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SELF-INSURED EMPLOYER LIST 24-Sep-13 STATE OF NEVADA DEPARTMENT OF BUSINESS AND INDUSTRY DIVISION OF INSURANCE C of A # Employer Name/DBA Self-Insured Contact Third Party Administrator Subsidiary DBA Eff. Date 397 AFFINITY GAMING See Addendum 1/1/2011 Elizabeth Guth V.P. Of Insurance and Benefits Affinity GAMING LLC 3755 Breakthrough Way Suite 300 Las Vegas NV 89135 (702) 341-2419 Certification Date: SIERRA NEVADA ADMINISTRATORS Michele Taylor 2716 N. Tenaya Way, 5th FL Las Vegas NV 89114-5750 (702) 240-8935 The Primadonna Company, LLC 3/1/2012 Primm Valley Resort and Casino Flamingo Paradise Gaming LLC 7/1/2013 Silver Sevens Hotel & Casino Affinity Gaming 1/1/2011 The Primadonna Company, LLC 3/1/2012 Whiskey Pete's Hotel and Casino The Primadonna Company, LLC 3/1/2012 Buffalo Bill's Resort and Casino Plantation Investments, LLC 3/1/2012 Rail City Casino Flamingo Paradise Gaming, LLC 7/1/2013 Henderson Casino Bowl 106 AMERISTAR CASINOS, INC. 10/1/1990 Karen Burris Benefits Manager AMERISTAR CASINOS INC 3773 Howard Hughes Parkway, Ste 4 90 South Las Vegas NV 89169 (702) 567-7060 Certification Date: SEDGWICK CLAIMS MANAGEMENT SERVICES, INC. Richard Gomez P O Box 34660 Las Vegas NV 89133 702-568-3750 Ameristar Casinos, Inc. 4/1/1994 The Horseshu 10/1/1990 Cactus Pete's Resort Casino 10/1/1990 Cactus Pete's Inc. 10/1/1990 1

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SELF-INSURED EMPLOYER LIST24-Sep-13

STATE OF NEVADADEPARTMENT OF BUSINESS AND INDUSTRYDIVISION OF INSURANCE

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

397 AFFINITY GAMINGSee Addendum

1/1/2011

Elizabeth GuthV.P. Of Insurance and Benefits

Affinity GAMING LLC3755 Breakthrough Way Suite 300Las Vegas NV 89135(702) 341-2419

Certification Date:

SIERRA NEVADA ADMINISTRATORS

Michele Taylor2716 N. Tenaya Way, 5th FLLas Vegas NV 89114-5750(702) 240-8935

The Primadonna Company, LLC 3/1/2012Primm Valley Resort and Casino

Flamingo Paradise Gaming LLC 7/1/2013Silver Sevens Hotel & Casino

Affinity Gaming 1/1/2011

The Primadonna Company, LLC 3/1/2012Whiskey Pete's Hotel and Casino

The Primadonna Company, LLC 3/1/2012Buffalo Bill's Resort and Casino

Plantation Investments, LLC 3/1/2012Rail City Casino

Flamingo Paradise Gaming, LLC 7/1/2013Henderson Casino Bowl

106 AMERISTAR CASINOS, INC.

10/1/1990

Karen BurrisBenefits Manager

AMERISTAR CASINOS INC3773 Howard Hughes Parkway, Ste 490 SouthLas Vegas NV 89169(702) 567-7060

Certification Date:

SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Richard GomezP O Box 34660Las Vegas NV 89133702-568-3750

Ameristar Casinos, Inc. 4/1/1994

The Horseshu 10/1/1990

Cactus Pete's Resort Casino 10/1/1990

Cactus Pete's Inc. 10/1/1990

1

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

55 ARCHON CORPORATION

8/15/1982

David LowdenExecutive Office Administrator

ARCHON CORPORATION3221 S Torrey PinesLas Vegas NV 89146(702) 429-6742

Certification Date:

SIERRA NEVADA ADMINISTRATORS

Michele Taylor2716 N. Tenaya Way, 5th FLLas Vegas NV 89114-5750(702) 240-8935

Pioneer Hotel Inc. 9/15/1989Pioneer Hotel & Gambling Hall

45 ARKANSAS BEST CORPORATION

12/15/1981

Allen KingWorkers Comp Manager

ABF FREIGHT SYSTEMS3801 Old Greenwood Rd.Fort Smith AR 72903(479) 785-6218

Certification Date:

GALLAGHER BASSETT SERVICES, INC.

Charles Rostad2110 East Flamingo Rd #314Las Vegas NV 89119-0834(866)-889-4755

E-T-M-F Terminals 10/18/1982

ABF Freight Systems 12/15/1981

Cardinal Freight Lines 10/1/1995

326 BEST BUY CO INCBEST BUY STORES LP

12/1/1997

Rebecca SchoffConsultant

Aon Global Risk Consulting for Besy Buy5600 W. 83rd Street, Tower Ste 1100Minneapolis MN 55437952-807-0693

Certification Date:

GALLAGHER BASSETT SERVICES, INC.

Charles Rostad2110 East Flamingo Rd #314Las Vegas NV 89119-0834(866)-889-4755

2

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

52 BOYD GAMING CORPORATION

7/1/1981

Juliet VestalDirector of Benefits & Risk ManagementDirector of Benefits & Risk Management6465 South Rainbow BlvdLas Vegas NV 89118(702) 692-4156

Certification Date:

CANNON COCHRAN MANAGEMENT SERVICES (CCMSI)

Brigid WyszomirskiPO BOX 35350Las Vegas NV 89133-5350(702) 933-4800

Coast Hotel & Casino 1/1/1996

ETN Development Corporation 11/17/2004

Sam-Will, Inc. 7/1/1981Fremont Hotel and Casino

California Hotel & Casino 8/1/1982Sam's Town Hotel, Gambling Hall

Boyd Gaming Corporation 11/1/1990

Rodney Petroleum, Inc. 9/4/1992Downtown Texaco Station

The SunCoast Hotel & Casino 4/1/2000

California Hotel & Casino 8/1/1982California Hotel and Casino

Boyd Development Corporation 10/1/1995

Coast Vacations 8/13/1999

Orleans Hotel & Casino, The 2/12/1996

Gold Coast Hotel & Casino 2/1/1989

Boyd Shared Services, Inc. 6/1/2007

ETN Productions, Inc. 5/1/1994

Echelon Resorts LLC 12/1/2005

Eldorado, Inc. 8/1/1982Eldorado Casino

Boyd Travel, Inc. 10/1/1995Vacations-Hawaii

Boyd Central Region, Inc. 2/1/1996

M.S.W., Inc. 8/15/1995Main Street Station Hotel, Casino

Boyd Atlantic City, Inc. 1/1/1999

Constellation Insurance Company 7/1/2005

Echelon Resorts Corporation 12/1/2005

Eldorado, Inc. 1/1/1993Jokers Wild Casino

Mare-Bear, Inc. 7/1/1981Stardust Resort and Casino

3

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

11 CAESARS ENTERTAINMENT CORPORATIONformerly Harrah's

8/15/1980

Micki K Jordan, CICManager, Risk & Insurance

HARRAHS ENTERTAINMENT INC1 Caesars Palace DriveLas Vegas NV 89109(702) 407-6272

Certification Date:

CANNON COCHRAN MANAGEMENT SERVICES (CCMSI)

Brigid WyszomirskiPO BOX 35350Las Vegas NV 89133-5350(702) 933-4800

Harrah's Reno/Tahoe 8/15/1980

Bill's Casino 7/1/1987

Harrah's Las Vegas 6/1/1983

Harrah's Laughlin 4/28/1988

Rio Hotel & Casino Inc 6/1/1992

Bill's Gambling Hall & Saloon 2/27/2007

PHW Las Vegas, LLC 6/1/2013

Caesars Entertainment Inc 7/12/1980

Harveys Tahoe Management Co. 8/1/2001

Imperial Palace Casino Inc 2/8/1981

393 CARSON CITY

7/1/2010

Cecilia MeyerRisk Management Coordinator

CARSON CITY FINANCE DIVISION201 North Carson Street Ste 3Carson City NV 89701(775) 283-7484

Certification Date:

CANNON COCHRAN MANAGEMENT SERVICES (CCMSI)

Brigid WyszomirskiP O BOX 20068Reno NV 89515-0068(775) 324-3301 x 1011

394 CARSON CITY SCHOOL DISTRICT

7/1/2010

Amanda PrudhommeHR/Workers' Comp

CARSON CITY SCHOOL DISTRICT1402 West King StreetCarson City NV 89702(775) 283-2004

Certification Date:

NELSON DAVISON ADMINISTRATORS INC

Tom Nelson9855 DoubleR Blvd Ste 105/PO Box 12338Reno NV 89521(775) 825-9299 x 1

4

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

383 CATHOLIC CHARITIES OF SOUTHERN NEVADA

1/1/2006

Linda SummersHuman Resource Director

CATHOLIC CHARITIES OF SOUTHERN NV1501 Las Vegas Blvd NorthLas Vegas NV 89101(702) 385-2662

Certification Date:

NEVADA ALTERNATIVE SOLUTIONS, INC.

Charles R Nort9506 West Flamingo Rd Suite 102Las Vegas NV 89147(702) 796-1333 ext 228

199 CEDAR ENTERPRISES INCWENDY'S OF LAS VEGAS

1/1/1994

Deborah S HarmonDirector Human Resources

CEDAR ENTERPRISES INC1328 Dublin Road Ste 300Columbus OH 43215-1054(614) 787-7804

Certification Date:

SIERRA NEVADA ADMINISTRATORS

Michele Taylor2716 N. Tenaya Way, 5th FLLas Vegas NV 89114-5750(702) 240-8935

Cedar Bon Bakeries, Ltd. 9/10/2001

Wendy's of Las Vegas, Inc. 1/1/1994

169 CITY OF HENDERSON

4/1/1993

Amy M. L. WongSenior Disability Analyst

CITY OF HENDERSONP O Box 95050-MS 137Henderson NV 89009-5050(702) 267-1921

Certification Date:

CANNON COCHRAN MANAGEMENT SERVICES (CCMSI)

Brigid WyszomirskiPO BOX 35350Las Vegas NV 89133-5350(702) 933-4800

78 CITY OF LAS VEGAS

12/29/1985

Kelly LeermanRisk Manager

CITY OF LAS VEGAS495 S. Main St.Las Vegas NV 89101(702) 229-5043

Certification Date:

CITY OF LAS VEGAS

Victoria J Robinson, Ins Svcs400 East Stewart AvenueLas Vegas NV 89101-2986(702)229-5043

5

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

197 CITY OF NORTH LAS VEGAS

1/1/1994

Darlene RosenbergPrincipal Benefits Analyst

CITY OF NORTH LAS VEGAS2250 Las Vegas Blvd NorthNorth Las Vegas NV 89030(702) 633-2124

Certification Date:

CANNON COCHRAN MANAGEMENT SERVICES (CCMSI)

Brigid WyszomirskiPO BOX 35350Las Vegas NV 89133-5350(702) 933-4800

147 CITY OF RENO

9/1/1992

Renee RungisDirector of Human Resources

CITY OF RENOPO Box 1900Reno NV 89505(775) 785-5854

Certification Date:

CANNON COCHRAN MANAGEMENT SERVICES (CCMSI)

Brigid WyszomirskiP O BOX 20068Reno NV 89515-0068(775) 324-3301 x 1011

163 CITY OF SPARKS

2/1/1993

Jill ValdezHuman Resources Analyst

CITY OF SPARKS431 Prater WaySparks NV 89431(775) 353-4021

Certification Date:

CANNON COCHRAN MANAGEMENT SERVICES (CCMSI)

Brigid WyszomirskiP O BOX 20068Reno NV 89515-0068(775) 324-3301 x 1011

6

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

399 CITYCENTER HOLDINGS, LLC

11/30/2011

Tina SanchezDirector of Workers' Compensation

MGM Resorts International3260 Industrial RoadLas Vegas NV 89109(702) 692-9586

Certification Date:

MGM MIRAGE RISK MANAGEMENT

Tina Sanchez3260 So Industrial RoadLas Vegas NV 89109(702) 650-7443

ARIA RESORTS AND CASINO LLC 11/30/2011

PROJECT CC, LLC 11/30/2011

CITY CENTER REALTY CORPORATIO 11/30/2011

THE CRYSTALS AT CITY CENTER MA 11/30/2011

75 CLARK COUNTY

7/15/1985

Sandra SwickardAsst. County Manager

CLARK COUNTY RISK MGMT & SAFETY500 S Grand Central Pkwy, 5th Fl.Las Vegas NV 89106(702)455-5524

Certification Date:

SIERRA NEVADA ADMINISTRATORS

Michele Taylor2716 N. Tenaya Way, 5th FLLas Vegas NV 89114-5750(702) 240-8935

McCarran International Airport 7/15/1985

University Medical Center 8/1/1986

Volunteer Account (Ambulance & Fireme 4/1/1986

104 CLARK COUNTY SCHOOL DISTRICT

7/1/1990

Roque Lapuz JrWorkers Comp Coordinator

CLARK COUNTY SCHOOL DISTRICT4828 S. Pearl Street MS 200Las Vegas NV 89121(702) 799-0060 X5601

Certification Date:

CLARK COUNTY SCHOOL DISTRICT

Nancy Powell, W/C Claims Mgr4204 Channel 10 Drive-Risk MgtLas Vegas NV 89146(702) 799-2967 ext 5626

7

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

115 CLARK COUNTY WATER RECLAMATION DISTRICT

4/1/1992

Martin J FlynnAssistant to General Manager

CLARK COUNTY WATER RECLAMATION DISTRICT5857 East Flamingo RoadLas Vegas NV 89122(702) 668-8066

Certification Date:

NELSON DAVISON ADMINISTRATORS INC

Tom Nelson9855 DoubleR Blvd Ste 105/PO Box 12338Reno NV 89521(775) 825-9299 x 1

154 COSTCO WHOLESALE CORPORATION

1/1/1993

Anthony StoverWorkers Comp Data Analyst

COSTCO COMPANIES INC999 Lake DriveIssaquah WA 98027425-313-8503

Certification Date:

HELMSMAN MANAGEMENT SERVICES LLC

Alma Larios7881 W Charleston Blvd, Suite 190Las Vegas NV 89117(800) 593-1004 x35242

Costco Wholesale Corporation 1/1/1993

8

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

347 CREATIONS MEANDRES INCformerly cirque du soleil

2/1/1999

Mary SpeesSr. Director of Human Resources

CIRQUE DU SOLEIL980 Kelly Johnson Drive Suite 200Las Vegas NV 89119(702) 352-0190

Certification Date:

SIERRA NEVADA ADMINISTRATORS

Michele Taylor2716 N. Tenaya Way, 5th FLLas Vegas NV 89114-5750(702) 240-8935

Cirque du Soleil Perception, LLC 11/24/2003

Cirque du Soleil Zumanity, LLC 6/24/2003

Cirque EPE Las Vegas LLC 4/27/2009

Cirque du Soleil, Inc. 2/1/1999

Cirque du Soleil (US), Inc. 2/1/1999

Cirque du Soleil Holding USA, Inc. 2/1/1999

Cirque Apple Administration, LLC 12/5/2005

Cirque du Soleil Illusion LLC 11/16/2006

Cirque du Soleil "O", LLC 12/29/2003

Cirque du Soleil Radio CT.L.L.C. 10/9/2012

Cirque du Soleil My Call L.L.C. 2/18/2013

Cirque du Soleil Nevada, Inc. 2/1/1999

361 DIGNITY HEALTHchanged name from Catholic Healthcare West

10/1/2000

Terri KielhornVP, Risk Services

DIGNITY HEALTH185 Berry Street Suite 300San Francisco CA 94107(415)438-5530

Certification Date:

SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Peggy Harper102 E. Lake Mead DriveHenderson NV 89015(702) 616-4445

Saint Mary's Preferred Health Insurance 3/1/1997

Nevada Physician's Choice 10/1/2000

St Rose Dominican Health Foundation 10/1/2000

Saint Mary's Regional Medical Center 10/24/1980

St Rose Dominican Hospital - San Martin 8/1/2006

Saint Mary's Healthfirst 3/1/1997

St Rose Dominican Hospital 10/1/2000St. Rose Dominican Hospital, Sien

9

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

216 DOUGLAS COUNTY SCHOOL DISTRICT

7/1/1994

Holly LunaCFO, Business Services

DOUGLAS COUNTY SCHOOL DISTRICT1638 Mono Ave.Minden NV 89423(775)782-7177

Certification Date:

CANNON COCHRAN MANAGEMENT SERVICES (CCMSI)

Brigid WyszomirskiP O BOX 20068Reno NV 89515-0068(775) 324-3301 x 1011

323 EBSCO INDUSTRIES INC

10/1/1997

Heather MooreAssistant Vice President/Acctg. Mgr.

VALLEY JOIST INCP O Box 1943Birmingham AL 35201(205) 991-1473

Certification Date:

NELSON DAVISON ADMINISTRATORS INC

Tom Nelson9855 DoubleR Blvd Ste 105/PO Box 12338Reno NV 89521(775) 825-9299 x 1

Valley Joist, Inc. (aka Valley Joist West) 10/1/1997

58 ELDORADO RESORTS LLCELDORADO HOTEL & CASINO

11/1/1982

Robert Bruce MackayDirector of Administration

ELDORADO HOTEL & CASINO345 North Virginia StreetReno NV 89501(775) 786-5700 ext 7656

Certification Date:

NELSON DAVISON ADMINISTRATORS INC

Tom Nelson9855 DoubleR Blvd Ste 105/PO Box 12338Reno NV 89521(775) 825-9299 x 1

192 ELKO COUNTY SCHOOL DISTRICT

11/1/1993

Mike SmithAssistant Superintendent

ELKO COUNTY SCHOOL DISTRICTP O Box 1012Elko NV 89801(775) 738-5196

Certification Date:

ALTERNATIVE SERVICES CONCEPTS LLC

Mike Livermore1755 East Plumb Lane #148Reno NV 89502(775)329-1181

10

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

285 FEDEX CORPORATION (PARENT)(GROUND)FEDEX GROUND PACKAGE SYSTEM Inc

8/1/1996

Thomas P Dittoe Sr Manager Workers Compensation

FEDEX GROUND PACKAGE SYSTEM INCP O Box 535859Moon Twp. PA 15108(412) 747-8318

Certification Date:

BROADSPIRE SERVICES INC.

Amy KelleyPO Box 30670Las Vegas NV 89173(702)242-3020

FedEx Ground Package System, Inc. 8/1/1996Formerly RPS, Inc.

29 FEDEX CORPORATION FOR FEDERAL EXPRESS CORPFormerly FDX Corporation

4/1/1981

Julia StegallSr. Risk & Insurance Analyst

FEDERAL EXPRESS CORPORATION3620 Hacks Cross Road Bldg B 3rd FloorMemphis TN 38125-8800(901) 434-4557

Certification Date:

SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Richard GomezP O Box 34660Las Vegas NV 89133702-568-3750

Federal Express Corporation 4/1/1981

120 FEDEX CORPORATION FOR FEDEX FREIGHT INCFormerly FDX Corporation

11/1/1991

Kayla QuandtRisk Management Advisor

FEDEX FREIGHT INC2200 Forward Drive DC2256Harrison AR 72601(870) 704-5187

Certification Date:

SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Richard GomezP O Box 34660Las Vegas NV 89133702-568-3750

FedEx Freight Inc. 11/1/1991

174 FOUR QUEENS, LLCFOUR QUEENS HOTEL & CASINO

6/1/1993

Brian R. ArlinVP/Secretary/Treasurer

FOUR QUEENS HOTEL & CASINO202 East Fremont StreetLas Vegas NV 89101(702)366-7382

Certification Date:

NEVADA ALTERNATIVE SOLUTIONS, INC.

Charles R Nort9506 West Flamingo Rd Suite 102Las Vegas NV 89147(702) 796-1333 ext 228

TLC Casino Enterprises Inc 1/1/2008

11

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

400 FP HOLDINGS LLPPALMS CASINO HOTEL; fka Fiesta Palms LLC

12/23/2011

Cheryl KabesAnalyst - Aon Global Risk Consulting

AON GLOBAL RISK CONSULTING5600 W. 83rd Street; 8200 Tower, Suite 1100Minneapolis MN 55437(952)807-0661

Certification Date:

HELMSMAN MANAGEMENT SERVICES LLC

Alma Larios7881 W Charleston Blvd, Suite 190Las Vegas NV 89117(800) 593-1004 x35242

NM Ventures LLC 11/30/2011

Palms Place, LLC 11/30/2011

Little Buddah Café Las Vegas 11/30/2011

PPII Holdings, llc 11/30/2011

NM Ventures II LLC 11/30/2011

141 FRIAS HOLDING COMPANYABC UNION CAB COMPANY

7/1/1992

John HickmanChief Operating Officer

ABC UNION CAB COMPANY5010 South Valley View BlvdLas Vegas NV 89118(702) 798-3400 x2727

Certification Date:

R. A. WONG & ASSOCIATES

Paul Wong5110 S Valley View Blvd, Suite 100Las Vegas NV 89118(702)798-8910

Windmill Ridge, LLC 1/15/2010

A-NLV Cab Company 1/1/1996Las Vegas Limousines

A Cowboy's Dream Bed & Breakfast, LLC 1/15/2010

Virgin Valley Cab Company, Inc. 8/1/1994A-Virgin Valley Cab Co.

Vegas Western Cab Company 7/1/1992

Ace Cab Company 7/1/1992

Oxford Technologies, Inc. 7/1/1999El Mirador Motel

A-NLV Cab Company 7/1/1992

Airline Limousine Corporation 4/1/2000

12

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

288 GANNETT CO INC

10/1/1996

Michael J. BaglioConsultant

GANNETT CO INC5600 West 83rd Street, 8200 Tower Suite 1100Minneapolis MN 55437(952) 807-0620

Certification Date:

CONSTITUTION STATE SERVICES LLC

Brandi Lee7450 Arroyo Crossing Pkwy, Ste 200Las Vegas NV 89113-4081(702) 479-4218 x 94218

GCOE, LLC 10/1/2010

Gannett Publishing Services, LLC 1/1/2012

Reno Newspapers, Inc. 10/1/1996

Gannett International Commumications, I 4/17/2000

The Spectrum; Div of Gannett Satellite In 7/21/2000

USA Today; Div of Gannett Satellite Info 10/1/1996

Gannett Pacific Publications, Inc. 10/1/2007

Gannett Satellite Information Network, In 10/1/1996

386 GAUGHAN SOUTH LLCSOUTH POINT HOTEL & CASINO

10/25/2006

Heather HallRisk Manager

SOUTH POINT HOTEL & CASINO9777 Las Vegas Blvd SouthLas Vegas NV 89183(702) 797-8245

Certification Date:

NEVADA ALTERNATIVE SOLUTIONS, INC.

Charles R Nort9506 West Flamingo Rd Suite 102Las Vegas NV 89147(702) 796-1333 ext 228

380 GOLDEN NUGGET INCGOLDEN NUGGET HOTEL & CASINO

1/23/2004

Lea Ann LopezAssociate Director Risk Management

GOLDEN NUGGET HOTEL & CASINO1510 W Loop SouthHouston TX 77027(713) 386-7202

Certification Date:

CORVEL CORPORATION

Roger Steffen3900 Paradise Road, Ste 182Las Vegas NV 89169(702) 699-7020

GNLV, Corp. 1/23/2004

GNL, Corp 1/23/2004

13

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

182 HAMILTON HOLDING MANAGEMENT CORP

7/1/1993

Carolyn CooperHuman Resources Generalist II

HAMILTON HOLDING MGT CORP4990 Energy WayReno NV 89502(775) 858-3000 ext 284

Certification Date:

HOMETOWN HEALTH PARTNERS INC

Michele Chapman830 Harvard WayReno NV 89502(775) 982-3049

Hamilton Company 7/1/1993

Standard Pneumatic 7/1/1993

114 HAT LTD A NEVADA LIMITED PARTNERSHIPMANPOWER TEMPORARY SERVICES

3/1/1992

Mike HarriganPresident Harrigan Enterprises, Inc.

MANPOWER TEMPORARY SERVICES1155 West 4th Street Suite 223Reno NV 89503(775) 328-6020

Certification Date:

HAT LTD DBA/MANPOWER TEMPORARY SERVICES

Leslie Bell-W/C Rep1155 West 4th Street, Suite 223Reno NV 89503(775) 328-6020

14

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

165 HCA HOLDINGS, INC.formerly Columbia/HCA Healthcare

1/1/1986

Carrie A BinkleySenior Compliance Analyst

HCA INCOne Park Plaza Bldg II-4ENashville TN 37203(615) 344-1487

Certification Date:

BROADSPIRE SERVICES INC.

Amy KelleyPO Box 30670Las Vegas NV 89173(702)242-3020

Central Shared Services LLC 8/1/2007Far West Supply Chain

HCA IT&S Field Operations, Inc 5/11/2008IT&S Far West Service Center

Nevada Psychiatric Company, Inc. 8/1/1994

CosCorp, LLC 4/23/1999

Sunrise Physician Services, LLC 9/1/2009

Sun-Med, LLC 1/14/2005

Tennessee Healthcare Management Inc 3/1/2005

All About Staffing, Inc. 7/1/2002

Sunrise Trauma Services, LLC 2/11/2005

Healthcare Sales National Management 9/1/2009

Las Vegas Surgicare, Inc. 12/1/1994

Sahara Outpatient Surgery Center, Ltd. 12/1/1994

CHC Payroll Corporation 8/1/1994

Southern Hills Medical Center, LLC 3/1/2004

CHC Venture Co. 8/1/1994

Specialty Surgicare of Las Vegas, LP 7/16/2005

Las Vegas ASC, LLC 7/29/2005

HCA, Inc. 1/1/1986

Sunrise Mountainview Hospital, Inc. 1/1/1996

HSS Systems, LLC 5/1/2002Far West Supply Chain

HCA Management Services, LP 4/26/1999

HSS Systems, LLC 3/1/2001HCA Patient Account Services

Sunrise Flamingo Surgery Center, LP 1/30/1997

Surgicare of Las Vegas, Inc. 10/1/1992

Sunrise Hospital & Medical Center, LLC 3/1/1993

15

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

Sunrise Neuro Sciences, LLC 12/1/2007Nevada Neuro Sciences

Galen Health Care, Inc. 3/1/1993

136 HCR MANORCARE, INC.

7/1/1992

Lisa JurskiSr Mgr Workers Comp Program

HCR MANOR CARE INC, MANOR CARE, INC.333 N Summit StreetToledo OH 43699-0086(419) 254-5416

Certification Date:

BROADSPIRE SERVICES INC.

Amy KelleyPO Box 30670Las Vegas NV 89173(702)242-3020

HCR Manor Care Services, LLC 12/31/2011

Heartland Employment Services, LLC 1/1/2002

107 HEALTHSOUTH CORPORATION

10/1/1990

Josh BeamRisk Management Finance Manager

HEALTHSOUTH CORPORATION3660 Grandview Parkway Ste 200Birmingham AL 35243(205) 968-6206

Certification Date:

YORK CLAIM SERVICES FORMERLY MEDCOMP

Yvette Bouldin9085 W Post Road #100Las Vegas NV 89148(702) 727-2161

HEALTHSOUTH Corporation 12/1/1997

Rehabilitation Hospital of Nevada 2/1/1996

HEALTHSOUTH Surgery Center of Reno 7/1/1998

HEALTHSOUTH Valley View Surgery Ce 7/22/1998

HEALTHSOUTH Rehabilitation Hospital o 10/1/2001

Desert Canyon Rehabilitation Hospital 6/1/2010

HEALTHSOUTH Surgery Center 7/1/1998

Reno Rehabilitation Association 2/1/1996

16

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

129 HOME DEPOT USA INC

8/1/1992

Michelle CaseyRisk Analyst

HOME DEPOT USA INC2455 Paces Ferry Road Bldg. C-20Atlanta GA 30339(770) 433-8211 Ext. 85195

Certification Date:

HELMSMAN MANAGEMENT SERVICES LLC

Alma Larios7881 W Charleston Blvd, Suite 190Las Vegas NV 89117(800) 593-1004 x35242

HD Supply, Inc. 5/31/2005White Cap Construction Supply In

Grand Floor Designs Inc 1/31/2005

HD Supply, Inc. 3/31/2006HD Supply Management, Inc

Your "other" Warehouse 7/27/2004

THD At-Home Service, Inc. 7/1/2006

HD Supply, Inc. 6/30/2005HD Supply Distribution Services, L

U.S. Remodelers, Inc. 10/1/2012

U.S. Home Systems, Inc. 10/1/2012

HD Supply, Inc. 8/25/2005HD Supply Waterworks Group, Inc

THD At-Home Services, Inc. 10/1/2012

402 HRHH GAMING SENIOR MEZZ, LLCHARD ROCK HOTEL

3/1/2011

Marlo VandemoreCFO

HRHH Gaming Senior Mezz, LLC4455 Paradise RdLas Vegas NV 89169(702) 693-5062

Certification Date:

YORK CLAIM SERVICES FORMERLY MEDCOMP

Yvette Bouldin9085 W Post Road #100Las Vegas NV 89148(702) 727-2161

403 HUMBOLDT COUNTY SCHOOL DISTRICT

7/1/2012

David Jensen, Dr.Assisstant Superintendent

HUMBOLDT COUNTY SCHOOL DISTRICT310 East Fourth StWinnemucca NV 89445775-623-8100

Certification Date:

NELSON DAVISON ADMINISTRATORS INC

Tom Nelson9855 DoubleR Blvd Ste 105/PO Box 12338Reno NV 89521(775) 825-9299 x 1

17

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

338 HYATT HOTELS CORPORATION

2/1/1998

Jennifer HerzfeldRisk Manager-Risk Management

HYATT HOTELS CORPORATION17 S Wacker Drive Floor 17Chicago IL 60606(312)-780-5861

Certification Date:

GALLAGHER BASSETT SERVICES, INC.

Charles Rostad2110 East Flamingo Rd #314Las Vegas NV 89119-0834(866)-889-4755

Hyatt Corporation 2/1/1998

Select Hotels Group, LLC 1/5/2008

Hyatt Residential Group, Inc. 11/1/2012

63 IKE GAMING INCEL CORTEZ HOTEL & CASINO

10/9/1983

Joe WoodyChief Financial Officer

`107 North 6th Street 3rd FloorLas Vegas NV 89101(702) 474-3613

Certification Date:

NEVADA ALTERNATIVE SOLUTIONS, INC.

Charles R Nort9506 West Flamingo Rd Suite 102Las Vegas NV 89147(702) 796-1333 ext 228

99 INTERNATIONAL GAME TECHNOLOGY

9/15/1989

Sharolyn P WilsonWorkers Compensation Analyst

IGT9295 Prototype DriveReno NV 89521(775) 448-0411

Certification Date:

INTERNATIONAL GAME TECHNOLOGY

Sharolyn Wilson9295 Prototype DriveReno NV 89521(775) 448-0411

IGT-International 10/1/1993

IGT & Subs 9/1/1990

18

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

152 INTERNATIONAL PAPER COMPANY

1/1/1993

Penny HumphreyAdministrator, Insurance Program

INTERNATIONAL PAPER COMPANY6400 Poplar Ave Tower III, 4-110Memphis TN 38197(901) 419-3938

Certification Date:

SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Richard GomezP O Box 34660Las Vegas NV 89133702-568-3750

LLford Photo Corp. 1/1/1993

Dixon Paper Company 1/1/1993

Western Paper Company 1/1/1993

356 JOURNAL COMMUNICATIONS INCKTNV-TV Channel 13

10/1/1999

Jeffrey KlueverRisk Manager

JOURNAL COMMUNICATIONS INC333 West State StreetMilwaukee WI 53203(414) 224-2702

Certification Date:

GALLAGHER BASSETT SERVICES, INC.

Charles Rostad2110 East Flamingo Rd #314Las Vegas NV 89119-0834(866)-889-4755

Journal Broadcast Corporation 10/1/1999KTNV-TV Channel 13

119 KENNAMETAL INC (PARENT)KENNAMETAL INC NEVADA DIVISION

10/1/1991

Michael P MurphyManager Prop & Casualty Claims

KENNAMETAL INC1600 Technology Way, PO Box 231Latrobe PA 15650(724) 539-4647

Certification Date:

NEVADA ALTERNATIVE SOLUTIONS, INC.

Charles R Nort9506 West Flamingo Rd Suite 102Las Vegas NV 89147(702) 796-1333 ext 228

Tricon 7/1/2009

19

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

357 KIEWIT CORPORATION

11/1/1999

Debra L ProchaskaClaims Analyst

KIEWIT CORPORATION1000 Kiewit PlazaOmaha NE 68131(402) 271-2862

Certification Date:

SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Richard GomezP O Box 34660Las Vegas NV 89133702-568-3750

Kiewit Industrial Co. 11/1/1999

Kiewit Western Co. 11/1/1999

Lake Mead Constructors 11/1/1999

Kiewit Infrastructure Co. 11/1/1999

Gilbert Western Corp. 11/1/1999

Aero Automatic Sprinkler Company 8/26/2009

Continental Fire Sprinkler Company 2/26/2009

Tpac, A Division of Kiewit Western 11/1/1999

TIC-The Industrial Company 12/29/2008

Western Summit Constructors, Inc. 12/29/2008

Kiewit Infrastructure West Co. 9/1/2012

122 KINROSS GOLD CORPORATION

12/1/1991

Bridgett GraySafety Dept. Clerk

ROUND MOUNTAIN GOLDP O Box 480Round Mountain NV 89045(775) 377-3149

Certification Date:

PINNACLE RISK MANAGEMENT SERVICES INC

Su Crawford4055 Spencer St Ste 102Las Vegas NV 89119(877) 219-9395

Round Mountain Gold Corp 12/1/1991

Echo Bay Minerals Company 12/1/1991

20

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

382 KNIGHT TRANSPORTATION INC

10/1/2004

Todd CantrillDir. Workers' Compensation

KNIGHT TRANSPORTATION5601 West Buckeye RoadPhoenix AZ 85043(602) 269-2000

Certification Date:

YORK CLAIM SERVICES FORMERLY MEDCOMP

Yvette Bouldin9085 W Post Road #100Las Vegas NV 89148(702) 727-2161

44 KROGER COMPANY

11/1/1981

Nathan FraleyCorporate Assistant Claims Manager

THE KROGER CO1014 Vine Street 17th FloorCincinnati OH 45202(513) 762-4360

Certification Date:

SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Richard GomezP O Box 34660Las Vegas NV 89133702-568-3750

Ralphs Grocery Company 3/19/2001Food 4 Less

Fred Meyer Jewelers 11/15/1998

Smith's Food & Drug Centers, Inc. 11/1/1981Price Rite Stores

Quik Stop Markets, Inc. 10/11/2001

Fred Meyer, Inc. 9/9/1997

369 LAS VEGAS CONVENTION & VISITORS AUTHORITY

7/1/2002

Timothy CallawayBenefits Coordinator

LAS VEGAS CONVENTION & VISITORS AUTHORITY3150 Paradise RoadLas Vegas NV 89109(702) 892-7527

Certification Date:

CANNON COCHRAN MANAGEMENT SERVICES (CCMSI)

Brigid WyszomirskiPO BOX 35350Las Vegas NV 89133-5350(702) 933-4800

21

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

159 LAS VEGAS METRO POLICE DEPARTMENT

1/1/1993

Jeff RochDirector of Risk Management

LAS VEGAS METRO POLICE DEPARTMENT400 S. Martin Luther King BL.Las Vegas NV 89106(702) 828-3406

Certification Date:

CANNON COCHRAN MANAGEMENT SERVICES (CCMSI)

Brigid WyszomirskiPO BOX 35350Las Vegas NV 89133-5350(702) 933-4800

96 LAS VEGAS SANDS CORP

4/28/1989

Lee Ann HamiltonWorkers Comp Manager

THE VENETIAN RESORT HOTEL CASINO3355 Las Vegas Blvd SouthLas Vegas NV 89109702-414-4395

Certification Date:

SIERRA NEVADA ADMINISTRATORS

Michele Taylor2716 N. Tenaya Way, 5th FLLas Vegas NV 89114-5750(702) 240-8935

Venetian Operating Co. LLC 3/31/2000

Las Vegas Sands, LLC 4/28/1989

Venetian Casino Resort, LLC 1/1/1998Venetian Resort Hotel Casino

Venetian Hotel Operations, LLC 4/1/2003

Lido Casino Resort, LLC 3/31/2000

Lido Casino Resort Holding Co. LLC 8/1/2004

371 LAS VEGAS VALLEY WATER DISTRICT

1/1/2003

Matt ChorpeningRisk Manager

LAS VEGAS VALLEY WATER DISTRICT1001 South Valley View Blvd.Las Vegas NV 89153(702) 259-8165

Certification Date:

CANNON COCHRAN MANAGEMENT SERVICES (CCMSI)

Brigid WyszomirskiPO BOX 35350Las Vegas NV 89133-5350(702) 933-4800

22

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

325 LES SCHWAB WAREHOUSE CENTER INC

12/1/1997

Denny CarterRisk Services Supervisor

LES SCHWAB WAREHOUSE CENTER INCP O Box 5350Bend OR 97708-5350(541) 416-5479

Certification Date:

SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Richard GomezP O Box 34660Las Vegas NV 89133702-568-3750

Les Schwab Warehouse Center, Inc. 12/1/1997Les Schwab Tire Centers of Neva

374 LYON COUNTY SCHOOL DISTRICT

7/1/2003

(Ms.) Ronnie RowleyRisk Management

LYON COUNTY SCHOOL DISTRICT25 East Goldfield AveYerington NV 89447(775) 463-6800 ext 144

Certification Date:

NELSON DAVISON ADMINISTRATORS INC

Tom Nelson9855 DoubleR Blvd Ste 105/PO Box 12338Reno NV 89521(775) 825-9299 x 1

349 MACY'S INC

4/1/1999

Shanae BondRisk Management

Federated Dept Stores c/o Aon Risk Consultants Inc7 West Seventh StreetCincinatti OH 45202513-579-7015

Certification Date:

HELMSMAN MANAGEMENT SERVICES LLC

Alma Larios7881 W Charleston Blvd, Suite 190Las Vegas NV 89117(800) 593-1004 x35242

Macy's Systems and Technology, Inc. 4/1/1999

Macy's Corporate Services, Inc. 4/1/1999

Bloomingdale's, Inc. 11/1/2002

Macy's Retail Holdings, Inc. 5/1/1995

Macy's Inc. 4/1/1999

Macy's West Stores, Inc. 8/10/2009

23

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

47 MARRIOTT INTERNATIONAL INC

2/1/1982

Steve HuyCompliance Analyst

MARRIOTT INTERNATIONAL INC10400 Fernwood Road Dept 52/924.3Bethesda MD 20817(301) 380-4450

Certification Date:

MARRIOTT CLAIMS SERVICES

Nik Strauser2795 E Desert Inn Road Ste. 200Las Vegas NV 89121(702) 227-7678

Courtyard Management, Inc. 8/1/1989

Marriott Claims Services Corporation 10/1/2006

Springhill SMC, LLC 10/1/2011

Marriott Hotel Services, Inc. 12/1/1999

Marriott Int'l Administrative Services, Inc. 10/1/1997

The Ritz-Carlton Hotel Company LLC 10/1/2006

Residence Inn by Marriott, LLC 8/1/1989

Fairfield FMC LLC 11/1/1993

309 MASCO CORPORATION

4/1/1997

Tina SmithRisk Manager

MASCO CORPORATION21001 Van Born RoadTaylor MI 48180(313)792-6214

Certification Date:

CONSTITUTION STATE SERVICES LLC

Brandi Lee7450 Arroyo Crossing Pkwy, Ste 200Las Vegas NV 89113-4081(702) 479-4218 x 94218

Milgard Manufacturing Inc 12/31/2003

Sacramento Insulation Contractors 5/1/2001Gale Building Products

Behr Paint Corporation 9/1/2010Direct-To-Pro

Masco Cabinetry LLC 1/1/2011

Builder Services Group, Inc. 5/24/2002Central Valley Insulation

Service Partners Supply, LLC 11/1/2003

Masco Retail Sales Support, Inc. 1/1/2008

24

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

194 MCDONALD'S CORPORATION

12/1/1993

Steve LaughlinDirector Insurance & Safety Dept.

McDONALDS CORPORATIONMcDonald Plaza 2915 Jorie BlvdOak Brook IL 60523(630) 623-8079

Certification Date:

GALLAGHER BASSETT SERVICES, INC.

Charles Rostad2110 East Flamingo Rd #314Las Vegas NV 89119-0834(866)-889-4755

McDonald's Restaurants of Nevada, Inc. 12/1/1993

15 MCKESSON CORPORATION

10/1/1980

Kirsti LawsonRisk Manager

MCKESSON CORPORATIONOne Post Street 34th FloorSan Francisco CA 94104-5296(415) 983-7053

Certification Date:

GALLAGHER BASSETT SERVICES, INC.

Charles Rostad2110 East Flamingo Rd #314Las Vegas NV 89119-0834(866)-889-4755

Gulf South Medical Supply, Inc 7/1/2013

McKesson Pharmacy Optimization LLC 5/1/2008

McKesson Pharmacy Systems LLC 10/1/2008

McKesson Health Solutions LLC 1/1/2002

McKesson Technologies, Inc 1/1/2010

McKesson Medical-Surgical Minnesota S 11/1/2001

Zee Medical, Inc. 9/1/2003

McKesson Automation Inc. 5/1/2002

McKesson Medical-Surgical Inc. 12/1/1997

US Oncology Research LLC 1/1/2012

PSS World Medical, Inc. 7/1/2013

McKesson Specialty Care Distribution Co 1/1/2012

PST Services, Inc. 1/1/2007

25

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

398 MESQUITE GAMING LLCformerly Black Gaming

8/1/2011

Barry WinterDir Risk Management & Benefits

Mesquite Gaming LLC950 W. Mesquite Blvd.Mesquite NV 89027(702) 346-6827

Certification Date:

NELSON DAVISON ADMINISTRATORS INC

Tom Nelson9855 DoubleR Blvd Ste 105/PO Box 12338Reno NV 89521(775) 825-9299 x 1

CasaBlanca Resorts, LLC 8/1/2011

VRCC, LLC 8/1/2011

RBG, LLC 8/1/2011

Oasis Recreational Properties, Inc. 8/1/2011

26

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

43 MGM RESORTS INTERNATIONAL

10/26/1981

Tina SanchezDirector Workers' Comp

MGM MIRAGE RISK MANAGEMENT3260 South Industrial RoadLas Vegas NV 89109(702) 692-9586

Certification Date:

MGM MIRAGE RISK MANAGEMENT

Tina Sanchez3260 So Industrial RoadLas Vegas NV 89109(702) 650-7443

Victoria Partners 7/1/1996

Nevada Landing Hotel & Casino 6/1/1995

Revive Partners, LLC 1/1/2003

Mirage Casino & Hotel, The 5/1/1989

Mandalay Resort Group 11/15/1980

Mandalay Place 5/1/2001

Circus Circus Hotel (Las Vegas) 11/15/1980

Gold Strike Hotel & Gambling Hall 6/1/1995

Ramparts International 3/1/1997

Ramparts, Inc. 7/1/1993Luxor Hotel/Casino

Mandalay Vacation Resorts, Inc 11/1/1998

New York-New York Hotel & Casino 12/1/1996

MGM Grand Laundry, Inc. 12/1/1993

GO VEGAS 3/1/2000

New Castle Corp. 10/1/1989Excalibur Hotel/Casino

MGM Grand Las Vegas 12/1/1993

Slots-A-Fun 11/15/1980

Railroad Pass Hotel & Casino 6/1/1995

Bellagio 10/6/1994

M.I.R. Travel 1/1/1992

Shadow Creek 5/1/1989

Boardwalk Hotel & Casino, Inc. 6/30/1998Holiday Inn Casino Boardwalk

Atlandia Design & Furniture 10/26/1981

Mandalay Development 2/1/1996

Circus Circus (Reno) 11/15/1980

27

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

Mandalay Bay 4/1/1998

200 MONARCH CASINO & RESORT INCAtlantis Hotel & Casino

1/1/1994

Doug SimpsonDir. Of Security & Risk Management

ATLANTIS HOTEL & CASINO3800 South Virginia StreetReno NV 89502(775) 335-4534

Certification Date:

NELSON DAVISON ADMINISTRATORS INC

Tom Nelson9855 DoubleR Blvd Ste 105/PO Box 12338Reno NV 89521(775) 825-9299 x 1

Golden Road Motor Inn, Inc. 1/1/1994Atlantis Casino Resort

232 NEV YELLOW NEV CHECKER & NEV STAR CAB CORP

1/1/1995

Gene Auffert

NEVADA YELLOW & CHECKER CABS5225 W Post Rd.Las Vegas NV 89118(702) 933-1620

Certification Date:

YORK CLAIM SERVICES FORMERLY MEDCOMP

Yvette Bouldin9085 W Post Road #100Las Vegas NV 89148(702) 727-2161

210 NEVADA READY MIX CORPORATION

3/1/1994

Larry MillerCorporate Administrator

NEVADA READY MIX CORPORATION151 Cassia WayHenderson NV 89014(702) 457-1115 ext 3038

Certification Date:

NELSON DAVISON ADMINISTRATORS INC

Tom Nelson9855 DoubleR Blvd Ste 105/PO Box 12338Reno NV 89521(775) 825-9299 x 1

28

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

379 NEVADA SYSTEM OF HIGHER EDUCATIONformerly University & College System of Nevada

1/1/2004

Lisa SchallerDirector of Insurance & Loss Mgt.

NEVADA SYSTEM OF HIGHER EDUCATION2601 Enterprise Rd., Mail Stop 014Reno NV 89512-1666(775) 784-3472

Certification Date:

CANNON COCHRAN MANAGEMENT SERVICES (CCMSI)

Brigid WyszomirskiPO BOX 35350Las Vegas NV 89133-5350(702) 933-4800

University of Nevada Las Vegas 1/1/2004

Truckee Meadows Community College 1/1/2004

Nevada State College at Henderson 1/1/2004

Henderson Community College 1/1/2004

Charleston Community College 1/1/2004

University of Nevada Reno 1/1/2004

Great Basin College 1/1/2004

Desert Research Institute 1/1/2004

Western Nevada Community College 1/1/2004

Cheyenne Community College 1/1/2004

6 NEW ALBERTSON'S INC

7/4/1980

Gail R SylvesterRisk Mangement Financial Analyst II

ALBERTSONS INC155 North 400 West Suite 300Salt Lake City UT 84103(801) 961-3358

Certification Date:

SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Richard GomezP O Box 34660Las Vegas NV 89133702-568-3750

New Albertson's Inc. 7/4/1980

American Drug Stores LLC 4/1/1996

American Stores Company LLC 8/1/1982

29

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

373 NEW-COM, INC.

7/29/2003

Michael ThreetCFO

NEW-COM, INC.412 East Gowan RoadNorth Las Vegas NV 89032(702) 642-3331

Certification Date:

CANNON COCHRAN MANAGEMENT SERVICES (CCMSI)

Brigid WyszomirskiPO BOX 35350Las Vegas NV 89133-5350(702) 933-4800

TAB Contractors, Inc. 7/29/2003

MMC, Inc. 7/29/2003

MMC INC 6/1/2007MMC Southwest Inc

Biodiesel of Las Vegas Inc. 2/1/2007

All Electric, Inc. 7/29/2003

Airway, Inc. 7/29/2003Airway Rock Products

L.L.O, Inc. 7/29/2003ACME Electric

388 NEWMONT MINING CORPORATION

4/29/2008

Courtney MuirRisk Management Analyst

NEWMONT MINING CORPORATION6363 S. Fiddlers Green Cr.Greenwood Village CO 80111(303) 837-6019

Certification Date:

SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Richard GomezP O Box 34660Las Vegas NV 89133702-568-3750

Newmont Nevada Energy Investment, LL 4/29/2008

Newmont Gold Company 4/29/2008

Turquoise Ridge JV 4/29/2008

Newmont Indonesia Investment Ltd 4/29/2008

Newmont Global Employment Ltd Partner 4/29/2008

Newmont International Services Ltd 4/29/2008

Santa Fe Pacific Gold Corporation 4/29/2008

Battle Mountain Gold Company 4/29/2008

Newmont USA Ltd 4/29/2008Newmont Mining Corporation

Elko Land and Livestock Company 4/29/2008

Newmont Exploration Ltd 4/29/2008

30

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

133 NV ENERGY INC

7/1/1992

Camille WilliamsSenior Benefits Consultant

NV ENERGY INC6226 W. Sahara Ave.Las Vegas NV 89146(702) 402-2101

Certification Date:

CANNON COCHRAN MANAGEMENT SERVICES (CCMSI)

Brigid WyszomirskiPO BOX 35350Las Vegas NV 89133-5350(702) 933-4800

Sierra Gas Holdings Company 7/1/1994

Sierra Pacific Power Company 7/1/1992

Nevada Power Company 7/28/1999

Nevada Electric Investment Company 7/28/1999

Lands of Sierra 7/1/1994

NV Energy Inc 7/1/1994

Sierra Pacific Energy Company 9/1/1998

Sierra Pacific Communications 6/18/2001

389 NYE COUNTY SCHOOL DISTRICT

7/1/2008

Raymond RitchieCFO & Administrative Officer

NY COUNTY SCHOOL DISTRICT484 S West StreetPahrump NV 89048(775)727-7743 ext 234

Certification Date:

NELSON DAVISON ADMINISTRATORS INC

Tom Nelson9855 DoubleR Blvd Ste 105/PO Box 12338Reno NV 89521(775) 825-9299 x 1

221 OCEAN SPRAY CRANBERRIES INC

9/1/1994

Lori HenaultTreasury Supervisor

OCEAN SPRAY CRANBERRIES INCOne Ocean Spray DriveLakeville-Middleboro MA 02349(508) 923-3995

Certification Date:

HELMSMAN MANAGEMENT SERVICES LLC

Alma Larios7881 W Charleston Blvd, Suite 190Las Vegas NV 89117(800) 593-1004 x35242

31

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

319 OFFICEMAX INCORPORATEDformerly Boise Cascade Corporation

8/1/1997

Catherine GrahamRisk Management Analyst

OFFICEMAX INCORPORATED263 Shuman BlvdNaperville IL 60563-1255(630) 864-6829

Certification Date:

HELMSMAN MANAGEMENT SERVICES LLC

Alma Larios7881 W Charleston Blvd, Suite 190Las Vegas NV 89117(800) 593-1004 x35242

OfficeMax North America, Inc. 1/1/2005

OfficeMax Contract, Inc. 4/20/2000

230 PACCAR INC

1/1/1995

DeeAnne FlegelManager, Workplace Absence ProgramsPACCAR INCP O Box 1518Bellevue WA 98009(425) 468-7939

Certification Date:

SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Richard GomezP O Box 34660Las Vegas NV 89133702-568-3750

Paccar Parts Division 1/1/1995

90 PEPPERMILL CASINO'S INCFormerly Nevada Properties

7/1/1988

Michael HewardDirector of Risk Management

PEPPERMILL CASINOS INC830 Brinkby Ave, Suite BReno NV 89509(775) 982-8992

Certification Date:

HOMETOWN HEALTH PARTNERS INC

Michele Chapman830 Harvard WayReno NV 89502(775) 982-3049

Rainbow Associates, Inc. 7/1/1988Rainbow Club (3/1/94)

Wendover Properties 7/1/1988Peppermill Inn & Casino (3/1/94)

Nevada Properties 7/1/1988Peppermill Hotel & Casino

Rainbow Casino, The 1/31/1995

Peppermill Hotel, Reno 7/1/1988

Western Village Limited Partnership 7/1/1988Western Village Casino (7/1/93)

32

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

401 PILOT TRAVEL CENTERS, LLCacquired Flying J

3/1/2012

Don GrahamSenior Manager, Corporate Risk

Pilot Travel Centers, LLCP.O. Box 10146Knoxville TN 37939(800) 562-6210

Certification Date:

HELMSMAN MANAGEMENT SERVICES LLC

Alma Larios7881 W Charleston Blvd, Suite 190Las Vegas NV 89117(800) 593-1004 x35242

391 POLY-AMERICA FOR POLY-WEST INC

2/1/2009

Ron HallChief Financial Officer

POLY-AMERICA FOR POLY-WEST INC251 Conestoga WayHenderson NV 89002972-337-7266

Certification Date:

YORK CLAIM SERVICES FORMERLY MEDCOMP

Yvette Bouldin9085 W Post Road #100Las Vegas NV 89148(702) 727-2161

333 PURCELL TIRE & RUBBER COMPANY

1/1/1998

Cassie AmsdenClaims Administrator

PURCELL TIRE & RUBBER COMPANY301 N. Hall StreetPotosi MO 63664(573) 438-2138 X1153

Certification Date:

GALLAGHER BASSETT SERVICES, INC.

Charles Rostad2110 East Flamingo Rd #314Las Vegas NV 89119-0834(866)-889-4755

Purcell Tire & Rubber Co. 1/1/1998Purcell's Western States Tire

Purcell Tire & Rubber Co. 1/1/1998Purcell Rossi Tire

80 RALEY'S INC

7/1/1986

Andrew GrantSr Director

RALEYS, INCP O Box 15618Sacramento CA 95605(916) 373-6214

Certification Date:

NELSON DAVISON ADMINISTRATORS INC

Tom Nelson9855 DoubleR Blvd Ste 105/PO Box 12338Reno NV 89521(775) 825-9299 x 1

33

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

105 RENO SPARKS CONVENTION & VISITORS AUTHORITY

7/1/1990

Charlotte AndersonHuman Resources Manager

RENO SPARKS CONVENTION CENTER4001 S. Virginia St., #GReno NV 89502(775) 827-7618

Certification Date:

ALTERNATIVE SERVICES CONCEPTS LLC

Mike Livermore1755 East Plumb Lane #148Reno NV 89502(775)329-1181

National Bowling Stadium 10/1/1994

76 RENOWN HEALTH

8/1/1985

Larry MonsonDirector of Risk Management

RENOWN REGIONAL MEDICAL CENTER1155 Mill Street - MAIL STOP J-11Reno NV 89502(775) 982-4798

Certification Date:

HOMETOWN HEALTH PARTNERS INC

Michele Chapman830 Harvard WayReno NV 89502(775) 982-3049

Renown Health 8/1/1985

Nevada Healthcare Cooperative 10/15/2004

Renown Businesses 1/1/1992

Renown Regional Medical Center 8/1/1985

Nevada Heart Institute 1/1/2011

Hometown Health Mgt Co (incl. Medical 1/1/1989

Hometown Health Plan Inc. 1/1/1989

Renown South Meadows Medical Center 2/1/1999

Renown Health Foundation 1/1/1989

Renown Network Services 1/1/1989

Renown Skilled Nursing 6/17/2004

77 RIVERSIDE RESORT & CASINO

9/28/1985

Steve WillettDirector Human Resources

RIVERSIDE RESORT & CASINO1650 S Casino DriveLaughlin NV 89029(702) 298-2535

Certification Date:

YORK CLAIM SERVICES FORMERLY MEDCOMP

Yvette Bouldin9085 W Post Road #100Las Vegas NV 89148(702) 727-2161

Laughlin Transit, Inc. 7/9/2003

34

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

218 RIVIERA OPERATING CORPORATIONformerly Riviera Holdings

7/1/1994

Tullio MarchionneLegal Exec. VP

RIVIERA HOLDINGS CORPORATION2901 Las Vegas Blvd SouthLas Vegas NV 89109-1931(702) 794-9511

Certification Date:

RIVIERIA OPERATING COMPANY

LeCretia Evans2901 Las Vegas Blvd. SouthLas Vegas NV 89109(702) 794-9511

Riviera Operating Company 7/1/1994Riviera Hotel & Casino

311 SAFEWAY INC

4/8/1997

Gilbert B. CabreraVP of Finance - Corp. Risk ManagementSAFEWAY INC11555 Dublin Canyon RdPleasanton CA 94588(925) 226-5100

Certification Date:

NELSON DAVISON ADMINISTRATORS INC

Tom Nelson9855 DoubleR Blvd Ste 105/PO Box 12338Reno NV 89521(775) 825-9299 x 1

Groceryworks Holdings Inc 5/11/2005

Groceryworks.com Operating Company 5/11/2005

Vons Companies, Inc., The 4/8/1997

331 SCHNEIDER NATIONAL INC

1/1/1998

Jessica UhlenbrauckSr Insurance Administrator

SCHNEIDER NATIONAL INC3101 S. Packerland Dr.Green Bay WI 54313(920) 592-3071

Certification Date:

HELMSMAN MANAGEMENT SERVICES LLC

Alma Larios7881 W Charleston Blvd, Suite 190Las Vegas NV 89117(800) 593-1004 x35242

Schneider Tank Lines 1/1/1998

Schneider Transport, Inc. 1/1/1998

Schneider Specialized Carriers 1/1/1998

Schneider National Bulk Carriers 1/1/1998

Schneider National Carriers 1/1/1998

Schneider Logistics, Inc. 1/1/1998

35

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

117 SHERWIN-WILLIAMS COMPANY

7/1/1991

Anthony Colangelo; Matt FlynnManager Workers Comp

SHERWIN-WILLIAMS COMPANY101 Prospect Avenue NWCleveland OH 44115-1075(216) 566-3095

Certification Date:

SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Richard GomezP O Box 34660Las Vegas NV 89133702-568-3750

244 SILVER LEGACY RESORT CASINO

7/1/1995

Tracy HudsonGst. Relations Mgr./Wkrs' Comp. Mgr

SILVER LEGACY RESORT CASINO407 N. Virginia StreetReno NV 89502(775) 325-7040

Certification Date:

NELSON DAVISON ADMINISTRATORS INC

Tom Nelson9855 DoubleR Blvd Ste 105/PO Box 12338Reno NV 89521(775) 825-9299 x 1

317 SILVERTON CASINO LLC & MAJESTIC NV PROPERTY H

7/1/1997

Kim AlcalaBenefits Manager

SILVERTON HOTEL CASINO3333 Blue Diamond RoadLas Vegas NV 89139702-893-7444

Certification Date:

CANNON COCHRAN MANAGEMENT SERVICES (CCMSI)

Brigid WyszomirskiPO BOX 35350Las Vegas NV 89133-5350(702) 933-4800

Silverton Casino, LLC 12/2/1997Silverton Hotel Casino & RV Park

Silverton Casino, LLC 12/2/1997Silverton RV Park & Sundries Stor

375 SOUTHERN NEVADA HARLEY DAVIDSON SALES INC & LV Harley-Davidson & Red Rock Harley-Davidson

8/1/1996

Jeffry RosenblattController

LAS VEGAS HARLEY DAVIDSON2605 South Eastern Avenue, Ste 100Las Vegas NV 89169(702) 431-8500 ext 103

Certification Date:

NEVADA ALTERNATIVE SOLUTIONS, INC.

Charles R Nort9506 West Flamingo Rd Suite 102Las Vegas NV 89147(702) 796-1333 ext 228

Henderson Harley-Davidson, Inc. 9/1/2002

36

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

376 SOUTHERN NEVADA HEALTH DISTRICT

7/1/2005

Susan DamitzHuman Resources Analyst

SOUTHERN NEVADA HEALTH DISTRICTP O Box 3902Las Vegas NV 89127(702) 759-1106

Certification Date:

SIERRA NEVADA ADMINISTRATORS

Michele Taylor2716 N. Tenaya Way, 5th FLLas Vegas NV 89114-5750(702) 240-8935

263 SOUTHERN NEVADA TBA SUPPLY COMPANY INCTED WIENS TIRE & AUTO

3/1/1996

Brenda MartzHR Manager

TED WIENS TIRE & AUTO1701 Las Vegas Blvd SouthLas Vegas NV 89104(702) 732-2382 ext 139

Certification Date:

CANNON COCHRAN MANAGEMENT SERVICES (CCMSI)

Brigid WyszomirskiPO BOX 35350Las Vegas NV 89133-5350(702) 933-4800

208 SOUTHWEST AIRLINES CO

3/1/1994

Patti ColwellManager, Workers Compensation

SOUTHWEST AIRLINES CO2702 Love Field Dr.Dallas TX 75235(214) 792-6462

Certification Date:

SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Richard GomezP O Box 34660Las Vegas NV 89133702-568-3750

92 SOUTHWEST GAS CORPORATION

7/1/1988

Carol RichardsSupervisor Workers' Comp & InsuranceSOUTHWEST GAS CORPORATIONPO Box 98510Las Vegas NV 89193-8510(702) 364-3025

Certification Date:

SOUTHWEST GAS CORPORATION

Carol Richards5241 Spring Mountain Rd/Box 98510Las Vegas NV 89193-8510(702)364-3025

37

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

42 SPARKS NUGGET INC

10/1/1981

Larry HarveyExec VP-HR & Risk Mgmt

SPARKS NUGGET INC1100 Nugget AveSparks NV 89431(775) 356-3397

Certification Date:

NEVADA ALTERNATIVE SOLUTIONS, INC.

Charles R Nort9506 West Flamingo Rd Suite 102Las Vegas NV 89147(702) 796-1333 ext 228

Double J.A. Land & Livestock Company 12/1/1993Ascuaga's Cattle Co.

396 STATION CASINOS LLC

6/14/2011

Tim CameronCorp Director Risk Management

STATION CASINOS1505 S. Pavilion Center DriveLas Vegas NV 89135(702) 495-3476

Certification Date:

YORK CLAIM SERVICES FORMERLY MEDCOMP

Yvette Bouldin9085 W Post Road #100Las Vegas NV 89148(702) 727-2161

384 SUN CITY ELECTRIC INC

8/18/2003

Andrea GouldRisk Manager

SUN CITY ELECTRIC INC C/O SEASORE HOLDINGS1220 S Commerce Street #120Las Vegas NV 89102(702) 220-5621

Certification Date:

SUN CITY ELECTRIC INC

Andrea Gould1220 S Commerce St Ste 120Las Vegas NV 89102(702) 220-5621

Focus Plumbing, LLC 6/1/2009

Focus Concrete, LLC 1/1/2010

Focus Framing, Door & Trim 9/15/2011

Focus Electric, LLC 6/1/2009

Green Image, LLC 2/1/2011G T I

Wire Power Electric 4/15/2013Daylight Electric

Floor Designs of Nevada LLC 10/1/2005

38

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

125 TARGET CORPORATION (TARGET STORES)

2/1/1992

Judy EssenConsultant - Risk Consulting

AON Global RISK CONSULTING C/O TARGET5600 W. 83rd Street, Suite 1100Minneapolis MN 55437(952) 807-0637

Certification Date:

SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Richard GomezP O Box 34660Las Vegas NV 89133702-568-3750

330 THE COCA-COLA COMPANY AND/OR COCA-COLA REF

1/1/1998

Lawanda HallPrinciple Risk Analyst

THE COCA-COLA COMPANYOne Coca-Cola PlazaAtlanta GA 30313(404) 676-7494

Certification Date:

SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Richard GomezP O Box 34660Las Vegas NV 89133702-568-3750

Coca-Cola Refreshments USA, Inc. 10/2/2010

BCI Coca-Cola Bottling Co of Los Angele 1/1/1998Coca-Cola Bottling Co of Las Veg

392 TREASURE ISLAND LLC

8/1/2009

Gayle KurokawaV/P Human Resources

TREASURE ISLAND LLC3300 Las Vegas Blvd SouthLas Vegas NV 89109(702) 894-7506

Certification Date:

YORK CLAIM SERVICES FORMERLY MEDCOMP

Yvette Bouldin9085 W Post Road #100Las Vegas NV 89148(702) 727-2161

39

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

395 TROPICANA LAS VEGAS HOTEL & CASINOTROPICANA LAS VEGAS, INC.

12/2/2010

Joanne M BeckettVP & Gen. Counsel

TROPICANA LAS VEGAS, INC3801 Las Vegas Blvd SouthLas Vegas NV 89109(702)739-3530

Certification Date:

NEVADA ALTERNATIVE SOLUTIONS, INC.

Charles R Nort9506 West Flamingo Rd Suite 102Las Vegas NV 89147(702) 796-1333 ext 228

Trilliant Management LP 12/2/2010

Tropicana Las Vegas Intermediate Holdin 12/2/2010

Armenco Holdings LLC 12/2/2010

299 TRUE BLUE INCFORMERLY LABOR READY INC

12/1/1996

April SmithAssociate Financial/Insurance CoordinatorLABOR READY INCPO Box 2910Tacoma WA 98401(800) 610-8920 x 8498

Certification Date:

ESIS, INC.

Randy Barclay6935 Aliante Pkwy Ste 104-411Las Vegas NV 89084(702)731-1510

Labor Ready Southwest, Inc. 1/1/1999

Labor Ready Northwest, Inc. 8/28/1998

168 U S FOODS INCFKA US Foodservice Inc

4/1/1993

Dena AbdallahDirector-Risk Management

U S FOODS9399 W. Higgins RoadRosemont IL 60018(847) 720-1689

Certification Date:

GALLAGHER BASSETT SERVICES, INC.

Charles Rostad2110 East Flamingo Rd #314Las Vegas NV 89119-0834(866)-889-4755

Outwest Meat Company 4/1/1998

Harrison's Prime Meats & Provisions 3/1/1997

40

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

73 UNITED AIR LINES INC

3/1/1985

Maureen ZahnowSenior Manager Corporate Insurance

UNITED AIRLINES INC233 S Wacker Drive - HDQCIChicago IL 60606(872) 825-7630

Certification Date:

GALLAGHER BASSETT SERVICES, INC.

Charles Rostad2110 East Flamingo Rd #314Las Vegas NV 89119-0834(866)-889-4755

116 VIAD CORP

7/1/1991

Terry CrullSr. Vice President-Willis of AZ

WILLIS CORROON CORP FOR VIAD CORP16220 N. Scottsdale Rd. #600Scottsdale AZ 85254(602) 787-6040

Certification Date:

NEVADA ALTERNATIVE SOLUTIONS, INC.

Charles R Nort9506 West Flamingo Rd Suite 102Las Vegas NV 89147(702) 796-1333 ext 228

GES Exposition Services, Inc. 7/1/1991

Giltspur, Inc. 3/1/1996

Shows Unlimited, Inc. 1/1/1997

Restaura, Inc. 10/10/1995

Game Financial Corporation 4/1/1998

36 WASHOE COUNTY

7/1/1981

Celeste WallickRisk Management Analyst

WASHOE COUNTYPO Box 11130Reno NV 89520(775) 328-2074

Certification Date:

CANNON COCHRAN MANAGEMENT SERVICES (CCMSI)

Brigid WyszomirskiP O BOX 20068Reno NV 89515-0068(775) 324-3301 x 1011

41

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

37 WASHOE COUNTY SCHOOL DISTRICT

7/1/1986

Jackie JamesSr. Risk Mgt Analyst

WASHOE COUNTY SCHOOL DISTRICTPO Box 30425Reno NV 89520(775) 348-3854

Certification Date:

CANNON COCHRAN MANAGEMENT SERVICES (CCMSI)

Brigid WyszomirskiP O BOX 20068Reno NV 89515-0068(775) 324-3301 x 1011

Hot Lunch Progam 7/1/1987

370 WENDOVER CASINOS INCMONTEGO BAY CASINO & RESORT

12/19/2002

Michael HewardDirector of Risk Management

Peppermill Casinos Inc for Wendover Casinos380 Brinby Ave, Suite BReno NV 89509(775) 689-8992

Certification Date:

HOMETOWN HEALTH PARTNERS INC

Michele Chapman830 Harvard WayReno NV 89502(775) 982-3049

PPLLC 12/19/2002

365 WESTERN CAB COMPANY INC

9/1/2001

Martha A SarverGeneral Manager

WESTERN CAB CO801 South Main StreetLas Vegas NV 89101(702) 382-7100

Certification Date:

R. A. WONG & ASSOCIATES

Paul Wong5110 S Valley View Blvd, Suite 100Las Vegas NV 89118(702)798-8910

246 WESTERN STATES CONTRACTING INC

9/1/1995

Troy ShiozawaRisk Manager

WESTERN STATES CONTRACTING INC4129 W Cheyenne Suite BNorth Las Vegas NV 89032(702)336-4656

Certification Date:

WESTERN STATES CONTRACTING INC

Troy Shiozawa, Asst Controller4129 W. Cheyenne Ave.North Las Vegas NV 89032(702) 336-4656

WS-Dynoco Petroleum Management LLC 1/15/2013Wesley's

Tejas Underground LLC 5/1/1998

BDF Employment Services LLC 1/15/2013

42

C of A # Employer Name/DBA Self-Insured Contact Third Party AdministratorSubsidiary DBA Eff. Date

94 WEYERHAEUSER COMPANY

1/1/1989

Lisa WysockiSelf-Insurance Administrator

WEYERHAEUSER COMPANYP O Box 9777 CH3K33Federal Way WA 98063-9777(253) 924-7471

Certification Date:

SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

Richard GomezP O Box 34660Las Vegas NV 89133702-568-3750

Pardee Homes of Nevada 1/1/1989

Pardee Homes 1/1/1989

Weyerhaeuser NR Company 1/1/2009

70 YOUNG ELECTRIC SIGN COMPANY

7/1/1984

Clark SmithDirector of Finance/Treasurer

YOUNG ELECTRIC SIGN COMPANY2401 Foothill DriveSalt Lake City UT 84109(801) 464-4600

Certification Date:

NEVADA ALTERNATIVE SOLUTIONS, INC.

Charles R Nort9506 West Flamingo Rd Suite 102Las Vegas NV 89147(702) 796-1333 ext 228

YESCO LLC 1/1/2008

YESCO Outdoor Media LLC 1/1/2008

YESCO Electronics LLC 1/1/2008

YESCO Administration LLc 1/1/2008

79 YRC INCYRC Freight

5/1/1986

Megan McDairmantSenior Risk Analyst

YRC WORLDWIDE INC10990 Roe Avenue, MS A305Overland Park KS 66211-1213(913) 266-6575

Certification Date:

GALLAGHER BASSETT SERVICES, INC.

Charles Rostad2110 East Flamingo Rd #314Las Vegas NV 89119-0834(866)-889-4755

43