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SELF INSURED LIST
Page 1 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: [email protected] Smith, AR 72917-0048 [email protected]
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 "[email protected], CO 80401-0001 OFFICE: 720-523-6076450 South 4th Avenue FAX: 720-523-6069Brighton, CO 80601-3123 EMAIL: [email protected]
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: [email protected]
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: [email protected]
SELF INSURED LIST
Page 2 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 [email protected] 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: [email protected]
x
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:[email protected]: 303-361-5251 ""[email protected]" 720-898-7595EMAIL: [email protected] 12/31/2011
SELF INSURED LIST
Page 3 10/7/2014
PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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 [email protected]
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: [email protected]
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: [email protected]
460 11/01/11 Baker Concrete Construction Arnold DelossantosWorkers' Compensation Claims ManagerBaker Concrete Construction900 N Garver rd Monroe OH 45050Monroe OH 45050
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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 [email protected] 303-460-3716 Rob Garside Director Credit Risk [email protected]
x Mr. Harold L. Lykins
SELF INSURED LIST
Page 5 10/7/2014
PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]
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: [email protected]@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: [email protected]
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Page 6 10/7/2014
PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]
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: [email protected]
SELF INSURED LIST
Page 7 10/7/2014
PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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 [email protected]
Carmel Cosentino [email protected]
OFFICE: 925-842-8162FAX: 925-842-8185 Ms. Kelly George left company 9/15/2011EMAIL: [email protected]
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: [email protected]
SELF INSURED LIST
Page 8 10/7/2014
PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]
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: [email protected]
SELF INSURED LIST
Page 9 10/7/2014
PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]
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: [email protected]
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 [email protected]
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Page 10 10/7/2014
PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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) [email protected]
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: [email protected]
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: [email protected]
SELF INSURED LIST
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PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]
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 [email protected]
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: [email protected]
x
SELF INSURED LIST
Page 12 10/7/2014
PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
483 01/01/00 COSTCO WHOLESALE CORPORATION Uyen NguyenWorkers Compensation Program AdministratorCostco Wholesale Corporation999 Lake DriveIssaquah, WA 98027-8990Katrina Zitnik Ditrector WC [email protected]
OFFICE: 425-313-2874FAX: 425-416-2171
x EMAIL: [email protected] copy Anthony Stover on distribution [email protected]
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 [email protected]
x
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: [email protected]
x
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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: [email protected]
Email [email protected] 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: [email protected]
x
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: [email protected]
SELF INSURED LIST
Page 14 10/7/2014
PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]
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: [email protected]. O. Box 52106 [email protected], AZ 85004-4577 *Send copy of Anniversary letter to:
Ms. Ann LoweryOFFICE: 602-427-6044 Corporate Risk ManagerFAX: 440-914-2551 Edward C. LevyEMAIL: [email protected] 9300 Dix Street
Detroit, MI 48209-1023
OFFICE: 313-429-2200 FAX: 313-849-9446
x EMAIL: [email protected]
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PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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"[email protected]
OFFICE: 302-773-6473TPA Broadspire Svcs FAX: 302-773-3428
§8-42-124 Larry [email protected] EMAIL: [email protected] 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:[email protected]
OFFICE: 720-962-0222FAX: 720-962-0301 [email protected]
x EMAIL: [email protected]
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: [email protected]
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
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Page 16 10/7/2014
Chicago Il 60601
Email [email protected]
Carolyn Bjur last day end of July 2011
SELF INSURED LIST
Page 17 10/7/2014
PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]
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: [email protected]
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: [email protected]
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PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
849 10/01/91 FEDEX FREIGHT WEST, INC. Kayla QuandtAdvisor Risk ManagementFedEx Freight2200 Forward DrHarrison AR 72601
Email [email protected] CreamerRisk Manager 870-741-9000FedEx Freight West, Inc. FAX: 870-391-76516411 Guadalupe Mines RoadSuite 3180 Email [email protected] 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: [email protected]"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: [email protected] [email protected]
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PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]
x
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
SELF INSURED LIST
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PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]
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 [email protected]
[email protected]. Nhu Miller [email protected] Andrew Whitman, JD
x Specialty Risk Services800-829-7985P. O. Box 221700Denver, CO 80222-8700
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PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]
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:[email protected]. Cristina Tate [email protected]@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."[email protected] 2455 Pace Ferry road Bldg. C-20
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Atlanta GA 30339770-384-4150678-556-8889 [email protected]
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 [email protected] 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: [email protected], TX 75201-3302
OFFICE: 214-849-5018FAX: 214-849-5201EMAIL: [email protected]
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 [email protected]" FAX: 303-271-8442 EMAIL: [email protected]
303-271-8430
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PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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
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: [email protected]
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: [email protected] North Meridian, Suite 700Indianapolis, IN 46204-1036OFFICE: 317-636-9800, x320FAX: 317-632-9444
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PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]"[email protected]
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: [email protected] 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 [email protected] 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: [email protected] CCMSI will adjust claims on or before 123107 [email protected]
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
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200 Union Blvd Suite 580 [email protected] CO 80228
OFFICE: 970-498-5962FAX: 970-498-5965
x
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 [email protected]
PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]
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: [email protected]
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PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]@srsconnect.comOFFICE: 303-645-8644 800-829-7985FAX: 303-645-8654
PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]@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: [email protected]
464 02/01/06 Macy's inc
824 04/01/93 MC LANE COMPANY, INC. Ms. Melanie BennettCorporate Senior Supervisor AccountantMcLane Company, Inc.
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Page 27 10/7/2014
4747 McLane ParkwayTemple, TX 76503-6115
OFFICE: 254-771-7428FAX: 254-770-5387 EMAIL: [email protected]
SELF INSURED LIST
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PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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 [email protected]
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: [email protected]@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: [email protected]
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PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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:
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: [email protected]
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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: [email protected]
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 [email protected]
OFFICE: 970-429-2792FAX: 970-920-5049
x
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PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]
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: [email protected]
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 """" [email protected] or [email protected] """
OFFICE: 720-489-9300FAX: 720-489-1166 EMAIL: [email protected] Diane M Gross resigned in March 2011
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PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]
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: [email protected]
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PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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
[email protected]" [email protected]
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 [email protected]" OFFICE: 719-549-7132
§8-42-124 FAX: 719-253-6042EMAIL: [email protected]
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: [email protected]
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PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]
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: [email protected]
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: [email protected]@usw.salvationarmy.org
Evelyn Berger
PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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
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OFFICE: 913-895-2879FAX: 913-895-2910 EMAIL: [email protected]
PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]
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: [email protected]@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: [email protected]
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PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]
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: [email protected]
xBill Rush effective 12/16/13 Director of Risk Mana
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PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]
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 [email protected]: 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
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PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected] EMAIL: [email protected]
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: [email protected]
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PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
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: [email protected]
x
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
[email protected]: 614-764-3385
303-796-9494 Fax 614-760-2089FAX: 303-796-9498 EMAIL: [email protected]: [email protected]
Sneha Kanta [email protected]
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PERMITANNIVERSARY
DATE NAME OF PERMIT PERMIT HOLDER
§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: [email protected]
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: [email protected]
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 [email protected] 10/1/08 Becci [email protected]
Jill Rueter retired Email [email protected] Roe Avenue Overlandpark KS 66211
