Self insured list - Colorado Department of Labor and Employment

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SELF INSURED LIST PERMIT ANNIVERSARY DATE NAME OF PERMIT TPA OR LOCAL PERMIT HOLDER 470 08/01/04 COLORADO STATE UNIVERSITY Ms. Karen Marie Lesko Sally Alexander Director, Sales & Claims Services Director, Risk Management and Insurance (Tail claims from 07/01/96 - 06/30/04) TRI-Star Risk Management Colorado State University 200 Union Boulevard, Suite 580 Office of Risk Management & Insurance Environmental Health Sevices P. O. Box 5007 (80217-5007) 141A General Services Builduing Denver, CO 80228-1849 Campus Delivery 6002 Fort Collins, CO 80523-0001 OFFICE: 720-962-0274 OFFICE: 970-491-6745 FAX: 720-962-0301 FAX: 970-491-4804 EMAIL: karen.lesko@tristargroup.net EMAIL: sally.alexander@colostate.edu sally.alexander@colostate.edu 469 01/01/05 COLUMBINE HEALTH SYSTEMS Ms. Karen Marie Lesko Kim Gabriel Director, Sales & Claims Services Senior Accountant Effective 7/1/09 change in TPA TRI-Star Risk Management Columbine Health Systems Mr. Gary Swenson 200 Union Boulevard, Suite 580 947 Worthington Circle Director P. O. Box 5007 (80217-5007) Fort Collins, CO 80526-1841 Support Services, Inc. Denver, CO 80228-1849 7335 East Orchard Road, Suite 200 OFFICE: 970-482-0198 Greenwood Village, CO 80111-2518 OFFICE: 720-962-0274 FAX: 970-482-9148 FAX: 720-762-0301 EMAIL: dawn.filsinger@columbinehealth.com OFFICE: 720-489-9300 EMAIL: karen.lesko@tristargroup.net kim.gabriel@columbinehealth.com FAX: 720-489-1166 Dawn Filsinger, Safety Officer, Columbine Health EMAIL: gary.swenson@cha.com TRI-Star will handle all self-Insured period claims Systems,802 West Drake Suite 145,Fort Collins80526 970-492-6233 970-492-6206 Fax 888 11/01/87 CONAGRA FOODS, INC. Mr. Mike Stefan Mr. Jeff Regler Area Manager Associate Financial Analyst Sedgwick CMS ConAgra Foods, Inc. P. O. Box 540040 One ConAgra Drive, I-220 Omaha, NE 68154-0040 Omaha, NE 68102-5001 OFFICE: 402-963-2823 OFFICE: 402-595-4491 FAX: 402-496-9830 FAX: 402-517-3168 EMAIL: kcorcoran@sedgwickcms.com EMAIL: Rebecca_Schoff@ars.aon.com Linda_J_Smith@ars.aon.com mstefan@sedgwickcms.com Page 10 6/22/2009
SELF INSURED LIST PERMIT ANNIVERSARY DATE NAME OF PERMIT TPA OR LOCAL PERMIT HOLDER 482 01/01/00 COORSTEK, INC. Ms. Jan Olszewski Ondrea Matthews Sentry Insurance Company Risk Manager P. O. Box 29466 CoorsTek, Inc. Phoenix, AZ 85038-9466 16000 Table Mountain Parkway Golden CO 80403-1693 OFFICE: 480-860-7811 OFFICE: 303-271-7211 FAX: 480-860-7702 FAX: 303-271-7003 EMAIL: jan.olszewski@sentry.com EMAIL: omatthews@coorstek.com 483 01/01/00 COSTCO WHOLESALE CORPORATION Ms. Elaine Nevens Ms. Ann Loonam Supervisor Workers Compensation Program Administrator Sedgwick CMS Costco Wholesale Corporation 7400 East Orchard Road, Suite 4015 999 Lake Drive P. O. Box 5107 (80155-5107) Issaquah, WA 98027-8990 Greenwood Village, CO 80111-2518 P.O.Box14493 Lexington KY 40512-4493 OFFICE: 303-713-6035 OFFICE: 425-313-8547 800-507-9656 FAX: 425-313-8232 FAX: 303-713-6056 EMAIL: aloonam@costco.com EMAIL: enevens@sedgwickcms.com 976 01/01/81 DENVER, CITY & COUNTY Mr. Raymond F. Sibley Robin Gray Director, Risk Management 201 W. Colfax Ave #1105 §8-42-124 City and County of Denver City and County of Denver 201 West Colfax Avenue, Dept. 1105 201 West Colfax Avenue, Dept. 1105 Denver, CO 80202-5332 Denver, CO 80202-5332 OFFICE: 720-913-3330 OFFICE: 720-913-3330 FAX: 720-913-3184 FAX: 720-913-3184 EMAIL: Robin.Gray@ci.denver.co.us Page 11 6/22/2009
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Self insured list - Colorado Department of Labor and Employment

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