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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 />CONTINUED. <br />REP D1 <br />9048876-21 <br />RENEWAL <br />SP <br />3-68-03-58 <br />PAGE 3 OF <br />EMPLOYEE AND RETAINS RECORDS OF THE TREATMENT AND MEDICAL <br />HISTORY. <br />THE EMPLOYER PROVIDES THE STAFF WITH NONOCCUPATIONAL GROUP <br />HEALTH COVERAGE IN A HEALTH—CARE SERVICE PLAN (SUCH AS AN <br />HMO/PPO PROGRAM). <br />OR <br />THE EMPLOYER PROVIDES NONOCCUPATIONAL HEALTH COVERAGE IN A <br />GROUP HEALTH PLAN OR A GROUP HEALTH INSURANCE POLICY, PER <br />LABOR CODE 4616.7. <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 />3 <br />�oRaN <br />RiskManWmentDMsian <br />&�9AP$P1R�,O,qgVgED BY.- <br />CcREVIEWED <br />pl. YaXX�'I"I <br />Risk Management Analyst <br />