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 3 OF <br />3. THE SPECIFIC ADDRESS OR ADDRESSES OF THE EMPLOYEE'S <br />SPECIFIC PLACE OF EMPLOYMENT DURING THE 14—DAY PERIOD <br />PRECEDING THE DATE OF THE EMPLOYEE'S POSITIVE TEST. <br />4. THE HIGHEST NUMBER OF EMPLOYEES WHO REPORTED TO WORK AT <br />THE EMPLOYEE'S SPECIFIC PLACE OF EMPLOYMENT IN THE 45— <br />DAY PERIOD PRECEDING THE LAST DAY THE EMPLOYEE WORKED AT <br />EACH SPECIFIC PLACE OF EMPLOYMENT. <br />LABOR CODE SECTIOP: 3212.88(J) STATES THAT THE INTENTIONAL <br />SUBMISSION OF FALSE OR MISLEADING INFORMATION OR THE <br />FAILURE TO REPORT THE ABOVE INFORMATION AS REQUIRED MAY <br />SUBJECT YOU TO A CIVIL PENALTY IN THE AMOUNT OF UP TO <br />$10,000 TO BE ASSESSED BY THE LABOR COMMISSIONER. <br />FOR THE PURPOSES OF THESE REQUIREMENTS, CALIFORNIA LABOR <br />CODE SECTION 3212.88(M) PROVIDES THE FOLLOWING: <br />1. "COVID-19" MEANS THE 2019 NOVEL CORONAVIRUS DISEASE. <br />2. "TEST" OR "TESTING" MEANS A PCR (POLYMERASE CHAIN <br />REACTION) TEST APPROVED FOR USE OR APPROVED FOR <br />EMERGENCY USE BY THE UNITED STATES FOOD AND DRUG <br />ADMINISTRATION TO DETECT THE PRESENCE OF VIRAL RNA. <br />"TEST" OR "TESTING" DOES NOT INCLUDE SEROLOGIC TESTING, <br />ALSO KNOWN AS ANTIBODY TESTING. "TEST" OR "TESTING" MAY <br />INCLUDE ANY OTHER VIRAL CULTURE TEST APPROVED FOR USE OR <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 />5! <br />�oRaN <br />o t <br />' <br />Risk MmVinerdUi isfan <br />REVIEWE D & APPROVED BY: <br />f R. VSA44a <br />Risk Management Analyst <br />