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 855 02/01/91 TARGET STORES CLAIMS 02/01/05 & FORWARD Ms. Susan Holt Ms. Judy Essen Sedgwick CMS Target Stores Custer Court 1 C/O Aon Risk Consultants, Inc. 501 West President George Bush Highway 8300 Norman Center Drive, Suite 400 Richardson, TX 75080-1132 Minneapolis, MN 55437-3844 OFFICE: 469-624-1000 OFFICE: 952-656-8290 FAX: 214-624-1010 FAX: 847-953-2851 EMAIL: sholt@sedgwickcms.com EMAIL: judy_essen@ars.aon.com CLAIMS PRIOR TO 02/01/05 Unit Manager (Ms. Elaine Nevens) Constitution States Service Company P. O. Box 173762 Denver, CO 80217-3762 OFFICE: 800-227-1538 FAX: 877-801-9674 EMAIL: 844 01/01/92 THORNTON, CITY OF Mr. Bill Rush, CPCU, ARM, AIC, AIS Ms. Chris Schneider FCC Services, Inc. Risk Management Administrator §8-42-124 7951 East Maplewood Avenue, Suite 225 City of Thornton Greenwood Village, CO 80111-4723 Civic Center 9500 Civic Center Drive Thornton, CO 80229-1220 OFFICE: 303-721-3265 OFFICE: 303-538-7303 FAX: 303-721-9202 FAX: 303-538-7522 EMAIL: bill.rush@fccservices.com EMAIL: chris.schneider@cityofthornton.net 838 04/01/92 TRI-STATE GENERATION & Ms. Elda M. de la Pena Ms. Elda M. de la Pena TRANSMISSION ASSOCIATION, INC. Tri-State Generation & Transmission Association, Inc. Tri-State Generation & Transmission Association, Inc. 1100 West 116th Street 1100 West 116th Street Westminster, CO 80234-2814 Westminster, CO 80234-2814 OFFICE: 303-254-3198 OFFICE: 303-254-3198 FAX: 303-254-6018 FAX: 303-254-6018 EMAIL: edelapena@tristategt.org EMAIL: edelapena@tristategt.org P.O.Box 33695 Denver CO 80233 P.O.Box 33695 Denver CO 80233 Page 32 6/22/2009
SELF INSURED LIST PERMIT ANNIVERSARY DATE NAME OF PERMIT TPA OR LOCAL PERMIT HOLDER 942 01/01/72 UNITED AIRLINES, INC. Ms. Cynthia Tucker Mr. John Smolk Branch Manager Manager §8-42-124 Gallagher Bassett Services, Inc. Workers' Compensation Program P. O. Box 4068 WHQHR Englewood, CO 80155-4068 United Airlines, Inc. P. O. Box 66100 Chicago, IL 60666-0100 OFFICE: 303-796-9494, x201 OFFICE: 847-700-7504 FAX: 720-493-3845 FAX: 847-700-5833 EMAIL: cynthia_tucker@gbtpa.com EMAIL: john.smolk@united.com 496 10/01/96 UNIVERSITY OF COLORADO Mr. Gary Longfellow Teena Shepperson University Risk Management Financial Analyst §8-42-124 University of Colorado University Risk Management 1800 Grant Street, Suite 700 University of Colorado Denver, CO 80203-1185 1800 Grant Street, Suite 700 Denver, CO 80203-1185 OFFICE: 303-860-5677 303-860-5712 FAX: 303-860-5680 FAX: 303-860-5680 EMAIL: gary.longfellow@cusys.edu teena.shepperson-turner@cu.edu 970 01/01/80 VAIL ASSOCIATES, INC. CLAIMS 08/01/05 & FORWARD Original Mr. Bruce Borner Mr. Craig George Anniversary Liberty Mutual Group Risk Management Date: 01/10/80 Helmsman Management Services, Inc. Vail Associates, Inc. 2100 Walnut Hill Lane P. O. Box 7 P. O. Box 168208 Vail, CO 81658-7000 Irving, TX 75016-8208 OFFICE: 800-300-0110, x2225 OFFICE: 303-404-1894 FAX: 603-334-8098 FAX: 303-404-6422 EMAIL: bruce.borner@libertymutual.com EMAIL: Ccathcart@vailresorts.com CLAIMS PRIOR TO 08/01/05 Ms. Wendy Garcia Account Manager CCMSI 7600 East Orchard Road, Suite 360N Greenwood Village, CO 80111-2518 OFFICE: 303-804-2020 FAX: 303-804-2005 EMAIL: wgarcia@ccmsi.com Page 33 6/22/2009
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Self insured list - Colorado Department of Labor and Employment

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