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R Self-Insured List STATE OF NEVADA DEPARTMENT OF BUSINESS AND INDUSTRY DIVISION OF INSURANCE SELF-INSURED EMPLOYER LIST 01-Apr-13 C of A # Employer Name/DBA Self-Insured Contact Third Party Administrator Subsidiary DBA Eff. Date 397 AFFINITY GAMING LLC Elizabeth Guth SIERRA NEVADA ADMINISTRATORS formerly Herbst Gaming LLC V.P. Of Insurance and Benefits Certification Date: 1/1/2011 Affinity GAMING LLC Michele Taylor 3755 Breakthrough Way Suite 300 2716 N. Tenaya Way, 5th FL Las Vegas NV 89135 Las Vegas NV 89114-5750 (702) 341-2419 (702) 240-8935 Flamingo Paradise LLC 1/1/2011 Last Chance LLC 1/1/2011 Whiskey Pete's Hotel & Casino LLC 1/1/2011 Herbst Gaming LLC 1/1/2011 Zante LLC Sands Regency 1/1/2011 Buffalo Bills LLC 1/1/2011 Primmadonna Resort & Casino LLC 1/1/2011 Plantation Investment LLC 1/1/2011 Dayton Depot LLC 1/1/2011 ETT LLC 1/1/2011 106 AMERISTAR CASINOS INC Karen Burris SEDGWICK CLAIMS MANAGEMENT Benefits Manager SERVICES, INC. Certification Date: 10/1/1990 AMERISTAR CASINOS INC Janet Machado 3773 Howard Hughes Parkway, Ste 4 P O Box 34660 90 Las Vegas NV 89169 Las Vegas NV 89133 (702) 567-7060 (888)713-1112ex83828 Cactus Pete's Inc. 10/1/1990 Ameristar Casinos, Inc. 4/1/1994 The Horseshu 10/1/1990 Cactus Pete's Resort Casino 10/1/1990 1 C of A # Employer Name/DBA Self-Insured Contact Third Party Administrator Subsidiary DBA Eff. Date 55 ARCHON CORPORATION David Lowden SIERRA NEVADA ADMINISTRATORS Executive Office Administrator Certification Date: 8/15/1982 ARCHON CORPORATION Michele Taylor 3221 S Torrey Pines 2716 N. Tenaya Way, 5th FL Las Vegas NV 89146 Las Vegas NV 89114-5750 (702) 429-6742 (702) 240-8935 Pioneer Hotel Inc. 9/15/1989 45 ARKANSAS BEST CORPORATION Allen King GALLAGHER BASSETT SERVICES, INC. Workers Comp Manager Certification Date: 12/15/1981 ABF FREIGHT SYSTEMS Charles Rostad 3801 Old Greenwood Rd. 2110 East Flamingo Rd #314 Fort Smith AR 72903 Las Vegas NV 89119-0834 (479) 785-6218 (866)-889-4755 Cardinal Freight Lines 10/1/1995 ABF Freight Systems 12/15/1981 E-T-M-F Terminals 10/18/1982 326 BEST BUY CO INC Rebecca Schoff GALLAGHER BASSETT SERVICES, INC. BEST BUY STORES LP Consultant Certification Date: 12/1/1997 Aon Global Risk Consulting for Besy Buy Charles Rostad 5600 W. 83rd Street, Tower Ste 1100 2110 East Flamingo Rd #314 Minneapolis MN 55437 Las Vegas NV 89119-0834 952-807-0693 (866)-889-4755 2 C of A # Employer Name/DBA Self-Insured Contact Third Party Administrator Subsidiary DBA Eff. Date 52 BOYD GAMING CORPORATION Juliet Vestal CANNON COCHRAN MANAGEMENT Director of Benefits & Risk Managem SERVICES (CCMSI) ent Certification Date: 7/1/1981 Director of Benefits & Risk Management Brigid Wyszomirski 6465 South Rainbow Blvd PO BOX 35350 Las Vegas NV 89118 Las Vegas NV 89133-5350 (702) 692-4156 (702) 933-4800 Mare-Bear, Inc.Stardust Resort and Casino 7/1/1981 Boyd Shared Services, Inc. 6/1/2007 Boyd Gaming Corporation 11/1/1990 ETN Productions, Inc. 5/1/1994 Coast Hotel & Casino 1/1/1996 Sam-Will, Inc. Fremont Hotel and Casino 7/1/1981 Echelon Resorts Corporation 12/1/2005 Eldorado, Inc. Jokers Wild Casino 1/1/1993 Boyd Atlantic City, Inc. 1/1/1999 Boyd Travel, Inc.Vacations-Hawaii 10/1/1995 Eldorado, Inc. Eldorado Casino 8/1/1982 California Hotel & CasinoCalifornia Hotel and Casino 8/1/1982 Boyd Central Region, Inc. 2/1/1996 The SunCoast Hotel & Casino 4/1/2000 Echelon Resorts LLC 12/1/2005 Gold Coast Hotel & Casino 2/1/1989 M.S.W., Inc. Main Street Station Hotel, Casino 8/15/1995 ETN Development Corporation 11/17/2004 Boyd Development Corporation 10/1/1995 Rodney Petroleum, Inc.Downtown Texaco Station 9/4/1992 California Hotel & CasinoSam's Town Hotel, Gambling Hall 8/1/1982 Orleans Hotel & Casino, The 2/12/1996 Coast Vacations 8/13/1999 Constellation Insurance Company 7/1/2005 3 C of A # Employer Name/DBA Self-Insured Contact Third Party Administrator Subsidiary DBA Eff. Date 11 CAESARS ENTERTAINMENT CORPORATION Maila Aganon CANNON COCHRAN MANAGEMENT formerly Harrah's Insurance Manager SERVICES (CCMSI) Certification Date: 8/15/1980 HARRAHS ENTERTAINMENT INC Brigid Wyszomirski One Caesars Palace Drive PO BOX 35350 Las Vegas NV 89109 Las Vegas NV 89133-5350 (702) 407-6277 (702) 933-4800 Harrah's Laughlin 4/28/1988 Bill's Casino 7/1/1987 Harrah's Las Vegas 6/1/1983 Harveys Tahoe Management Co. 8/1/2001 Caesars Entertainment Inc 7/12/1980 Bill's Gambling Hall & Saloon 2/27/2007 Imperial Palace Casino Inc 2/8/1981 Rio Hotel & Casino Inc 6/1/1992 Harrah's Reno/Tahoe 8/15/1980 393 CARSON CITY Cecilia Meyer CANNON COCHRAN MANAGEMENT Risk Management Coordinator SERVICES (CCMSI) Certification Date: 7/1/2010 CARSON CITY FINANCE DIVISION Brigid Wyszomirski 201 North Carson Street Ste 3 P O BOX 20068 Carson City NV 89701 Reno NV 89515-0068 (775) 283-7484 (775) 324-3301 x 1011 394 CARSON CITY SCHOOL DISTRICT Amanda Prudhomme NELSON DAVISON ADMINISTRATORS INC HR/Workers' Comp Certification Date: 7/1/2010 CARSON CITY SCHOOL DISTRICT Tom Nelson 1402 West King Street 9855 DoubleR Blvd Ste 105/PO Box 12338 Carson City NV 89702 Reno NV 89521 (775) 283-2004 (775) 825-9299 x 1 4 C of A # Employer Name/DBA Self-Insured Contact Third Party Administrator Subsidiary DBA Eff. Date 383 CATHOLIC CHARITIES OF SOUTHERN NEVADA Linda Summers NEVADA ALTERNATIVE SOLUTIONS, INC. Human Resource Director Certification Date: 1/1/2006 CATHOLIC CHARITIES OF SOUTHERN NV Charles R Nort 1501 Las Vegas Blvd North 9506 West Flamingo Rd Suite 102 Las Vegas NV 89101 Las Vegas NV 89147 (702) 385-2662 (702) 796-1333 ext 228 199 CEDAR ENTERPRISES INC Deborah S Harmon SIERRA NEVADA ADMINISTRATORS WENDY'S OF LAS VEGAS Director Human Resources Certification Date: 1/1/1994 CEDAR ENTERPRISES INC Michele Taylor 1328 Dublin Road Ste 300 2716 N. Tenaya Way, 5th FL Columbus OH 43215-1054 Las Vegas NV 89114-5750 (614) 787-7804 (702) 240-8935 Cedar Bon Bakeries, Ltd. 9/10/2001 Wendy's of Las Vegas, Inc. 1/1/1994 169 CITY OF HENDERSON Amy M. L. Wong CANNON COCHRAN MANAGEMENT Senior Disability Analyst SERVICES (CCMSI) Certification Date: 4/1/1993 CITY OF HENDERSON Brigid Wyszomirski P O Box 95050-MS 137 PO BOX 35350 Henderson NV 89009-5050 Las Vegas NV 89133-5350 (702) 267-1921 (702) 933-4800 78 CITY OF LAS VEGAS Connie I. Strauser CITY OF LAS VEGAS Workers' Compensation Analyst Certification Date: 12/29/1985 CITY OF LAS VEGAS Victoria J Robinson, Ins Svcs 495 S. Main St. 400 East Stewart Avenue Las Vegas NV 89101 Las Vegas NV 89101-2986 (702) 229-5044 (702)229-5043 5 C of A # Employer Name/DBA Self-Insured Contact Third Party Administrator Subsidiary DBA Eff. Date 197 CITY OF NORTH LAS VEGAS Darlene Rosenberg CANNON COCHRAN MANAGEMENT Principal Benefits Analyst SERVICES (CCMSI) Certification Date: 1/1/1994 CITY OF NORTH LAS VEGAS Brigid Wyszomirski 2250 Las Vegas Blvd North PO BOX 35350 North Las Vegas NV 89030 Las Vegas NV 89133-5350 (702) 633-2124 (702) 933-4800 147 CITY OF RENO Renee Rungis CANNON COCHRAN MANAGEMENT Director of Human Resources SERVICES (CCMSI) Certification Date: 9/1/1992 CITY OF RENO Brigid Wyszomirski PO Box 1900 P O BOX 20068 Reno NV 89505 Reno NV 89515-0068 (775) 785-5854 (775) 324-3301 x 1011 163 CITY OF SPARKS Jill Valdez CANNON COCHRAN MANAGEMENT Human Resources Analyst SERVICES (CCMSI) Certification Date: 2/1/1993 CITY OF SPARKS Brigid Wyszomirski 431 Prater Way P O BOX 20068 Sparks NV 89431 Reno NV 89515-0068 (775) 353-4021 (775) 324-3301 x 1011 6 C of A # Employer Name/DBA Self-Insured Contact Third Party Administrator Subsidiary DBA Eff. Date 399 CITYCENTER HOLDINGS, LLC Tina Sanchez MGM MIRAGE RISK MANAGEMENT Director of Workers' Compensation Certification Date: 11/30/2011 MGM Resorts International Tina Sanchez 3260 Industrial Road 3260 So Industrial Road Las Vegas NV 89109 Las Vegas NV 89109 (702) 650-6746 (702) 650-7443 ARIA RESORTS AND CASINO LLC 11/30/2011 THE CRYSTALS AT CITY CENTER MA 11/30/2011 CITY CENTER REALTY CORPORATIO 11/30/2011 PROJECT CC, LLC 11/30/2011 75 CLARK COUNTY Sandra Swickard SIERRA NEVADA ADMINISTRATORS Asst. County Manager Certification Date: 7/15/1985 CLARK COUNTY RISK MGMT & SAFETY Michele Taylor 500 S Grand Central Pkwy, 5th Fl. 2716 N. Tenaya Way, 5th FL Las Vegas NV 89106 Las Vegas NV 89114-5750 (702)455-5524 (702) 240-8935 McCarran International Airport 7/15/1985 Volunteer Account (Ambulance & Fireme 4/1/1986 University Medical Center 8/1/1986 104 CLARK COUNTY SCHOOL DISTRICT Roque Lapuz Jr CLARK COUNTY SCHOOL DISTRICT Workers Comp Coordinator Certification Date: 7/1/1990 CLARK COUNTY SCHOOL DISTRICT Nancy Powell, W/C Claims Mgr 4828 S. Pearl Street MS 200 4204 Channel 10 Drive-Risk Mgt Las Vegas NV 89121 Las Vegas NV 89146 (702) 799-0060 X5601 (702) 799-2967 ext 5626 7 C of A # Employer Name/DBA Self-Insured Contact Third Party Administrator Subsidiary DBA Eff. Date 115 CLARK COUNTY WATER RECLAMATION DISTRICT Martin J Flynn NELSON DAVISON ADMINISTRATORS INC Assistant to General Manager Certification Date: 4/1/1992 CLARK COUNTY WATER RECLAMATION DISTRIC Tom Nelson T 5857 East Flamingo Road 9855 DoubleR Blvd Ste 105/PO Box 12338 Las Vegas NV 89122 Reno NV 89521 (702) 668-8066 (775) 825-9299 x 1 154 COSTCO WHOLESALE CORPORATION Uyen Nguyen SEDGWICK CLAIMS MANAGEMENT Workers Comp Data Analyst SERVICES, INC.
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