HomeMy WebLinkAbout911567.tiff RrJY F.O,NIER
Tu'CTof DEPARTMENT OF LABOR AND EMPLOYMENT
rte[ i-Nrlor „°, DIVISION OF WORKERS' COMPENSATION KENNETH NNI. PLNTT
Insurance Compliance Unit DIRECTOR
1120 Lincoln Street. 17th Floor
Denver.Colorado SO'_03 JACQUELIN A.HOLME.S
(303)764-?976 DEPUTY DIRECTOR
December 20, 1991
Donald Warden
Director Finance & Administration
Weld County
P.O. Box 758
Greeley, CO 80632
RE : Permit to Self-Insure the Workers' Compensation Risk in
Colorado
Dear Mr. Warden:
Effective January 1, 1992 Weld County is authorized to self-insure
in Colorado under block permit no. 846 .
All required security and excess coverage in the form of bonds,
certificates or other evidence of coverage, in force, must be on
file with this office no later than thirty (30) days of receipt of
this certified letter.
Sincerely,
John M. Berger, ARM, CHCM
Self-Insurance Administrator
Encl : Permit
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911561
395-96-01-?409(R 1/91)
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t.;�'ra '3..••; DEPARTMENT OF LABOR AND EMPLOYMENT
''•."".?;,. '`-.I DIVISION OF WORKERS'COMPENSATION
:.;:
'' RANGE PERMIT
I SELF-INSURANCE ;,4= °y�
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zr: BLOCK NO. es."-• '.
!Mr In consideration of the statements and financial records submitted by the employer tsti,i
•�� WELD COUNTY i 1' "r
said employer is hereby granted permission by the director to be its own insurance carrier for the payment t .y�,
....'.'-'-h•-•.: `! of the compensation and benefits provided by the Workers' Compensation Act of Colorado and any .;i::
1st January 42 �>, :: � -
amendments thereto, beginning with the day of 19 and to be :f3;;,•:
�,i continuous until cancelled or revoked, covering the entire operation of said employer within the State of l�i,.•_ '
I Colorado,and including its wholly owned subsidiaries. :a_"'',"'
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This permit is granted subject to the provisions of the Workers' Compensation Act,as oic. ' >::4
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?'~y it Din. exists or as it mad' from time to time be amended, and also subject to the rules, regulations and 1:.1.,;;: :.;t
'; :j orders of the Department of Labor and Employment as they now exist or may from time to time be made. *s jT.:, ':
31terNci or amended. :4•,.",`:,..\1b.>::..:.:-.-
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THIS PERMIT IS SL;BIECTTO REVOCATION OR CANCELLATION BY THE EXECUTIVE DIRECTOR I`'f,"'"),,,''
v.: ref,....?•"),,,':.
'_,'!` AT ANY TIME IN ACCORDANCE WITH SELF-INSURANCE RULES AND REGULATIONS. 'E�ixtti�6,..
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