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<br />STATE <br />COMPENSATION <br />INSURANCE <br />I=UND <br /> <br />ENDORSEMENT AGREEMENT <br />MEDICAL PROVIDER NETWORK <br /> <br />HOME OFFICE <br />SAN FRANCISCO <br /> <br />1801464-07 <br />RENEWAL <br />SG <br /> <br />EFFECTIVE <br /> <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 /> <br />OCTOBER <br /> <br />1, 2007 AT 12.01 A.M. <br /> <br />PAGE <br /> <br />1 OF <br /> <br />3 <br /> <br />ADVANCED TRNSPRTTN CNCPTS GRP, INC <br />14 SORENSON <br />IRVINE, CA 92602 <br /> <br />ANY CONTRADICTION BETWEEN THE POLICY AND THIS ENDORSEMENT <br />WILL BE CONTROLLED BY THIS ENDORSEMENT. <br /> <br />THE SlATE 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 /> <br />PART FOUR OF THE POLICY, YOUR DUTIES IF INJURY OCCURS, IS <br />AMENDED AS FOLLOWS: <br /> <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 /> <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 /> <br />CONTINUED <br /> <br />NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE <br />OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS <br />POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE <br />HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR <br />LIMITATIONS OF THIS ENDORSEMENT. <br /> <br />COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: <br /> <br /> <br /> <br />6:::EPRESENTATIV <br />selF FORM 10217 IREV.J-07l <br /> <br /> <br />SEPTEMBER 14, 2007 <br /> <br />~~~~- <br /> <br />PRESIDENT <br /> <br />2437 <br /> <br />OLD DP 217 <br />