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ENDORSEMENT AGREEMENT <br />HOME OFFICE <br />SAN FRANCISCO <br />ALL EFFECTIVE DATES ARE <br />AT 12:01 AM PACIFIC <br />STANDARD TIME OR THE <br />TIME INDICATED AT <br />PACIFIC STANDARD TIME <br />MEDICAL PROVIDER NETWORK <br />EFFECTIVE JULY 1, 2021 AT 12.01 A.M. <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 />ANY CONTRADICTION BETWEEN THE POLICY AND THIS ENDORSEMENT <br />WILL BE CONTROLLED BY THIS ENDORSEMENT. <br />THE STATE COMPENSATION INSURANCE FUND MEDICAL PROVIDER <br />NETWORK IS ESTABLISHED IN ACCORDANCE WITH CALIFORNIA LABOR <br />CODE 4600 ET SEQ AND APPROVED BY THE CALIFORNIA DIVISION OF <br />WORKERS' COMPENSATION ADMINISTRATIVE DIRECTOR. THE INTENT <br />OF THE 2004 LEGISLATION REQUIRING THE ESTABLISHMENT OF THE <br />MEDICAL PROVIDER NETWORK IS INCREASED EMPLOYER CONTROL OVER <br />THE COSTS OF TREATING EMPLOYEE WORK RELATED INJURIES AND <br />DISEASE. <br />PART FOUR OF THE POLICY, YOUR DUTIES IF INJURY OCCURS, IS <br />AMENDED AS FOLLOWS: <br />IT IS AGREED THAT THE POLICYHOLDER SHALL REFER ALL WORK <br />RELATED INJURIES OR DISEASE TO THE STATE COMPENSATION <br />INSURANCE FUND MEDICAL PROVIDER NETWORK AT THE TIME OF AN <br />OCCUPATIONAL INJURY OR UPON KNOWLEDGE OF AN OCCUPATIONAL <br />INJURY OR DISEASE. <br />IT IS FURTHER AGREED THAT WHEN AN EMPLOYEE NOTIFIES THE <br />POLICYHOLDER OF AN OCCUPATIONAL INJURY OR FILES A CLAIM FOR <br />WORKERS' COMPENSATION WITH THE POLICYHOLDER, THE POLICY— <br />HOLDER SHALL ARRANGE AN INITIAL MEDICAL EVALUATION AND <br />BEGIN TREATMENT WITHIN THE MEDICAL PROVIDER NETWORK. THE <br />POLICYHOLDER SHALL NOTIFY THE EMPLOYEE OF HIS OR HER RIGHT <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 />2437 <br />AUTHORIZED REPRESENT IVE <br />SCIF FORM 10217 (REV.4-2018) <br />JUNE 25, 2021 <br />PRESIDENT AND <br />91 <br />�oRaN <br />o r <br />RiskMmWmentDMsian <br />REVIEWED & APPROVED BY: <br />f R. V;&wd <br />Risk Management Analyst <br />