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 813 02/01/95 E. I. duPONT DeNEMOURS & COMPANY Mr. Mark DiLoreto Ms. Carole A. Carr Manager Insurance Administrator, Finance Broadspire, A Crawford Company E. I. duPont deNemours & Company §8-42-124 P. O. Box 5347 1007 Market Street, #D8065 Denver, CO 80217-5347 Wilmington, DE 19898-0001 OFFICE: 303-752-5420 OFFICE: 302-773-6473 800-321-9515 FAX: 302-773-3428 FAX: 303-752-5425 EMAIL: carole.a.carr@usa.dupont.com mark.diloreto@choosebroadspire.com 845 01/01/92 EL PASO COUNTY Bev Richmond Ms. Andrea McGee TriStar risk management Risk & Workers' Compensation Division Manager P O Box 5007 El Paso County Risk Management Bev Richmond Denver CO 80217-5007 27 East Vermijo Avenue, #560 TriStar risk management Colorado Springs, CO 80903-2010 P O Box 5007 Denver CO 80217-5007 OFFICE: 720-962-0222 or 888-538-9847 OFFICE: 719-520-7431 FAX: 720-962-0301 FAX: 719-520-7413 EMAIL: beverly.richmond@tristargroup.net EMAIL: andreamcgee@elpasoco.com OFFICE: 720-962-0222 FAX: 720-962-0301 na EMAIL: beverly.richmond@tristargroup.net nanenemerenda@elpasoco.com 869 11/01/89 EMERSON ELECTRIC CO. Mr. John Walker Ms. Linda Donahue Operations Manager Sr. Insurance Analyst Sedgwick CMS Emerson Electric Co. 7400 East Orchard Road, Suite 4015 8000 West Florissant Avenue P. O. Box 5107 (80155-5107) Building AA, Station 1918 Greenwood Village, CO 80111-2518 St. Louis, MO 63136-8506 OFFICE: 303-713-6030 OFFICE: 314-553-1918 800-507-9656 FAX: 314- 553-2463 FAX: 303-713-6036 EMAIL: linda.donahue@emrsn.com EMAIL: jewalker@sedgwickcms.com Page 14 6/22/2009
SELF INSURED LIST PERMIT ANNIVERSARY DATE NAME OF PERMIT TPA OR LOCAL PERMIT HOLDER 880 01/01/88 EXEMPLA, INC. Mr. John Walker Ms. Michelle Horning Operations Manager Occupational Health Services Original Sedgwick CMS Exempla, Inc. Anniversary 7400 East Orchard Road, Suite 4015 3655 Lutheran Parkway, Suite 407 P. O. Box 5107 (80155-5107) Wheat Ridge, CO 80022-6009 Date: 08/01/88 Greenwood Village, CO 80111-2518 OFFICE: 303-713-6030 OFFICE: 303-425-2603 800-507-9656 FAX: 303-467-8789 FAX: 303-713-6056 EMAIL: horningm@exempla.org EMAIL: jewalker@sedgwickcms.com 883 05/01/88 FEDERAL EXPRESS CORPORATION Ms. Debbie Baird Ms. Julia Stegall Claims Supervisor Federal Express Risk Management Sedgwick CMS Federal Express Corporation 7400 East Orchard Road, Suite 4015 3620 Hacks Cross Road P. O. Box 5107 (80155-5107) Building B, 3rd Floor Greenwood Village, CO 80111-2518 Memphis, TN 38125-8800 OFFICE: 303-713-6010 OFFICE: 901-434-4557 800-507-9656 FAX: 901-434-4585 FAX: 303-713-6056 EMAIL: jgstegall@fedex.com EMAIL: dbaird@sedgwickcms.com 464 02/01/06 FEDERATED DEPARTMENT STORES, INC. Mr. Tom Conrad Mr. Ron Godfrey Workers' Compensation Manager Director, Risk Management Macy's (Federated Department Stores), Inc. Macy's (Federated Department Stores), Inc. Name Change to Macy's, inc. effective 6/1/07 7 West Seventh Street 7 West Seventh Street Cincinnati, OH 45202-2424 Cincinnati, OH 45202-2424 OFFICE: 513-579-7996 OFFICE: 513-579-7628 FAX: 513-579-7115 FAX: 513-579-7174 EMAIL: tom.conrad@fds.com EMAIL: ron.godfrey@fds.com ron.godfrey@macys.com tom.conrad@macys.com Page 15 6/22/2009
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Self insured list - Colorado Department of Labor and Employment

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