SECTION 3212.88(I), WHEN <br />YOU KNOW, OR REASONABLY SHOULD KNOW, THAT AN EMPLOYEE HAS <br />TESTED POSITIVE FOR COVID-19 BETWEEN SEPTEMBER 17, 2020 AND <br />JANUARY 1, 2023, YOU MUST REPORT TO YOUR CLAIMS <br />ADMINISTRATOR IN WRITING VIA ELECTRONIC MAIL OR FACSIMILE <br />WITHIN 3 BUSINESS DAYS 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 />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 />11 <br />�oRaN <br />o r <br />a' <br />RiskManWmentDMslnn <br />REVIEWED & APPROVED BY: <br />p M1. YSA44a <br />Risk Management Analyst <br />