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HOME OFFICE <br />SAN FRANCISCO <br />ALL EFFECTIVE DATES ARE <br />AT 12.09 AM PACIFIC <br />STANDARD TIME OR THE <br />TIME INDICATED AT <br />PACIFIC STANDARD TIME <br />ENDORSEMENT AGREEMENT <br />MEDICAL PROVIDER NETWORK <br />EFFECTIVE JULY 1, 2015 AT 12.01 A.M. <br />FRIENDS OF SANTA ANA ZOO <br />1801 E CHESTNUT AVE <br />SANTA ANA, CA 92701 <br />CONTINUED. <br />9048876-15 <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 CONTAINED SHALL BE HELD TO VARY, ALTER, WAAIIII <br />OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS c-rA [Tdr <br />POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL. BE <br />VARY,HELD TO ALTER, LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR <br />LIMITATIONS OF THISENDORSEMENT. <br />S t"` <br />COUNTERSIGNED AND ISSUED <br />lAT <br />SAN FRANCISCO: JUNE 26, 2015 <br />AUTHORIZED REPRESENT IVEPRE5IDENT AND CEO 2437 <br />3 <br />