SELF INSURED LIST - Colorado · 2014-10-07 · PERMIT HOLDER 939 06/15/86: ABF FREIGHT SYSTEM, INC....

SELF INSURED LIST

10/7/2014

PERMIT ANNIVERSARY DATE

NAME OF PERMIT PERMIT HOLDER

939 06/15/86 ABF FREIGHT SYSTEM, INC. Mr. Stan McDaniel (ARKANSAS BEST CORPORATION AND Director, Risk Management ITS WHOLY-OWNED SUBSIDIARY ABF ABF Freight System, Inc. FREIGHT SYSTEM, INC.) 3801 Old Greenwood Road 72903

P. O. Box 10048Allen King Fort Smith, AR 72917-0048Manager, Workers' CompensationABF FREIGHT SYSTEM, INC. OFFICE: 479-785-63193801 Old Greenwood Road 72903 FAX: 479-494-6624P. O. Box 10048 EMAIL: aking@arkbest.comFort Smith, AR 72917-0048 stanmcd@arkbest.com

989 04/01/84 Adams County Mr. Charles B. DuSchaRisk Manager

Joel Hirschboeck Adams County§8-42-124 Risk Manager Risk Management/HR Department

Adams County Workers' Compensation 4430 South Adams County ParkwayC/O Jefferson County School Dist R-1 4th floor, suite 4000BRisk Management Department Brighton, CO 80601-8213P O Box 4001 "cduscha@adcogov.orgGolden, CO 80401-0001 OFFICE: 720-523-6076450 South 4th Avenue FAX: 720-523-6069Brighton, CO 80601-3123 EMAIL: cduscha@co.adams.co.us

Nancee Rosen462 02/01/09 Adventist Health Systems Nancee R Smith ARM, CWCP

Director Workers' Compensation DeptNancee Rosen Adventist Health systemsNancee R Smith ARM, CWCP 900 Hope wayDirector Workers' Compensation Dept Altamonte Springs, FL 32714Adventist Health systems900 Hope wayAltamonte Springs, FL 32714 OFFICE: 407-357-2239

FAX: 866-359-3397EMAIL: nancee.rosen@ahss.org

Tim Wood484 11/01/99 AGILENT TECHNOLOGIES, INC. Ms. Arlyne Gittens retired Feb 2014

Diane Kramer Pavelich Corporate Risk ManagementSedgwick CMS Agilent Technologies, Inc.7400 East Orchard St Suite 4015 5301 Stevens Creek BoulevardP O Box 5107 (80155-5107) Mail Stop 1A-1RGreen Wood Village, CO 80111-2518 Santa Clara, CA 95051-7201

TPA MAILING ADDRESS IS OFFICE: 408-345-8227P.O.Box 14493, Lexington KY 40512-4493 FAX: 408-553-7516

EMAIL: timothy_wood@agilent.com

timothy_wood@agilent.com

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

DATE NAME OF PERMIT PERMIT HOLDER

477 04/01/02 AMERICAN FURNITURE WAREHOUSE Ms. Becky RouseRisk ManagerAmerican Furniture Warehouse8820 American WayEnglewood, CO 80112-7056

OFFICE: 720-873-8612FAX: 720-873-8615

Contacts Locally Mimi Sarma brouse@afwonline.com200 Union Blvd Suite 580lakewood CO 80228

870 01/01/90 ARAPAHOE COUNTY Ms. Pat SkahillArapahoe County

§8-42-124 5334 South Prince StreetLittleton, CO 80166-0001

OFFICE: 303-795-4573FAX: 303-734-5479EMAIL: pskahill@co.arapahoe.co.us

Kirstie Dineen 894 07/01/87 ARVADA, CITY OF Risk Management Division

City of Arvada§8-42-124 8101 Ralston RoadTeree Carr P. O. Box 8101Business Director Arvada, CO 80001-8101PINNACOL ASSURANCE7501 E Lowery Blvd OFFICE: 720-898-7595Denver, CO 80230-7006 FAX: 720-898-7591 OFFICE: 303-361-4251 EMAIL:kdineen@arvada.orgFAX: 303-361-5251 ""jlange@arvada.org" 720-898-7595EMAIL: teree.carr@pinnacol.comTill 12/31/2011

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

975 10/06/81 ASPEN SKIING COMPANY Steven HowardWorkers’ Compensation Manager

§8-42-124 Aspen Skiing CompanyBox 1248Aspen, CO 81612-1248

OFFICE: 970-920-0977FAX: 970-920-0955 Email showard@aspensnowmass.com

957 10/01/76 AURORA, CITY OF Renee Pettinato MosleyRisk Manager

§8-42-124 City of Aurora15151 East Alameda ParkwayThird FloorAurora, Co 80012-1555

OFFICE: 303-739-7003FAX: 303-739-7650 EMAIL: rpettina@auroragov.org

463 11/07/08 BARRETT BUSINESS SERVICES INC Mr. Steven McCombBBSI WORKERS' COMPENSATION ADMINISTRATOR

BARRETT BUSINESS SERVICES INC8100 NE PARKWAY DR SUITE 200VANCOUVER, WA 98662-

OFFICE: 360-828-0685950 S CHERRY ST SUITE 1600 FAX: 360-828-0699

EMAIL: STEVEN.MCCOMB@BBSIHQ.COM

460 11/01/11 Baker Concrete Construction Arnold DelossantosWorkers' Compensation Claims ManagerBaker Concrete Construction900 N Garver rd Monroe OH 45050Monroe OH 45050

SELF INSURED LIST

10/7/2014

OFFICE: 513-539-4097FAX: 513-539-4251

1904 Jasper st Aurora CO 80014

993 01/01/85 BALL CORPORATION Cheryl KabesAon Global Risk Consulting

§8-42-124 5600 West 83rd street Suite 1100Kelly Knauer Minneapolis, MN 55437Sr. Risk Analyst Cheryl Kabes 952-807-0661Ball Corporation Linda Smith 952-807-069810 Longs Peak DriveBroomfeild, CO 80038-5000 Fax 847-953-2851kknauer@ball.comFax 303-460-3716 Rob Garside Director Credit Risk rgarside@ball.com

x Mr. Harold L. Lykins

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

489 01/01/98 BANNER HEALTH Mr. Phil HoltSystems Director, Risk FinancingBanner Health 1441 North 12th StreetPhoenix, AZ 85006-2837

OFFICE: 602-747-4799FAX: 602-495-4781 EMAIL: tammy.willis@bannerhealth.com

829 01/01/93 BOULDER, CITY OF Stewart Ellenberg ARM-PRisk ManagerCity of BoulderP. O. Box 791 or 1777 BroadwayBoulder, CO 80306-0791

OFFICE: 303-441-3075FAX: 303-441-4381

x EMAIL: eichemb@bouldercolorado.govellenbergs@bouldercolorado.govMr. Bob Eichem 303-441-1819Finance Director

852 01/01/91 BOULDER COMMUNITY HOSPITAL Ms. Denise GranbergBoulder Community HospitalNorth Broadway & Balsam

For Mimi and Sarma P. O. Box 9019Contacts Locally Boulder, CO 80301-9019200 Union Blvd Suite 580lakewood CO 80228

OFFICE: 303-938-5344FAX: 720-565-0457 EMAIL: emphealth1@bch.org

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

867 01/01/90 BOULDER COUNTY Ms. Pam Stonecipher, ARM, CICBoulder County

§8-42-124 Risk ManagerP. O. Box 471Boulder, CO 80306-04712025 14th st 1st FloorOFFICE: 303-441-3872

x FAX: 303-441-3568EMAIL: pstonecipher@bouldercounty.org

873 06/01/89 CARGILL, INC.

Mr. Brian TurnwallCasualty Insurance Manager

Cancelled effective 6/1/07 Cargill, Inc.15407 McGinty Road West MS 12Wayzata, MN 55391-2365

OFFICE: 952-742-5274FAX: 952-742-7990 EMAIL: nancy_whitehead@cargill.com

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

956 12/01/75 CHEVRON U.S.A., INC. Megan O'Boyle-ParaisoClaims Analyst, Workers' CompensationTreasury Department-Insurance DivisionChevron Corporation6001 Bollinger Canyon Rd

Nancy Bircher P.O. Box 6022Insurance Division Claims Administrator San Ramon, CA 94583Chevron U.S.A., Inc. Tel 925 842 8161P. O. Box 6022 Fax 925 842 8185San Ramon, CA 94583-0722 MQRD@Chevron.com

Carmel Cosentino carmel.cosentino@chevron.com925-842-9399

OFFICE: 925-842-8162FAX: 925-842-8185 Ms. Kelly George left company 9/15/2011EMAIL: nbircher@chevron.com

468 03/01/05 CHILDREN’S HOSPITAL ASSOCIATION, THE

Director of Benefits and Employee Health ServicesFor Mimi and Sarma The Children’s Hospital of DenverContacts Locally 13611 E Colfax Ave. #200200 Union Blvd Suite 580 Aurora, CO 80045lakewood CO 80228

OFFICE: 303-861-6402FAX: 303-764-8080

EMAIL: theresa.baca@childrenscolorado.org

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

479 07/01/01 COACHMEN INDUSTRIES, INC. LES THIMLARVice President

Revoked 7/1/2012 Coachmen Industries, Inc.P. O. Box 33002831 Dexter DriveElkhart, IN 46515-3300

OFFICE: 574-266-2514FAX: 574-206-1700 EMAIL: mmiranda@coachmen.com

487 05/17/99 COBE CARDIOVASCULAR, INC. Ms. Diane Marie LuceroTreasury Manager

Now known as SORIN Group USA Cobe Cardiovascular, Inc.effective 1/1/2007 14401 West 65th Way

Arvada, CO 80004-3539Canceled 5/1/10

OFFICE: 303-467-6280FAX: 303-467-6591EMAIL: diane.lucero@sorin-na.com

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

988 10/01/83 COLORADO HOSPITAL ASSOCIATION Mr. Gary SwensonDirectorSupport Services, Inc.7335 East Orchard Road, Suite 200Greenwood Village, CO 80111-2518720-489-9300OFFICE: 720-330-6029FAX: 720-489-1166 EMAIL: gary.swenson@cha.com

839 01/01/92 COLORADO PERMANENTE MEDICAL Melanie Chavez GROUP Human Resources Department

Original Kaiser Foundation Health Plan of Colorado10065 E Harvard Ave suite 400

Anniversary Denver, CO 80231Date: 04/01/92

OFFICE: 303-614-1546FAX: 303-614-1495melanie.chavez@kp.org

877 01/01/89 COLORADO SPRINGS, CITY OF Victoria McColmRisk Manager

§8-42-124 Risk ManagementCity of Colorado SpringsP. O. Box 1575 - Mail Code 630

Mark Anderson no longer with City Colorado Springs, CO 80901-1575

OFFICE: 719-385-5669FAX: 719-385-5677

x Victoria McCollum 719-385-5669Email vmccolm@springsgov.com

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

858 07/01/91 COLORADO SPRINGS SCHOOL DISTRICT Hank HahneNO. 11 Manager, Workers' Compensation Program

Colorado Springs School District 11Risk Management Dept.Colorado Springs School District 111115 North El Paso StreetColorado Springs, CO 80903

Phone: (719) 520-2490Fax: (719) 5230-2383henry.hahne@d11.org-----

471 08/01/04 COLORADO STATE UNIVERSITY Sally AlexanderClaims 8/1/04 ongoing Director, Risk Management and Insurance

Colorado State University

For Mimi and SarmaOffice of Risk Management & Insurance Environmental Health Sevices

Contacts Locally 141A General Services Builduing200 Union Blvd Suite 580 Campus Delivery 6002lakewood CO 80228 Fort Collins, CO 80523-0001

OFFICE: 970-491-6745FAX: 970-491-4804 EMAIL: sally.alexander@colostate.edu

earlie.thomas@colostate.edu

For claims 7/1/1996 to 7/31/2004470 08/01/04 COLORADO STATE UNIVERSITY Sally Alexander

Director, Risk Management and InsuranceColorado State University

For Mimi and SarmaOffice of Risk Management & Insurance Environmental Health Sevices

Contacts Locally 141A General Services Builduing200 Union Blvd Suite 580 Campus Delivery 6002lakewood CO 80228 Fort Collins, CO 80523-0001

OFFICE: 970-491-6745FAX: 970-491-4804 EMAIL: sally.alexander@colostate.edu

sally.alexander@colostate.edu

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

469 01/01/05 COLUMBINE HEALTH SYSTEMS Dawn Filsinger, Safety Officer, Columbine HealthSenior AccountantColumbine Health Systems

For Mimi and Sarma 802 W Drake rdContacts Locally Fort Collins, CO 80526-1841200 Union Blvd Suite 580lakewood CO 80228 OFFICE: 970-492-6233

FAX: 970-492-6206EMAIL: dawn.filsinger@columbinehealth.com

x Dawn Filsinger, Safety Officer, Columbine HealthSystems,802 West Drake Suite 145,Fort Collins80526970-492-6233 970-492-6206 Fax

888 11/01/87 CONAGRA FOODS, INC. Mr. Jeff ReglerFinancial AnalystConAgra Foods, Inc.Eleven ConAgra Drive, 11-200Omaha, NE 68102-5001Rebecca for Renewal and Px TaxOFFICE: 402-240-4491FAX: 402-517-3168

Email Jeff.regler@conagrafoods.com

482 01/01/00 COORSTEK, INC. Ondrea MatthewsRisk ManagerCoorsTek, Inc.16000 Table Mountain ParkwayGolden CO 80403-1693

OFFICE: 303-271-7211FAX: 303-277-4342 EMAIL: omatthews@coorstek.com

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

483 01/01/00 COSTCO WHOLESALE CORPORATION Uyen NguyenWorkers Compensation Program AdministratorCostco Wholesale Corporation999 Lake DriveIssaquah, WA 98027-8990Katrina Zitnik Ditrector WC kzitnik@costco.com

OFFICE: 425-313-2874FAX: 425-416-2171

x EMAIL: unguyen@costco.comPlease copy Anthony Stover on distribution anthonystover@costco.com

976 01/01/81 DENVER, CITY & COUNTY Robin Gray201 W. Colfax Ave #1105

§8-42-124 City and County of Denver201 West Colfax Avenue, Dept. 1105Denver, CO 80202-5332

OFFICE: 720-913-3330FAX: 720-913-3184 robin.gray@ci.denver.co.us

478 01/01/02 DENVER HEALTH & HOSPITAL Mr. Richard R Reed, CRMAUTHORITY Director, Risk Management

Denver Health & Hospital Authority660 Bannock Street M/C 5015Denver, CO 80204-4507

OFFICE: 303-436-6602FAX: 303-436-5073EMAIL: rreed@dhha.org

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

DATE NAME OF PERMIT PERMIT HOLDER8-42-124

480 07/01/01 DENVER PUBLIC SCHOOLS Terri SahliDirector, Risk ManagementDenver Public Schools

For Mimi and Sarma 900 Grant Street Ste 711Contacts Locally Denver, CO 80203-2907200 Union Blvd Suite 580lakewood CO 80228

OFFICE: 720-423-3465FAX: 720-423-3396EMAIL: karen_bright@dpsk12.org

Email terri_sahli@dpsk12.orgStephen Finley Retired

847 01/01/92 DOUGLAS COUNTY Ms. Sheryl D. Monroe, ARMRisk Manager

§8-42-124 Douglas County100 3rd StreetCastle Rock, CO 80104-2425

OFFICE: 303-660-7425FAX: 303-688-6596EMAIL: smonroe@douglas.co.us

851 08/01/91 DOUGLAS COUNTY SCHOOL DISTRICT Mr. John ZimmermanRE-1 Risk Manager

Douglas County School District RE-1620 North Wilcox StreetCastle Rock, CO 80104-1739

OFFICE: 303-387-0037FAX: 303-387-0110EMAIL: john.zimmerman@dcsdk12.org

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

943 10/01/72 EASTMAN KODAK COMPANY Mr. Mark JohnsonMS CPE

§8-42-124 Eastman Kodak Company200 Ridge Road West

Cancelled effective 5/1/07 Rochester, NY 14652-3403

OFFICE: 585-588-3868FAX: 585-722-9856EMAIL: mark.darence.johnson@kodak.com

Jake Michel820 01/01/93 EDWARD C. LEVY COMPANY Mr. Kenneth Harrell

ControllerOriginal Edward C. Levy Company

2635 Delta DriveAnniversary Colorado Springs, CO 80910-1007Date: 10/01/93 Till 3/31/08

Mr. Joseph Tracey OFFICE: 719-392-4207Regional Claims Manager FAX: 719-392-4245Cambridge Integrated Services Group EMAIL: dharrell@schmidtconstr.comP. O. Box 52106 jmichel@schmidtconstr.comPhoenix, AZ 85004-4577 *Send copy of Anniversary letter to:

Ms. Ann LoweryOFFICE: 602-427-6044 Corporate Risk ManagerFAX: 440-914-2551 Edward C. LevyEMAIL: joseph.tracey@cambridge-na.com 9300 Dix Street

Detroit, MI 48209-1023

OFFICE: 313-429-2200 FAX: 313-849-9446

x EMAIL: alowery@edwclevy.net

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

813 02/01/95 E. I. duPONT DeNEMOURS & COMPANY Ms. Carole A. CarrResposible for Clm Admin Treasury SpecialistEugene J Slesicki E. I. duPont deNemours & CompanyManager Global Risk Management Finance 1007 Market Street, #D8065302-774-4520 302-773-3428 Fax Wilmington, DE 19898-0001"eugene.j.slesicki@usa.dupont.com

OFFICE: 302-773-6473TPA Broadspire Svcs FAX: 302-773-3428

§8-42-124 Larry Corbett@choosebroadspire.com EMAIL: carole.a.carr@usa.dupont.com631-981-3286631-981-3305 Fax

845 01/01/92 EL PASO COUNTY Ricky Bransford Risk & Workers' Compensation Division ManagerEl Paso County Risk Management

Anne Schrader 2880 International circle suite N060TriStar risk management Colorado Springs, CO 80903-2010P O Box 5007Denver CO 80217-5007 OFFICE: 719-520-7486

FAX: 719-520-7406EMAIL:rickybransford@elpasoco.com

OFFICE: 720-962-0222FAX: 720-962-0301 andreamcgee@elpasoco.com

x EMAIL: anne.schrader@tristargroup.net

869 11/01/89 EMERSON ELECTRIC CO. Ms. Linda DonahueSr. Insurance AnalystEmerson Electric Co.

Canceled 6/30/10 8000 West Florissant Avenue Building AA, Station 1918St. Louis, MO 63136-8506

OFFICE: 314-553-1918FAX: 314- 553-2463 EMAIL: linda.donahue@emrsn.com

PERMITANNIVERSARY

DATE NAME OF PERMIT PERMIT HOLDEREVRAZ

826 03/01/93 Amy GrzeskCorporation Manager Workers’ Compensation

(OREGON STEEL MILLS, INC. - d.b.a. Rocky Rocky Mountain Steel MillsMountain Steel Mills) 200 E Randolph Drive 78th Floor

SELF INSURED LIST

10/7/2014

Chicago Il 60601

Email amy.grzesk@evrazincna.com

Carolyn Bjur last day end of July 2011

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

880 01/01/88 EXEMPLA, INC. Teri HudsonManager Insurance and RMIS

Original Sisters of Charity of Leavenworth Health System, Inc.Anniversary 8919 Parallel Parkway suite 402

Kansas City, KS 66112-1655Date: 08/01/88

OFFICE: 913-895-2879Revoked FAX: 913-895-2910

01/31/14EMAIL: teri.hudson@sclhs.net

883 05/01/88 FEDERAL EXPRESS CORPORATION Ms. Julia StegallFederal Express Risk ManagementFederal Express Corporation3620 Hacks Cross RoadBuilding B, 3rd FloorMemphis, TN 38125-8800

OFFICE: 901-434-4557FAX: 901-434-4585EMAIL: jgstegall@fedex.com

464 02/01/06 FEDERATED DEPARTMENT STORES, INC. Tom ConardDirector, Risk ManagementMacy's (Federated Department Stores), Inc.

Name Change to Macy's, inc. effective 6/1/07

7 West Seventh Street

Cincinnati, OH 45202-2424

OFFICE: 513-579-7628FAX: 513-579-7174EMAIL: ron.godfrey@macys.com

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

849 10/01/91 FEDEX FREIGHT WEST, INC. Kayla QuandtAdvisor Risk ManagementFedEx Freight2200 Forward DrHarrison AR 72601

Email connie.creamer@fedex.comConnie CreamerRisk Manager 870-741-9000FedEx Freight West, Inc. FAX: 870-391-76516411 Guadalupe Mines RoadSuite 3180 Email Kayla.quandt@fedex.comSan Jose, CA 95120-5000OFFICE: 408-323-4147

865 01/01/90 FEDEX GROUND PACKAGE SYSTEMS, INC. Thomas DittoeSenior Manager, Workers’ CompensationFedEx Ground Package Systems, Inc.P.O.Box 535859Pittsburgh PA 152531000 FedEx Dr Moon Twp.,PA 15108Laura Detwiler 412-747-8321OFFICE: 412-747-8318FAX: 412-747-8320EMAIL: kylee.secrist@fedex.com"thomas.dittoe @fedex.com"

893 09/15/87 FORD MOTOR COMPANY Mr. Richard WoodFord Motor Company19540 Allen RoadMelvindale, MI 48122-1622

OFFICE: 313-248-9917FAX: 313-206-4660EMAIL: rwood4@ford.com lmcdon16@ford.com

SELF INSURED LIST

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PERMITANNIVERSARY

876 01/01/89 FORT COLLINS, CITY OF Mr. Lance MurrayRisk Manager

§ 8-42-124 City of Fort CollinsRisk Management DivisionP. O. Box 580Ft. Collins, CO 80522-0580

OFFICE: 970-221-6807FAX: 970-221-6296 EMAIL: lmurray@fcgov.com

815 01/01/94 FREEDOM COMMUNICATIONS, INC. Jaime FloresHR Generalist, Corporate

Original Freedom Communications, Inc.Anniversary 17666 Fitch

Irvine, CA 92614-6022Date: 04/15/94

OFFICE: 949-253-2388FAX: 949-798-3566

"jflores@freedom.com

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

909 01/01/66 GATES CORPORATION

Ms. Jeanette McAllisterHSE/Manager, Workers’ CompensationGates Corporation

Revoked 6/1/08 P. O. Box 58871551Wewatta StreetDenver, CO 80217-5887

OFFICE: 303-744-5072FAX: 303-744-4895

EMAIL: jmcallister@gates.com

834 01/01/93 GOODRICH CORPORATION Pat NolanEHS Manager Goodrich Corporation

§ 8-42-124 Goodrich Corporation50 William White BoulevardPueblo, CO 81001-4856

Revoked effective 3/31/2013OFFICE: 719-948-0404FAX: 719-948-3422Email patrick.nolan@goodrich.com

judy.salas@goodrich.comMs. Nhu Miller nhu.miller@srsconnect.com Andrew Whitman, JD

x Specialty Risk Services800-829-7985P. O. Box 221700Denver, CO 80222-8700

SELF INSURED LIST

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PERMITANNIVERSARY

887 01/01/88 GRAND JUNCTION, CITY OF Mr. David L. RoperCity of Grand Junction250 North 5th StreetGrand Junction, CO 81501-2668

For Mimi and SarmaContacts Locally200 Union Blvd Suite 580lakewood CO 80228

OFFICE: 970-244-1592FAX: 970-256-4007

EMAIL: daver@ci.grandjct.co.us

889 09/30/87 HEWLETT-PACKARD COMPANY Mr Kevin JonesProgram ManagerHewlett-Packard Company3000 Hanover StreetMail Stop 1041

Revoked effective mid night 9/30/2011 Palo Alto, CA 94304-1112

OFFICE: 650-857-3187 650-857-6940FAX: 650-852-8116 EMAIL:kevin.a.jones@hp.comMs. Cristina Tate cristina.tate@hp.com236-2563janice.styles@hp.com

PERMITANNIVERSARY

DATE NAME OF PERMIT PERMIT HOLDER458 03/01/13 Home Depot USA inc. Jim Bramlett ARM

Michelle Casey Director--Risk ManagementRisk Analyst Idetta Curtis Store-Support Center, Bldg C-20

Senior Risk Manager Home Depot USA inc."idetta.curtis@homedepot.com 2455 Pace Ferry road Bldg. C-20

SELF INSURED LIST

10/7/2014

Atlanta GA 30339770-384-4150678-556-8889 Faxjim_bramlett@homedepot.com

PERMITANNIVERSARY

DATE NAME OF PERMIT Hyatt corporation

811 08/01/95 Jennifer HerzfeldAon Global Risk Consulting Hyatt CorporationAttn: Marlys Mohs 71 South Wacker Drive, 17th Floor5600 West 83rd Street, Suite 1100 Chicago, IL 60606-4637Minneapolis, MN 55437OFFICE: 952-807-0671 312-780-5861FAX: 847-953-2851 jennfer.herzfeld@hyatt.comLinda Smith 952-807-0698

312-780-5509312-780-5284 Fax

853 07/01/91 INTERNATIONAL PAPER COMPANY Ms. Penny HumphreyWC Insurance AdministratorInternational Paper Company6400 Poplar Avenue, Tower 3 4-110Memphis, TN 38197

Ms. Courtney ThomasExaminer OFFICE: 901-419-3938Sedgwick CMS FAX: 901-419-3940 901-214-0315500 North Akard Street, Suite 2200 EMAIL: penny.humphrey@ipaper.comDallas, TX 75201-3302

OFFICE: 214-849-5018FAX: 214-849-5201EMAIL: cathomas@sedgwickcms.com

875 01/01/89 JEFFERSON COUNTY Dan ZeislerFCC Services (Summit Point Consulting)7951 E Maplewood ave. Suite 225 Human ResourcesGreenwood Village CO 80111-0000 Jefferson County

100 Jefferson County Pkwy Suite 4500303-721-3265 Golden, CO 80419-6023866-811-4004 Fax OFFICE: 303-271-8440 8447

§8-42-124 bill.rush@fccservices.com" FAX: 303-271-8442 EMAIL: dzeisler@jeffco.us

303-271-8430

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PERMITANNIVERSARY

973 07/01/80 JEFFERSON COUNTY SCHOOL Joel HirschbackDISTRICT R-1 Insurance Manager

Risk Management DepartmentJefferson County School District R-1

§8-42-124 P. O. Box 4001 Golden, CO 80401-0001

OFFICE: 303-982-2439FAX: 303-982-2447

jhirschb@jeffco.k12.co.us

840 01/01/92 KAISER FOUNDATION HEALTH PLAN Melanie Chavez OF COLORADO Human Resources Department

Kaiser Foundation Health Plan of Colorado10065 E Harvard Ave suite 400

Original Denver, CO 80231AnniversaryDate: 04/01/92

OFFICE: 303-614-1546FAX: 303-614-1495melanie.chavez@kp.org

475 08/01/03 KNIGHT TRANSPORTATION, INC. Mr. Brett SantVice President, Safety Knight Transportation, Inc.5601 West Buckeye RoadPhoenix, AZ 85043-4603

Till 12/31/08 OFFICE: 602-606-6218 OR 800-489-2000, x218Ms. Michelle Murray FAX: 602-606-6118 Baldwin & Lyons, Inc. EMAIL: bsant@knighttrans.com1099 North Meridian, Suite 700Indianapolis, IN 46204-1036OFFICE: 317-636-9800, x320FAX: 317-632-9444

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

962 02/01/78 KROGER COMPANY, THE Nathan FraleyCorporate Claims ManagerThe Kroger Company1014 Vine stCincinnati, OH 45202-1100

OFFICE: 513-762-4360FAX: 513-762-1546EMAIL: nathan.fraley@kroger.com"mark.gully@kroger.com

Mark Gully

481 09/01/00 LABOR READY, INC. April SmithRisk FinanceLabor Ready, Inc.P. O. Box 2910Tacoma, WA 98401-2910

OFFICE: 253-680-8484 OR 800-610-8920FAX: 253-502-5865 OR 800-850-9809

Janet Johnson EMAIL: adsmith@trueblueinc.comState Reporting AssociateESIS, Inc120 North 9th stRichmond, IN 47374

Dee Ann Pfifer Risk Mgmt Admin896 01/01/87 LAKEWOOD, CITY OF Mr. Ken Milano

Department of Employee Relations§8-42-124 Risk Management DivisionMs. Stacy Ross sross@ccmsi.com City of LakewoodState Director 480 South Allison ParkwayCCMSI Lakewood, CO 80226-31237600 East Orchard Road, #360NP. O. Box 4998 (80155-4998) OFFICE: 303-987-7701Greenwood Village, CO 80111-2518 FAX: 303-987-7712

EMAIL: kenmil@lakewood.orgx CCMSI will adjust claims on or before 123107 deepfi@lakewood.org

OFFICE: 303-804-2032FAX: 303-804-2005

PERMITANNIVERSARY

DATE NAME OF PERMIT PERMIT HOLDER8-42-124

884 01/01/88 LARIMER COUNTY Jeff GreenRisk ManagerLarimer County

For Mimi and Sarma 200 West Oak St #4000Contacts Locally Fort Collins, CO 80521-4425

SELF INSURED LIST

10/7/2014

200 Union Blvd Suite 580 jlgreen@larimer.orglakewood CO 80228

OFFICE: 970-498-5962FAX: 970-498-5965

PERMITANNIVERSARY

DATE NAME OF PERMIT PERMIT HOLDER459 07/01/12 Les Schwab Tire Center inc Bob Erickson

Director of Risk ServicesLes Schwab Tire Center IncP O Box 5350Bend OR 97708541-416-5685bob.s.erickson@lesschwab.com

PERMITANNIVERSARY

465 01/01/06 LITTLETON, CITY OF Erich Won savageHR DirectorCity Of Littleton2255 West Berry AvenueLittleton, CO 80120-1151

Sarah Hein HR Analyst II 303-795-3860 3819faxOFFICE: 303-795-3902FAX: 303-795-3794EMAIL: ewonsavage@littletongov.org

890 10/01/87 LONGMONT, CITY OF Ms. Kim BrunsonClaims Adjuster

§8-42-124 City of LongmontCivic Center Complex350 KimbarkLongmont, CO 80501-5500

OFFICE: 303-651-8724FAX: 303-774-4314 EMAIL: kim.brunson@ci.longmont.co.us

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

455 02/01/14 LOWE’S Home Improvement Centers Ms. Tia SchweikertManager, Workers’ CompensationLowe’s HIW, Inc.P. O. Box 1000

Ms. Nhu Miller Mooresville, NC 28115-1000Specialty Risk Services P. O. Box 221700 OFFICE: 704-758-3055Denver, CO 80222-8700 FAX: 704-757-0530

EMAIL: tia.l.schweikert@lowes.comnhu.miller@srsconnect.comOFFICE: 303-645-8644 800-829-7985FAX: 303-645-8654

PERMITANNIVERSARY

466 09/01/05 LOWE’S HIW, INC. Ms. Tia SchweikertManager, Workers’ CompensationLowe’s HIW, Inc.P. O. Box 1000

Ms. Nhu Miller Mooresville, NC 28115-1000Specialty Risk Services

Revoked P. O. Box 221700 OFFICE: 704-758-305501/31/14 Denver, CO 80222-8700 FAX: 704-757-0530

EMAIL: tia.l.schweikert@lowes.comnhu.miller@srsconnect.comOFFICE: 303-645-8644 800-829-7985FAX: 303-645-8654

485 01/01/99 LSI LOGIC CORPORATION Ms. Karen Miller, ARMRisk Manager

Original LSI Logic CorporationAnniversary 1621 Barber Lane, MS: AD-106Date: 09/01/99 Milipitas, CA 95035-7455

Revoked 1/1/09OFFICE: 408-433-7022FAX: 408-954-3634EMAIL: karen.miller@lsi.com

464 02/01/06 Macy's inc

824 04/01/93 MC LANE COMPANY, INC. Ms. Melanie BennettCorporate Senior Supervisor AccountantMcLane Company, Inc.

SELF INSURED LIST

10/7/2014

4747 McLane ParkwayTemple, TX 76503-6115

OFFICE: 254-771-7428FAX: 254-770-5387 EMAIL: melanie.bennett@mclaneco.com

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

814 08/01/94 MEMORIAL HOSPITAL Will MercadoMemorial Health System

§8-42-124 (2) 175 S Union blvd suite 315Colorado Springs, CO 80910-3126

OFFICE: 719-365-1192FAX: 719-365-6812 guillermo.mercado@memorialhealthsystem.com

2502 Pikes Peak Ave #108

§8-42-124 (2)473 01/01/04 MESA COUNTY Jean Boothe Risk Specialist 970-244-1868

Risk SpecialistRisk Management

For Mimi and Sarma Mesa CountyContacts Locally 544 Rood Avenue, 2nd Floor200 Union Blvd Suite 580 P. O. Box 20000lakewood CO 80228 Grand Junction, CO 81501-5063

Jean Boothe Risk Specialist 970-244-1868OFFICE: 970-255-7150FAX: 970-244-1868

EMAIL: Jean.Boothe@mesacounty.usmark.reitz@mesacounty.usMr. Mark Reitz, C.P.M. Purchasing Risk mgmt

8-42-124476 07/01/03 MESA COUNTY VALLEY SCHOOL Dist Ms. Sheila Naski

Workers’ CompensationMesa County Valley School District 51

For Mimi and Sarma 2115 Grand AvenueContacts Locally Grand Junction, CO 81501-8007200 Union Blvd Suite 580lakewood CO 80228

OFFICE: 970-254-5176FAX: 970-254-5284EMAIL: shenaski@mesa.k12.co.us

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

817 01/01/94 NATIONAL JEWISH MEDICAL AND Research Sarah Taylor

Vice President Human Resources National Jewish Medical and

For Mimi and Sarma Research CenterContacts Locally 1400 Jackson Street, G-113200 Union Blvd Suite 580 Denver, CO 80206-2761lakewood CO 80228

OFFICE: 303-398-1035FAX: 303-398-1775 EMAIL:

x taylorsarah@njhealth.org

497 07/01/96 NORDSTROM, INC.

Ms. Debbie BordeauxNetwork AdministratorNordstrom, Inc.P. O. Box 21865Seattle, WA 98111-3865

OFFICE: 206-303-2506FAX: 206-303-2689 EMAIL: debbie.bordeaux@nordstrom.com

SELF INSURED LIST

10/7/2014

472 04/15/04 PEABODY ENERGY CORPORATION Shannon OrlandoManager--Insurance ClaimsPeabody Energy Corporation701 Market Street, Suite 600St. Louis, MO 63101-1826

Cancelled effective 2/15/2010 OFFICE: 314-342-3469FAX: 314-342-7740

ACE USA is Commercial Carrier EMAIL: sorlando@peabodyenergy.com

Lynnette M. Rasch LEFT Peabody Feb 2009

828 01/01/93 PITKIN COUNTY Dannette LoganHuman Resources manager

§8-42-124 Pitkin County530 East Main Street, Suite 202Aspen, CO 81611-1948dannette.logan@pitkincounty.com

OFFICE: 970-429-2792FAX: 970-920-5049

kris.jewkes@pitkincounty.com

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

885 01/01/88 PORTERCARE ADVENTIST HEALTH Mr. Richard Osborn SYSTEM Director, Risk Management

PorterCare Adventist Health System2525 South Downing StreetDenver, CO 80210-5876

Canceled effective midnight 1/31/09

In Adventist Health Systems effective 2/1/09 OFFICE: 303-778-2538

FAX: 303-778-5295 EMAIL: richardosborn@centura.org

897 01/01/87 POUDRE SCHOOL DISTRICT R-1 Ms. Kristin BennettBenefits Manager

§8-42-124 Poudre School District R-12407 LaPorte AvenueFt. Collins, CO 80521-2297

A1 OFFICE: 970-490-3627FAX: 970-490-3529 EMAIL: kbennett@psdschools.org

871 04/01/89 POUDRE VALLEY HEALTH CARE, INC. David Wood--Interim General CounselRevoked 12/31/12 tail clms in Univ of Katie Zeller--Compliance Department

Original Colorado Hospital as of 3/31/12Anniversary Travelers Policy Poudre Valley Health SystemDate: 01/01/89 Mr. Gary Swenson till 12/31/08 2315 E Hormony rd

Director Fort Collins, CO 80528-3929Support Services, Inc. OFFICE: 970-624-13467335 East Orchard Road, Suite 200 FAX: 970-624-1896Greenwood Village, CO 80111-2518 """" kz3@pvhs.org or dw11@pvhs.org """

OFFICE: 720-489-9300FAX: 720-489-1166 EMAIL: gary.swenson@cha.com Diane M Gross resigned in March 2011

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

843 01/01/92 PRECISION CASTPARTS CORPORATION - ADVANCED FORMING TECHNOLOGIES Lisa Dockins Controller

Kevin SchwindtHuman Resources Manager

Revoked 8/8/2012 Precision Castparts Corporation -Advanced Forming Technologies7040 Weld County Road 20Longmont, CO 80504-9423

OFFICE: 303-833-6012FAX: 303-833-6440 EMAIL: kschwindt@pcc-aft.com

Ms. Mim Duffy

494 01/01/97 PRINCIPAL FINANCIAL GROUP, INC. Ms. Lori DiercksAssistant Claim ManagerPrincipal Financial Group, Inc.711 High StreetDes Moines, IA 50392-2040

OFFICE: 515-247-6761x FAX: 866-496-6524

EMAIL: diercks.lori@principal.com

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

857 01/01/91 PUEBLO, CITY OF David M AndersonDirector, Personnel

FCC Services (Summit Point Consulting) City of Pueblo7951 E Maplewood ave. Suite 225 P. O. Box 1427Greenwood Village CO 80111-0000 Pueblo, CO 81002-1427

303-721-3265 OFFICE: 719-553-2629§8-42-124 866-811-4004 Fax FAX: 719-553-2696

bill.rush@fccservices.com" danderson@pueblo.us

All Self-Insurance period claims transferred from SCA to Summit effective 1/1/08

836 07/01/92 PUEBLO SCHOOL DISTRICT NO. 60 Corrine ArriagaFCC Services (Summit Point Consulting) Executive Director of Staff Relations7951 E Maplewood ave. Suite 225 Human Resources OfficeGreenwood Village CO 80111-0000 315 W 11th st

Pueblo, CO 81003-2804303-721-3265866-811-4004 Faxbill.rush@fccservices.com" OFFICE: 719-549-7132

§8-42-124 FAX: 719-253-6042EMAIL: corrine.arriaga@pueblocityschools.us

All Self-Insurance period claims transferred from SCA to Summit effective 1/1/08

891 10/01/87 R. R. DONNELLEY & SONS Mr. Timothy GagenSenior Risk AnalystR. R. Donnelley & Sons

Canceled effective 7/1/07 111 South Wacker Drive, 37th FloorChicago, IL 60606-4301

OFFICE: 312-326-8925FAX: 312-326-8557 EMAIL: timothy.gagen@rrd.com

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

972 03/01/80 REGIONAL TRANSPORTATION DISTRICT Mr. Robert L. MedinaRisk ManagerRegional Transportation District1600 Blake StreetDenver, CO 80202-1324

OFFICE: 303-299-2715FAX: 303-299-2029 EMAIL: robert.medina@rtd-denver.com

960 02/18/77 SAFEWAY, INC. Ms Chi NguyenLoss Control AnalystCorporate Workers' Compensation Risk ManagementSafeway, Inc.4410 Rosewood DrivePleasanton, CA 94588-3050OFFICE: 925-226-5074FAX: 925-226-5990EMAIL: chi.nguyen2@safeway.com

F Nathan Fraley

827 01/01/93 SALVATION ARMY, THE Major James BoydDirector, Risk ManagementThe Salvation Army180 East Ocean BoulevardLong Beach, CA 90802-4709

OFFICE: 562-491-8380Mr. John McCarthy Retired FAX: 562-491-8793

EMAIL: james.boyd@usw.salvationarmy.orgevelyn.berger@usw.salvationarmy.org

Evelyn Berger

PERMITANNIVERSARY

456 02/01/14 SISTERS OF CHARITY OF LEAVENWORTH Teri HudsonSYSTEM, INC. Manager Insurance and RMIS

Sisters of Charity of Leavenworth Health System, Inc.Frontrange f/k/a Exempla included 8919 Parallel Parkway suite 402

Kansas City, KS 66112-1655

SELF INSURED LIST

10/7/2014

OFFICE: 913-895-2879FAX: 913-895-2910 EMAIL: teri.hudson@sclhs.net

PERMITANNIVERSARY

492 03/01/97 SISTERS OF CHARITY OF LEAVENWORTH Teri HudsonSYSTEM, INC. Manager Insurance and RMIS

Sisters of Charity of Leavenworth Health System, Inc.8919 Parallel Parkway suite 402Kansas City, KS 66112-1655

Revoked01/31/14 OFFICE: 913-895-2879

FAX: 913-895-2910 EMAIL: teri.hudson@sclhs.net

848 11/01/91 SMURFIT-STONE CONTAINER Monica Lavy ENTERPRISES, INC. Casualty & Self Insurance Specialist

Smurfit-Stone Container Enterprises, Inc.Six CityPlace Drive

Canceled 9/1/10 Creve Coeur, MO 63141-7167Insurance Analyst

OFFICE: 314-656-5433FAX: 314-787-6182EMAIL: cmalawy@smurfit.commlavy@smurfit.com

487 05/17/99 SORIN Group USA

499 07/01/96 STATE OF COLORADO Brenda hardwickRisk Manager

§8-42-124 Department of Personnel and AdministrationState of Colorado1313 Sherman Street, First FloorDenver, CO 80203-2236

OFFICE: 303-866-3846FAX: 303-894-2409 EMAIL: brenda.hardwick@state.co.us

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

855 02/01/91 TARGET STORES

Ms. Judy EssenTarget StoresC/O Aon Risk Consultants, Inc.33 S 6th street CC-0905Minneapolis, MN 55402

OFFICE: 952-656-8290FAX: 847-953-2851EMAIL: judy_essen@ars.aon.com952-807-0637

5600 W 83rd street suite 1100

844 01/01/92 THORNTON, CITY OF Ms. Chris SchneiderRisk Management Administrator

§8-42-124 City of ThorntonCivic Center9500 Civic Center DriveThornton, CO 80229-1220

OFFICE: 303-538-7303FAX: 303-538-7522 EMAIL: chris.schneider@cityofthornton.net

xBill Rush effective 12/16/13 Director of Risk Mana

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

838 04/01/92 TRI-STATE GENERATION & Elda M. de la PenaTRANSMISSION ASSOCIATION, INC. Tri-State Generation & Transmission Association, Inc.

1100 West 116th StreetWestminster, CO 80234-2814

OFFICE: 303-254-3166FAX: 303-254-6018 EMAIL: edelapena@tristategt.org

P.O.Box 33695 Denver CO 80233Ms. Elda M. de la Pena 254-3198

Maureen Zahnow942 01/01/72 UNITED AIRLINES, INC. Senior Manager Corporate Insuranve

Workers' Compensation Program§8-42-124 233 S Wacker Drive Chicago IL 60606

United Airlines, Inc.P. O. Box 66100Chicago, IL 60661-0100maureen.zahnow@united.com312-997-7630OFFICE: 872-825-7630FAX: 847-700-5833EMAIL:

457 04/01/13 United Airlines, inc Post April 1, 2013 Maureen ZahnowSenior Manager Corporate InsuranveWorkers' Compensation Program233 S Wacker Drive Chicago IL 60606 HDQCI

496 10/01/96 UNIVERSITY OF COLORADO Teena SheppersonFinancial Analyst

§8-42-124 University Risk ManagementUniversity of Colorado1800 Grant Street, Suite 700Denver, CO 80203-1185303-860-5712FAX: 303-860-5680

teena.shepperson-turner@cu.edu

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

970 01/01/80 VAIL ASSOCIATES, INC. Thomas Nix ARMDirector of Corporate Risk Management and Insurance

Original Tracy Venter Vail Resorts Management CompanyAnniversary Sr. Occupational Helath Manager 390 Interlocken Crescent Broomfeild CO 80021Date: 01/10/80 390 Interlocken Crescent P. O. Box 7

Broomfield, CO 80021 Vail, CO 81658-7000Direct: 303-404-1885 OFFICE: 303-404-1945Fax: 303-404-6415 FAX: 303-404-6416mventer@vailresorts.com EMAIL: pboatman@vailresorts.com

tnix@vailresorts.com

822 04/30/93 VALERO ENERGY CORPORATION Mr. Theodore Guidry IIExecutive DirectorBusiness Risk ManagementValero Energy Corporation

Revoked 4/30/13 6000 North Loop 1604 WSan Antonio, TX 78249-1100

OFFICE: 210-345-2048FAX: 210-345-2964 EMAIL: eric.honeyman@valero.com

theo.guidry@valero.com

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

846 01/01/92 WELD COUNTY Ms Michelle RaimerHuman Resources AnalystWeld CountyP. O. Box 758Greeley, CO 80632-07581150 O stOFFICE: 970-336-7220FAX: 970-352-9019EMAIL: mraimer@co.weld.co.us

467 06/01/05 WENDY’S INTERNATIONAL, INC. Emily Powell7/5/05 to 12/31/2009 Risk Analyst

Wendy's INTERNATIONAL LLCCynthia Tucker, Branch Manger One Dave Thomas BlvdGallagher Bassett Service, Inc. Dublin, OH 43017P. O. Box 4068Englewood, CO 80155-4068Allen Zearing Supervisor 800-933-8143 X234

allen_zearing@gbtpa.comOFFICE: 614-764-3385

303-796-9494 Fax 614-760-2089FAX: 303-796-9498 EMAIL: emily.powell@wendys.comEMAIL: cynthia_tucker@gbtpa.com

Sneha Kanta sneha.kanta@wendys.com

SELF INSURED LIST

10/7/2014

PERMITANNIVERSARY

§8-42-124997 01/01/86 WESTMINSTER, CITY OF

Ms. Martee ErichsonJoel Hirschback till 9/30/10 Risk ManagerRisk Manager City of Westminster/Risk ManagementC/O Jefferson County School District R-1 4800 West 92nd AvenueRisk Management Department Westminster, CO 80031-6387P. O. Box 4001Golden, CO 80401-0001

OFFICE: 303-982-2439 OFFICE: 303-658-2156FAX: 303-982-2327 FAX: 303-706-3924

x EMAIL: merichson@ci.westminster.co.us

886 01/01/88 WEYERHAEUSER COMPANY Lisa Wysocki

Weyerhaeuser CompanyP. O. Box 9777, CH 3K33

Weyerhaeuser Company Federal Way, WA 98063-9777PO Box 9777, NB2-2E4Federal Way, WA 98063-9777 OFFICE: 253-924-7591

FAX: 253-924-5300OFFICE: 253-924-7685 EMAIL: lisa.wysocki@weyerhaeuser.com

x FAX: 253-924-4440 EMAIL:

461 03/01/09 YRC Inc. Diane MyersCorporate Insurance Department managerYellow Transportation, Inc.P. O. Box 7270Overland Park, KS 66207-0270

OFFICE: 913-266-6574FAX: 913-234-9173

863 01/01/90 YELLOW TRANSPORTATION, INC. 863 Email diane.myers@yrcw.comRevoked 10/1/08 Becci McMahon913-696-6107becci.mcmahon@yrcw.com

Jill Rueter retired Email jilla.rueter@yrcw.com10990 Roe Avenue Overlandpark KS 66211

SELF INSURED LIST - Colorado · 2014-10-07 · PERMIT HOLDER 939 06/15/86: ABF FREIGHT SYSTEM, INC....

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