ACTIVE PRIVATE SELF INSURED ROSTER99 CENTS …

1 ACTIVE PRIVATE self INSURED ROSTER 10/28/2020 2207-012-90 BROADSPIRE SERVICES, INC., BREA Ms. Mary Kasper Chief Legal Officer 99 CENTS ONLY STORES LLC 4000 Union Pacific Ave Commerce,CA 90023 Phone: (323) 881-5748 1920-048-01 ATHENS ADMINISTRATORS, CONCORD Ms. Lynette Baker-Woodie Manager, Administration and Loss Control Workers' Compensation ABF FREIGHT SYSTEM, INC. Box 10048 Fort Smith,AR 72917 Phone: (479) 785-6047 Fax: (479) 785-6396 1013-005-21 ESIS, INC., CHATSWORTH 1013-005-38 ESIS, INC., FREMONT Mr. Chris Ridge Senior Risk Management Analyst ABM INDUSTRIES INCORPORATED 4151 Ashford Dunwoody Rd, Ste 600 Atlanta,GA 30319 Phone: (770) 850-3521 2061-011-10 SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

2 , ROSEVILLE Ms. Dei Singletary Director/Workers' Compensation ADVENTIST HEALTH SYSTEM/WEST One Adventist Health Way Roseville,CA 95661 Phone: (916) 406-1876 Fax: (916) 406-2330 2351-99-81 self Administered 2351-011-03 SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., BREA 2351-99-01 self Administered Chi Nguyen Financial Analyst Corporate Risk Management ALBERTSONS COMPANIES, INC. 5918 Stoneridge Mall Rd Pleasanton,CA 94588 Phone: (925) 469-7208 2076-011-07 SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., RIVERSIDE Andy Tharp WC Administrator AMERICAN HONDA MOTOR CO., INC. 24000 Honda Parkway Marysville,OH 43040 Phone: (937) 243-1276 1186-170-39 SPECIALTY RISK SERVICES, LLC, RIVERSIDE 1186-011-03 SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

3 , BREA Kristin Hinchman Claims Manager AMERISOURCEBERGEN CORPORATION 1300 Morris Drive Chesterbrook,PA 19087 Phone: (610) 727-2545 Fax: (845) 483-4888 2189-132-10 YORK RISK SERVICES GROUP, INC., RANCHO CUCAMONGA Mary A. Evancavich Corporate Insurance/Treasury AMGEN INC. 2202 N. Westshore Blvd Tampa,FL 33607 Phone: (813) 605-7916 1216-048-02 ATHENS ADMINISTRATORS, ORANGE Cole Gehrung Director of Finance & Administration ANGELUS BLOCK CO., INC. 11374 Tuxford Street Sun Valley,CA 91352 Phone: (818) 767-8576 2248-323-02 ST. PAUL FIRE AND MARINE INSURANCE CO., DIAMOND BAR 2248-086-38 HELMSMAN MANAGEMENT SERVICES LLC, GLENDALE 2248-362-02 CERVUS CLAIM SOLUTIONS, LLC, ROSEVILLE Mr.

4 John M. Perisich ARB, INC. 26000 Commercentre Dr Lake Forest,CA 92630 Phone: (949) 595-5532 Fax: (949) 595-5532 2075-086-34 HELMSMAN MANAGEMENT SERVICES LLC, ROCKLIN 2075-012-93 BROADSPIRE SERVICES, INC., FRESNO Brian C. Acker Risk Analyst ASPLUNDH TREE EXPERT, LLC 708 Blair Mill Rd Willow Grove,PA 19090 Phone: (215) 784-4487 2289-096-51 MURPHY AND BEANE INC., CULVER CITY Alisa Berdnik-Kaplan Director of Management Services & Compliance GENERAL, INC. 1506 S. Glendale Ave Glendale,CA 91205 Phone: (818) 247-6200 1960-012-90 BROADSPIRE SERVICES, INC., BREA Andrea Bonney Risk Analyst BALL CORPORATION 5600 W 83rd Street, Ste 1100 Minneapolis,MN 55437 Phone: (952) 807-0871 Fax: (847) 953-2851 2106-195-09 TRISTAR RISK MANAGEMENT, FRESNO Casey Razma CFO BASIC RESOURCES, INC.

5 928 12th Street, Ste 700 Modesto,CA 95354 Phone: (209) 521-9771 Fax: (209) 579-9502 2199-316-02 CORVEL ENTERPRISE COMP, INC., RANCHO CUCAMONGA Ms. Karen Nash HR Manager BIG 5 CORP. 2525 E El Segundo Blvd. El Segundo,CA 90245 Phone: (310) 536-0611 Fax: (310) 297-7628 2386-316-03 CORVEL ENTERPRISE COMP, INC., SAN DIEGO Mr. David Ziebarth CFO BURKE WILLIAMS, INC. 450 N. Oak Street Inglewood,CA 90302 Phone: (310) 651-9866 2010-195-07 TRISTAR RISK MANAGEMENT, CONCORD Ron Webb Vice President Human Resources CALIFORNIA WATER SERVICE COMPANY 1720 N. 1st Street San Jose,CA 95112 Phone: (408) 367-8546 Fax: (408) 367-8437 1893-096-51 MURPHY AND BEANE INC., CULVER CITY 1893-011-05 SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

6 , ORANGE Ms. Barrie Wexler Senior Vice President, Risk Management CBS OPERATIONS INC. 1515 Broadway New York,NY 10036 Phone: (212) 846-7201 2011-169-11 BETA HEALTHCARE GROUP, GRANITE BAY Kelly Moss Workers' Compensation Manager CEDARS-SINAI MEDICAL CENTER 8700 Beverly Blvd., TSB, Ste 130 Los Angeles,CA 90048 Phone: (310) 423-5935 Fax: (310) 423-0164 2287-011-13 SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., PLEASANTON Dana Glover-Smith Director of Safety CENTRAL CONCRETE SUPPLY CO., INC. 331 N Main Street Euless,TX 76039 Phone: (817) 835-4128 2390-195-09 TRISTAR RISK MANAGEMENT, FRESNO Kirby Ford VP, Workers Compensation CERES MARINE TERMINALS INC. 565 Marriott Drive, #400 Nashville,TN 37214 Phone: (800) 293-1420 1777-005-38 ESIS, INC.

7 , FREMONT 1777-005-21 ESIS, INC., CHATSWORTH Lynne Watt Mgr-Risk Mgmt & Insurance CERTAINTEED LLC 20 Moores Rd Malvern,PA 19355 Phone: (610) 893-5535 0381-012-93 BROADSPIRE SERVICES, INC., FRESNO Megan O'Boyle-Paraiso Work Comp Senior Program Manager CHEVRON CORPORATION 6001 Bollinger Canyon Rd, A2114 San Ramon,CA 94583 Phone: (925) 842-8161 Fax: (925) 842-8185 1135-048-01 ATHENS ADMINISTRATORS, CONCORD Alan Hermanson Manager Workers Compensation CHILDREN'S HOSPITAL LOS ANGELES 4650 Sunset Blvd. Los Angeles,CA 90027 Phone: (323) 361-4207 1448-195-01 TRISTAR RISK MANAGEMENT, SIGNAL HILL 1448-108-52 AIG CLAIMS, INC., SAN DIEGO Gregory Wren Director Financial Risk and Insurance CHILDREN'S HOSPITAL OF ORANGE COUNTY 1201 W La Veta Ave Orange,CA 92868 Phone: (714) 509-4937 Fax: (714) 509-4023 1662-092-60 ADMINSURE, INC.

8 , ONTARIO Ms. Cynthia Avila Insurance and Corporate Risk Management CITY OF HOPE NATIONAL MEDICAL CENTER 1500 East Duarte Rd Duarte,CA 91010 Phone: (626) 218-3841 2058-005-21 ESIS, INC., CHATSWORTH 2058-005-58 ESIS, INC., SAN DIEGO 2058-005-38 ESIS, INC., FREMONT Juventino Sanchez of Finance CLOUGHERTY PACKING, LLC 3049 E. Vernon Ave LOS ANGELES,CA 90058 Phone: (323) 583-4621 Fax: (323) 586-9885 2029-316-05 CORVEL ENTERPRISE COMP, INC., FOLSOM Mr. Jeremiah L. Paul Director, Workers' Compensation Operations COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA 1630 E Shaw Ave, Ste 163 Fresno,CA 93710 Phone: (559) 724-4564 Fax: (559) 724-4298 2328-096-51 MURPHY AND BEANE INC.

9 , CULVER CITY Timothy Hodge General COMPASS HEALTH, INC. 200 South 13th Street Grover Beach,CA 93433 Phone: (805) 474-7010 Fax: (805) 474-7013 2191-348-01 RANCHO RISK SERVICES, IRVINE Robert S. Hurtt Jr. CONTAINER SUPPLY COMPANY, INCORPORATED 12571 Western Ave Garden Grove,CA 92841 Phone: (714) 892-8321 Fax: (714) 892-3824 2060-086-34 HELMSMAN MANAGEMENT SERVICES LLC, ROCKLIN Mr. Uyen Nguyen Supervisor, Integrated Leave Data Analyst COSTCO WHOLESALE CORPORATION 999 Lake Drive Issaquah,WA 98027 Phone: (425) 313-2874 Fax: (425) 416-2171 1562-048-01 ATHENS ADMINISTRATORS, CONCORD Ms. Diana Jamison Chief Financial Officer COVIA COMMUNITIES 2185 N. California Blvd.

10 Ste 215 Walnut Creek,CA 94596 Phone: (925) 956-7446 Fax: (925) 871-4030 2387-343-02 PACIFIC CLAIMS MANAGEMENT, FRESNO Mr. Jerry Laval President CREAM OF THE CROP AG SERVICE, INC. 7060 N. Marks Ave, Ste 118 Fresno,CA 93711 Phone: (559) 558-4800 2366-025-05 GALLAGHER BASSETT SERVICES INC., CORONA Mr. Jeff Wofford CFO CROWN ENERGY SERVICES, INC. 868 Folsom Street San Francisco,CA 94107 Phone: (415) 981-7080 Fax: (415) 651-9423 2361-350-01 COTTINGHAM & BUTLER CLAIMS SERVICES, INC., WEST COVINA Jason M. Steffens Director of Risk Management CRST EXPEDITED, INC. 201 1st St. SE Cedar Rapids,IA 52401 Phone: (319) 390-2761 2094-011-46 SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.