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 973 07/01/80 JEFFERSON COUNTY SCHOOL Ms. Sally Phillips Joel Hirschback DISTRICT R-1 Insurance Manager Insurance Manager Risk Management Department Risk Management Department Jefferson County School District R-1 Jefferson County School District R-1 §8-42-124 P. O. Box 4001 P. O. Box 4001 Golden, CO 80401-0001 Golden, CO 80401-0001 OFFICE: 303-982-2439 OFFICE: 303-982-2439 FAX: 303-982-2447 FAX: 303-982-2447 EMAIL: sphillip@jeffco.k12.co.us Ms. Sally Phillips jhirschb@jeffco.k12.co.us 840 01/01/92 KAISER FOUNDATION HEALTH PLAN Mr. John Walker Arne Haram, M.S. OF COLORADO Operations Manager Human Resources Department Sedgwick CMS Kaiser Foundation Health Plan of Colorado 7400 East Orchard Road, Suite 4015 10065 E Harvard Ave suite 400 Original P. O. Box 5107 (80155-5107) Denver, CO 80231 Anniversary Greenwood Village, CO 80111-2518 Date: 04/01/92 OFFICE: 303-713-6030 OFFICE: 303-614-1546 800-507-9656 FAX: 303-614-1495 FAX: 303-713-6056 arne.i.haram@kp.org EMAIL: jewalker@sedgwickcms.com 475 08/01/03 KNIGHT TRANSPORTATION, INC. Avizent/Frank Gates Company Mr. Brett Sant 5353 N 16th st Suite 250 Vice President, Safety Phoenix, AZ 85016-3225 Knight Transportation, Inc. 5601 West Buckeye Road Effective 11/1/08 Phoenix, AZ 85043-4603 Till 12/31/08 Leo Mccann OFFICE: 602-606-6218 OR 800-489-2000, x218 Ms. Michelle Murray Vice-President Avizent/Frank Gates Company FAX: 602-606-6118 Baldwin & Lyons, Inc. 5000 Bradenton Ave EMAIL: bsant@knighttrans.com 1099 North Meridian, Suite 700 Dublin OH 43017 Indianapolis, IN 46204-1036 614-791-7642 OFFICE: 317-636-9800, x320 614-932-8663 Fax FAX: 317-632-9444 "lmccann@avizentrisk.com Page 20 6/22/2009
SELF INSURED LIST PERMIT ANNIVERSARY DATE NAME OF PERMIT TPA OR LOCAL PERMIT HOLDER Lisa Olson Assistant Operations Manager 962 02/01/78 KROGER COMPANY, THE Mr. Tim Nockels Mr. Mark Gully Operations Manager Corporate Claims Manager Sedgwick CMS The Kroger Company 215 South State Street, Suite 420 1014 Vine st Salt Lake City, UT 84111-2326 Cincinnati, OH 45202-1100 Lisa 801-258-9751 OFFICE: 801-258-9712 OFFICE: 513-762-1507 FAX: 801-258-9730 FAX: 513-762- EMAIL: tim.nockels@sedgwickcms.com EMAIL: mark.gully@kroger.com lisa.olson@sedgwickcms.com 481 09/01/00 LABOR READY, INC. Janet Johnson Stephanie Vezina State Reporting Associate Risk Finance ESIS, Inc Labor Ready, Inc. 120 North 9th st P. O. Box 2910 Richmond, IN 47374 Tacoma, WA 98401-2910 OFFICE: 253-680-8484 OR 800-610-8920 Office: 765-983-6244 FAX: 253-502-5865 OR 800-850-9809 Fax: 765-983-6303 EMAIL: svezina@laborready.com janet.johnson@esis.com 896 01/01/87 LAKEWOOD, CITY OF Adusting claims in house effective 1/1/08 Mr. Ken Milano Department of Employee Relations §8-42-124 Risk Management Division Ms. Stacy Ross sross@ccmsi.com Dee Ann Pfifer City of Lakewood State Director City of Lakewood 480 South Allison Parkway CCMSI Risk Management Coordinator Lakewood, CO 80226-3123 7600 East Orchard Road, #360N Employee Relations P. O. Box 4998 (80155-4998) 303-987-7660 OFFICE: 303-987-7701 Greenwood Village, CO 80111-2518 FAX: 303-987-7712 FAX: 303-987-7712 deepfi@lakewood.org EMAIL: kenmil@lakewood.org CCMSI will adjust claims on or before 123107 deepfi@lakewood.org OFFICE: 303-804-2032 FAX: 303-804-2005 Page 21 6/22/2009
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Self insured list - Colorado Department of Labor and Employment

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