PDF SELF INSURED LIST

SELF INSURED LIST

PERMIT

ANNIVERSARY DATE

NAME OF PERMIT

939

06/15/86 ABF FREIGHT SYSTEM, INC.

(ARKANSAS BEST CORPORATION AND

ITS WHOLY-OWNED SUBSIDIARY ABF

FREIGHT SYSTEM, INC.)

Allen King Manager, Workers' Compensation ABF FREIGHT SYSTEM, INC. 3801 Old Greenwood Road 72903 P. O. Box 10048 Fort Smith, AR 72917-0048

PERMIT HOLDER

Mr. Stan McDaniel Director, Risk Management ABF Freight System, Inc. 3801 Old Greenwood Road 72903 P. O. Box 10048 Fort Smith, AR 72917-0048

OFFICE: 479-785-6319

FAX:

479-494-6624

EMAIL: aking@

stanmcd@

989

04/01/84

?8-42-124

462

02/01/09

484

11/01/99

Adams County

Joel Hirschboeck Risk Manager Adams County Workers' Compensation C/O Jefferson County School Dist R-1 Risk Management Department P O Box 4001 Golden, CO 80401-0001 450 South 4th Avenue Brighton, CO 80601-3123

Adventist Health Systems

Nancee Rosen Nancee R Smith ARM, CWCP Director Workers' Compensation Dept Adventist Health systems 900 Hope way Altamonte Springs, FL 32714

Mr. Charles B. DuScha

Risk Manager

Adams County

Risk Management/HR Department

4430 South Adams County Parkway

4th floor, suite 4000B

Brighton, CO 80601-8213

"cduscha@

OFFICE: 720-523-6076

FAX:

720-523-6069

EMAIL: cduscha@co.adams.co.us

Nancee Rosen

Nancee R Smith ARM, CWCP Director Workers' Compensation Dept

Adventist Health systems 900 Hope way Altamonte Springs, FL 32714

OFFICE: 407-357-2239

FAX:

866-359-3397

EMAIL: nancee.rosen@

AGILENT TECHNOLOGIES, INC. Diane Kramer Pavelich Sedgwick CMS 7400 East Orchard St Suite 4015 P O Box 5107 (80155-5107) Green Wood Village, CO 80111-2518

Tim Wood Ms. Arlyne Gittens retired Feb 2014 Corporate Risk Management Agilent Technologies, Inc. 5301 Stevens Creek Boulevard Mail Stop 1A-1R Santa Clara, CA 95051-7201

TPA MAILING ADDRESS IS P.O.Box 14493, Lexington KY 40512-4493

OFFICE: 408-345-8227

FAX:

408-553-7516

EMAIL: timothy_wood@

timothy_wood@

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ANNIVERSARY

PERMIT

DATE

SELF INSURED LIST

NAME OF PERMIT

PERMIT HOLDER

477

04/01/02 AMERICAN FURNITURE WAREHOUSE

Ms. Becky Rouse Risk Manager American Furniture Warehouse 8820 American Way Englewood, CO 80112-7056

OFFICE: 720-873-8612

FAX:

720-873-8615

Contacts Locally Mimi Sarma 200 Union Blvd Suite 580 lakewood CO 80228

brouse@

870

01/01/90 ARAPAHOE COUNTY

?8-42-124

x

Ms. Pat Skahill Arapahoe County 5334 South Prince Street Littleton, CO 80166-0001

OFFICE: FAX: EMAIL:

303-795-4573 303-734-5479 pskahill@co.arapahoe.co.us

894

07/01/87 ARVADA, CITY OF

?8-42-124

Teree Carr

Business Director

PINNACOL ASSURANCE

7501 E Lowery Blvd

Denver, CO 80230-7006

OFFICE: 303-361-4251

FAX:

303-361-5251

EMAIL: teree.carr@ Till 12/31/2011

Kirstie Dineen Risk Management Division City of Arvada 8101 Ralston Road P. O. Box 8101 Arvada, CO 80001-8101

OFFICE: 720-898-7595

FAX:

720-898-7591

EMAIL:kdineen@

""jlange@" 720-898-7595

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ANNIVERSARY

PERMIT

DATE

SELF INSURED LIST

NAME OF PERMIT

PERMIT HOLDER

975

10/06/81 ASPEN SKIING COMPANY

?8-42-124

Steven Howard Workers' Compensation Manager Aspen Skiing Company Box 1248 Aspen, CO 81612-1248

OFFICE: 970-920-0977

FAX:

970-920-0955

Email showard@

957

10/01/76 AURORA, CITY OF

?8-42-124

Renee Pettinato Mosley Risk Manager City of Aurora 15151 East Alameda Parkway Third Floor Aurora, Co 80012-1555

OFFICE: 303-739-7003

FAX:

303-739-7650

EMAIL: rpettina@

463

11/07/08 BARRETT BUSINESS SERVICES INC

BBSI

950 S CHERRY ST SUITE 1600

Mr. Steven McComb WORKERS' COMPENSATION ADMINISTRATOR BARRETT BUSINESS SERVICES INC 8100 NE PARKWAY DR SUITE 200 VANCOUVER, WA 98662-

OFFICE: 360-828-0685

FAX:

360-828-0699

EMAIL: STEVEN.MCCOMB@

460

11/01/11 Baker Concrete Construction

Arnold Delossantos Workers' Compensation Claims Manager Baker Concrete Construction 900 N Garver rd Monroe OH 45050 Monroe OH 45050

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SELF INSURED LIST OFFICE: 513-539-4097

FAX:

513-539-4251

1904 Jasper st Aurora CO 80014

993

01/01/85 BALL CORPORATION

?8-42-124 Kelly Knauer

Sr. Risk Analyst Ball Corporation 10 Longs Peak Drive Broomfeild, CO 80038-5000 kknauer@ Fax 303-460-3716

x

Cheryl Kabes Aon Global Risk Consulting 5600 West 83rd street Suite 1100 Minneapolis, MN 55437 Cheryl Kabes 952-807-0661 Linda Smith 952-807-0698

Fax 847-953-2851

Rob Garside Director Credit Risk rgarside@

Mr. Harold L. Lykins

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ANNIVERSARY

PERMIT

DATE

SELF INSURED LIST

NAME OF PERMIT

PERMIT HOLDER

489

01/01/98 BANNER HEALTH

Mr. Phil Holt Systems Director, Risk Financing Banner Health 1441 North 12th Street Phoenix, AZ 85006-2837

OFFICE: 602-747-4799

FAX:

602-495-4781

EMAIL: tammy.willis@

829

01/01/93 BOULDER, CITY OF

x

852

01/01/91 BOULDER COMMUNITY HOSPITAL

For Mimi and Sarma Contacts Locally 200 Union Blvd Suite 580 lakewood CO 80228

Stewart Ellenberg ARM-P Risk Manager

City of Boulder P. O. Box 791 or 1777 Broadway Boulder, CO 80306-0791

OFFICE: 303-441-3075

FAX:

303-441-4381

EMAIL: eichemb@

ellenbergs@

Mr. Bob Eichem 303-441-1819

Finance Director

Ms. Denise Granberg Boulder Community Hospital North Broadway & Balsam P. O. Box 9019 Boulder, CO 80301-9019

OFFICE: 303-938-5344

FAX:

720-565-0457

EMAIL: emphealth1@

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DATE

SELF INSURED LIST

NAME OF PERMIT

PERMIT HOLDER

867

01/01/90 BOULDER COUNTY

?8-42-124

x

Ms. Pam Stonecipher, ARM, CIC

Boulder County

Risk Manager

P. O. Box 471

Boulder, CO 80306-0471

2025 14th st 1st Floor

OFFICE: 303-441-3872

FAX:

303-441-3568

EMAIL: pstonecipher@

873

06/01/89 CARGILL, INC.

Cancelled effective 6/1/07

Mr. Brian Turnwall Casualty Insurance Manager Cargill, Inc. 15407 McGinty Road West MS 12 Wayzata, MN 55391-2365

OFFICE: 952-742-5274

FAX:

952-742-7990

EMAIL: nancy_whitehead@

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PERMIT

DATE

SELF INSURED LIST

NAME OF PERMIT

PERMIT HOLDER

956

12/01/75 CHEVRON U.S.A., INC.

Megan O'Boyle-Paraiso Claims Analyst, Workers' Compensation

Treasury Department-Insurance Division

Chevron Corporation

6001 Bollinger Canyon Rd

Nancy Bircher

P.O. Box 6022

Insurance Division Claims Administrator Chevron U.S.A., Inc. P. O. Box 6022 San Ramon, CA 94583-0722

San Ramon, CA 94583 Tel 925 842 8161 Fax 925 842 8185 MQRD@

Carmel Cosentino carmel.cosentino@ 925-842-9399

OFFICE: 925-842-8162

FAX:

925-842-8185

Ms. Kelly George left company 9/15/2011

EMAIL: nbircher@

468

03/01/05 CHILDREN'S HOSPITAL ASSOCIATION,

THE

For Mimi and Sarma Contacts Locally 200 Union Blvd Suite 580 lakewood CO 80228

Director of Benefits and Employee Health Services

The Children's Hospital of Denver 13611 E Colfax Ave. #200 Aurora, CO 80045

OFFICE: 303-861-6402

FAX:

303-764-8080

EMAIL: theresa.baca@

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ANNIVERSARY

PERMIT

DATE

SELF INSURED LIST

NAME OF PERMIT

PERMIT HOLDER

479

07/01/01 COACHMEN INDUSTRIES, INC.

Revoked 7/1/2012

LES THIMLAR Vice President Coachmen Industries, Inc. P. O. Box 3300 2831 Dexter Drive Elkhart, IN 46515-3300

OFFICE: 574-266-2514

FAX:

574-206-1700

EMAIL: mmiranda@

487

05/17/99 COBE CARDIOVASCULAR, INC.

Now known as SORIN Group USA effective 1/1/2007

Canceled 5/1/10

Ms. Diane Marie Lucero Treasury Manager Cobe Cardiovascular, Inc. 14401 West 65th Way Arvada, CO 80004-3539

OFFICE: 303-467-6280

FAX:

303-467-6591

EMAIL: diane.lucero@sorin-

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