Georgia State Board of Workers' Compensation Insurer and Claim

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					                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10114       21ST CENTURY PREMIER INS CO FKA                21ST CENTURY PLAZA               WILMINGTON            DE 19803
            COLONIAL PENN FRAN INS CO

                                                           3 BEAVER VALLEY ROAD
Phone:      302-252-2000 Ext.

GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:      770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                              Page 1 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13246       ACCIDENT FUND GENERAL INSURANCE                232 SOUTH CAPITOL                LANSING               MI 48933     JUDY2T@ACCIDENTFUND.COM
            COMPANY                                        AVENUE



Phone:      517-367-1932 Ext.

ACCIDENT FUND CLAIMS DEPT                   38-3207001     200 N GRAND AVE                  LANSING               MI 48901     STEPHENW@ACCIDENTFUND.COM



Phone:      800-395-2366 Ext. 1702
                                                                                                               Contact Name:   STEVE WILSON
ACCIDENT FUND INSURANCE                     20-3058200     129 FREDERICK DR                 BRUNSWICK             GA 31520     GINNYS@ACCIDENTFUND.COM



Phone:      912-264-0988 Ext.
                                                                                                               Contact Name:   GINNY SIMMONS

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                              Page 2 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13214       ACCIDENT FUND INSURANCE CO OF                  232 SOUTH CAPITOL                LANSING               MI 48933     JUDY2T@ACCIDENTFUND.COM
            AMERICA                                        AVENUE



Phone:      517-367-1932 Ext.

ACCIDENT FUND CLAIMS DEPT                   38-3207001     200 N GRAND AVE                  LANSING               MI 48901     STEPHENW@ACCIDENTFUND.COM



Phone:      800-395-2366 Ext. 1702
                                                                                                               Contact Name:   STEVE WILSON
ACCIDENT FUND INSURANCE                     20-3058200     129 FREDERICK DR                 BRUNSWICK             GA 31520     GINNYS@ACCIDENTFUND.COM



Phone:      912-264-0988 Ext.
                                                                                                               Contact Name:   GINNY SIMMONS
BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:      800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT

Total # of Active Claim Offices: 3




Last Updated: Wednesday, June 1, 2011                                              Page 3 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13240       ACCIDENT FUND NATIONAL INSURANCE               232 SOUTH CAPITOL                LANSING               MI 48933     JUDY2T@ACCIDENTFUND.COM
            COMPANY                                        AVENUE



Phone:      517-367-1932 Ext.

ACCIDENT FUND CLAIMS DEPT                   38-3207001     200 N GRAND AVE                  LANSING               MI 48901     STEPHENW@ACCIDENTFUND.COM



Phone:      800-395-2366 Ext. 1702
                                                                                                               Contact Name:   STEVE WILSON
ACCIDENT FUND INSURANCE                     20-3058200     129 FREDERICK DR                 BRUNSWICK             GA 31520     GINNYS@ACCIDENTFUND.COM



Phone:      912-264-0988 Ext.
                                                                                                               Contact Name:   GINNY SIMMONS

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                              Page 4 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13235       ACCIDENT INSURANCE COMPANY                     131 DUTCHMAN BLVD                IRMO                  SC 29063     MICHAEL.HUNTER@ACCINSCO.COM




Phone:      -- Ext.

US ADMINISTRATOR CLAIMS                     26-3357762     3440 BLUE SPRINGS ROAD           KENNESAW              GA 30144     HMOSS@USADMINCLAIMS.COM


                                                           SUITE 203
Phone:      800-896-6884 Ext. 8459
                                                                                                               Contact Name:   HUNTER MOSS

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                              Page 5 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10253      ACE AMERICAN INS CO                             436 WALNUT STREET                PHILADELPHIA          PA 19106     MARILEE.BRABSON@ACEGROUP.COM



                                                           WB04G
Phone:     215-640-4565 Ext.

ALTERNATIVE SERVICE CONCEPTS LLC            43-1954328     P O BOX 15550                    LITTLE ROCK           AZ 72231     JAMES.CHANCELLOR@ASCRISK.COM



Phone:     800-669-0437 Ext. 108
                                                                                                               Contact Name:   JAMES CHANCELLOR
AVIZENT FKA FRANK GATES SERVICE             31-4359765     THIS IS NOT A CLAIMS             EDI USE ONLY          OH 43017     RKARIKAS@AVIZENTRISK.COM
                                                           OFFICE

Phone:     614-766-8747 Ext.
                                                                                                               Contact Name:   REBECCA KARIKAS
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA            BIRMINGHAM            AL 35209     DMCCLOSKEY@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 29106
                                                                                                               Contact Name:   DAVIDA MCCLOSKEY
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA            BIRMINGHAM            AL 35209     CMULLINS@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 20104
                                                                                                               Contact Name:   CHRISTINA MULLINS
BROADSPIRE INC                              36-3917295     P O BOX 926240                   NORCROSS              GA 30010     ATLANTA@CHOOSEBROADSPIRE.COM



Phone:     678-969-7337 Ext.
                                                                                                               Contact Name:   LORRAINE SHRINER


Last Updated: Wednesday, June 1, 2011                                              Page 6 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10253      ACE AMERICAN INS CO                             436 WALNUT STREET                PHILADELPHIA          PA 19106     MARILEE.BRABSON@ACEGROUP.COM



                                                           WB04G
Phone:     215-640-4565 Ext.

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
BROADSPIRE SERVICES INC.                    36-3917295     9502 WILLIAMSBURG PLACE          LOUISVILLE            KY 40222     TOM.WEBER@CHOOSEBROADSPIRE.COM


                                                           SUITE 200
Phone:     800-742-4248 Ext.
                                                                                                               Contact Name:   TOM WEBER
CAMBRIDGE INTEGRATED SERVICE                23-2731565     809 GLEN EAGLES COURT            TOWSON                MD 21286     BRIAN.WALSH@US.XCHANGING.COM
GROUP INC

                                                           SUITE 210
Phone:     419-847-6323 Ext.
                                                                                                               Contact Name:   BRIAN WALSH
CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD           POMPANO BEACH         FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:     877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD
CAMBRIDGE INTEGRATED SERVICES               23-2731565     6300 CENTER HILL ROAD            CINCINNATI            OH 45224     NICOLE.DEWITT@US.XCHANGING.COM
GROUP INC

Phone:     800-235-1134 Ext. 5
                                                                                                               Contact Name:   NICOLE DEWITT


Last Updated: Wednesday, June 1, 2011                                              Page 7 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10253      ACE AMERICAN INS CO                             436 WALNUT STREET                PHILADELPHIA          PA 19106     MARILEE.BRABSON@ACEGROUP.COM



                                                           WB04G
Phone:     215-640-4565 Ext.

CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR              MAITLAND              FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

                                                           SUITE 225
Phone:     866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN
CONSTITUTION STATE SERVICES                 06-1501229     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           STE 100
Phone:     770-352-2978 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
CONSTITUTION STATE SERVICES                 06-1501229     10401 HIGHLAND MANOR DR          TAMPA                 FL 33612     GEORGIAWCBOARD@TRAVELERS.COM


                                                           STE 200
Phone:     770-934-3414 Ext.
                                                                                                               Contact Name:   JOSEPH CIBULSKI
ESIS INC                                    95-2008390     500 COLONIAL PARKWAY             ROSWELL               GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES


Last Updated: Wednesday, June 1, 2011                                              Page 8 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10253      ACE AMERICAN INS CO                             436 WALNUT STREET                PHILADELPHIA          PA 19106     MARILEE.BRABSON@ACEGROUP.COM



                                                           WB04G
Phone:     215-640-4565 Ext.

GALLAGHER BASSETT SERVICES                  36-3365500     P O BOX 279310                   MIRAMAR               FL 33027     KRISTY_SANDS@GBTPA.COM



Phone:     800-473-9009 Ext.
                                                                                                               Contact Name:   KRISTY SANDS
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 292109                   NASHVILLE             TN 37229     GALE_LESIEUR@GBTPA.COM



Phone:     800-288-9843 Ext. 201
                                                                                                               Contact Name:   GALE LESIEUR
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 21227                    TAMPA                 FL 33622     WILLIAM_KIMBROUGH@GBTPA.COM



Phone:     866-428-0283 Ext.
                                                                                                               Contact Name:   WILLIAM KIMBROUGH
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 785071                   ORLANDO               FL 32878     KEITH_LEAHY@GBTPA.COM



Phone:     800-843-8999 Ext.
                                                                                                               Contact Name:   KEITH LEAHY


Last Updated: Wednesday, June 1, 2011                                              Page 9 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10253      ACE AMERICAN INS CO                             436 WALNUT STREET               PHILADELPHIA           PA 19106     MARILEE.BRABSON@ACEGROUP.COM



                                                           WB04G
Phone:     215-640-4565 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     1301 INTERNATIONAL              SUNRISE                FL 33323     ANDREA_HUMPHRIES@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 230
Phone:     800-889-6764 Ext. 201
                                                                                                               Contact Name:   ANDREA HUMPHRIES
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY           DULUTH                 GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
GALLAGHER BASSETT SERVICES INC              36-3365500     1096 ASSEMBLY DRIVE             FT MILL                SC 29716     JULIE_MCCOY-LINCOLN@GBTPA.COM


                                                           SUITE 210
Phone:     866-814-1740 Ext. 201
                                                                                                               Contact Name:   JULIE MCCOY-LINCOLN
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 4840                    CLEARWATER             FL 33758     KIM_BUCHANAN@GBTPA.COM



Phone:     800-226-8002 Ext.
                                                                                                               Contact Name:   KIM BUCHANAN
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 607                     FORT MILL              SC 29715     JULIE_MCCOY-LINCOLN@GBTPA.COM



Phone:     803-547-8036 Ext.
                                                                                                               Contact Name:   JULIE MCCOY-LINCOLN


Last Updated: Wednesday, June 1, 2011                                             Page 10 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10253      ACE AMERICAN INS CO                             436 WALNUT STREET               PHILADELPHIA           PA 19106     MARILEE.BRABSON@ACEGROUP.COM



                                                           WB04G
Phone:     215-640-4565 Ext.

HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 31204                   TAMPA                  FL 33618     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   CHARLES HUNNELL
RISK ENTERPRISE MANAGEMENT                  13-3832689     1140 HAMMOND DR                 ATLANTA                GA 30328     JANET.GREER@REMLTD.COM
LIMITED

                                                           SUITE J-2075
Phone:     800-347-4494 Ext.
                                                                                                               Contact Name:   JANET GREER
RISK ENTERPRISE MANAGEMENT                  13-3832689     565 MARRIOTT DRIVE              NASHVILLE              TN 37214     JANICE.GUIDRY@REMLTD.COM
LIMITED

                                                           SUITE 725
Phone:     800-871-6670 Ext.
                                                                                                               Contact Name:   JANICE GUIDRY
SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER           ATLANTA                GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN
SEDGWICK CMS                                36-2685608     1100 RIDGEWAY LOOP ROAD         MEMPHIS                TN 38120     APULLEN@SEDGWICKCMS.COM



Phone:     241-922-0638 Ext.
                                                                                                               Contact Name:   ANTHONY PULLEN


Last Updated: Wednesday, June 1, 2011                                             Page 11 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10253      ACE AMERICAN INS CO                             436 WALNUT STREET               PHILADELPHIA           PA 19106     MARILEE.BRABSON@ACEGROUP.COM



                                                           WB04G
Phone:     215-640-4565 Ext.

SEDGWICK CMS BELLSOUTH DISABILITY           36-2685608     1200 ASHWOOD PARKWAY            ATLANTA                GA 30338     TOBIN.BECKERMANN@SEDGWICKCMS.COM


                                                           SUITE 425
Phone:     770-353-4591 Ext.
                                                                                                               Contact Name:   TOBIN BECKERMANN
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 60000                   ATLANTA                GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM



Phone:     770-901-3121 Ext.
                                                                                                               Contact Name:   MARY D'AGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                   NASHVILLE              TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY             ATLANTA                GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE          LAKE MARY              FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:     800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN


Last Updated: Wednesday, June 1, 2011                                             Page 12 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10253      ACE AMERICAN INS CO                             436 WALNUT STREET               PHILADELPHIA           PA 19106     MARILEE.BRABSON@ACEGROUP.COM



                                                           WB04G
Phone:     215-640-4565 Ext.

TRAVELERS INDEMNITY COMPANY                 06-0566050     1000 WINDWARD                   ALPHARETTA             GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           SUITE 100
Phone:     800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
TRAVELERS INDEMNITY COMPANY                 06-0566050     1000 WINDWARD                   ALPHARETTA             GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           SUITE 100
Phone:     800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
UNDERWRITERS SAFETY & CLAIMS INC            61-0489172     5105 PAULSEN STREET             SAVANNAH               GA 31405     ANNF@USCKY.COM



Phone:     912-355-8989 Ext.
                                                                                                               Contact Name:   ANN FINNEGAN
YORK CLAIMS SERVICE INC                     13-1963636     99 CHERRY HILL ROAD             PARSIPPANY             NJ 07054     STEPHANIE.MARSHALL@YORKRSG.COMM



Phone:     877-927-2255 Ext.
                                                                                                               Contact Name:   STEPHANIE MARSHALL




Last Updated: Wednesday, June 1, 2011                                             Page 13 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 39




Last Updated: Wednesday, June 1, 2011                                             Page 14 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10221      ACE FIRE UNDERWRITERS                           436 WALNUT STREET               PHILADELPHIA           PA 19106     MARILEE.BRABSON@ACEGROUP.COM



                                                           WB04G
Phone:     302-476-7446 Ext.

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD           ATLANTA                GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
CAMBRIDGE INTEGRATED SERVICE                23-2731565     809 GLEN EAGLES COURT           TOWSON                 MD 21286     BRIAN.WALSH@US.XCHANGING.COM
GROUP INC

                                                           SUITE 210
Phone:     419-847-6323 Ext.
                                                                                                               Contact Name:   BRIAN WALSH
CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD          POMPANO BEACH          FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:     877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD
CAMBRIDGE INTEGRATED SERVICES               23-2731565     6300 CENTER HILL ROAD           CINCINNATI             OH 45224     NICOLE.DEWITT@US.XCHANGING.COM
GROUP INC

Phone:     800-235-1134 Ext. 5
                                                                                                               Contact Name:   NICOLE DEWITT
ESIS INC                                    95-2008390     500 COLONIAL PARKWAY            ROSWELL                GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN


Last Updated: Wednesday, June 1, 2011                                             Page 15 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10221      ACE FIRE UNDERWRITERS                           436 WALNUT STREET               PHILADELPHIA           PA 19106     MARILEE.BRABSON@ACEGROUP.COM



                                                           WB04G
Phone:     302-476-7446 Ext.

GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY           DULUTH                 GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 785071                  ORLANDO                FL 32878     KEITH_LEAHY@GBTPA.COM



Phone:     800-843-8999 Ext.
                                                                                                               Contact Name:   KEITH LEAHY
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                   NASHVILLE              TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY             ATLANTA                GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE          LAKE MARY              FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:     800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN


Last Updated: Wednesday, June 1, 2011                                             Page 16 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10221       ACE FIRE UNDERWRITERS                          436 WALNUT STREET               PHILADELPHIA           PA 19106     MARILEE.BRABSON@ACEGROUP.COM



                                                           WB04G
Phone:      302-476-7446 Ext.

UNDERWRITERS SAFETY & CLAIMS INC            61-0489172     5105 PAULSEN STREET             SAVANNAH               GA 31405     ANNF@USCKY.COM



Phone:      912-355-8989 Ext.
                                                                                                               Contact Name:   ANN FINNEGAN

Total # of Active Claim Offices: 11




Last Updated: Wednesday, June 1, 2011                                             Page 17 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13034      ACE INDEMNITY INSURANCE CO                      510 WALNUT STREET WB6B          PHILADELPHIA           PA 19106     MARILEE.BRABSON@ACEGROUP.COM




Phone:     215-640-4565 Ext.

CAMBRIDGE INTEGRATED SERVICE                23-2731565     809 GLEN EAGLES COURT           TOWSON                 MD 21286     BRIAN.WALSH@US.XCHANGING.COM
GROUP INC

                                                           SUITE 210
Phone:     419-847-6323 Ext.
                                                                                                               Contact Name:   BRIAN WALSH
CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD          POMPANO BEACH          FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:     877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD
CAMBRIDGE INTEGRATED SERVICES               23-2731565     6300 CENTER HILL ROAD           CINCINNATI             OH 45224     NICOLE.DEWITT@US.XCHANGING.COM
GROUP INC

Phone:     800-235-1134 Ext. 5
                                                                                                               Contact Name:   NICOLE DEWITT
ESIS INC                                    95-2008390     500 COLONIAL PARKWAY            ROSWELL                GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY           DULUTH                 GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES


Last Updated: Wednesday, June 1, 2011                                             Page 18 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13034      ACE INDEMNITY INSURANCE CO                      510 WALNUT STREET WB6B          PHILADELPHIA           PA 19106     MARILEE.BRABSON@ACEGROUP.COM




Phone:     215-640-4565 Ext.

PROPERTY & CASUALTY INS CO OF               06-1276326     300 SOUTH STATE STREET          SYRACAUSE              NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
HARTFORD                                                                                                                       ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                   NASHVILLE              TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY             ATLANTA                GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE          LAKE MARY              FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:     800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN




Last Updated: Wednesday, June 1, 2011                                             Page 19 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 9




Last Updated: Wednesday, June 1, 2011                                             Page 20 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10002      ACE PROPERTY & CASUALTY                         436 WALNUT STREET               PHILADELPHIA           PA 19106     MARILEE.BRABSON@ACEGROUP.COM



                                                           WB04G
Phone:     215-640-4565 Ext.

ESIS INC                                    95-2008390     500 COLONIAL PARKWAY            ROSWELL                GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY           DULUTH                 GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE             TUCKER                 GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
PROPERTY & CASUALTY INS CO OF               06-1276326     300 SOUTH STATE STREET          SYRACAUSE              NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
HARTFORD                                                                                                                       ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 60000                   ATLANTA                GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM



Phone:     770-901-3121 Ext.
                                                                                                               Contact Name:   MARY D'AGOSTINO


Last Updated: Wednesday, June 1, 2011                                             Page 21 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10002       ACE PROPERTY & CASUALTY                        436 WALNUT STREET               PHILADELPHIA           PA 19106     MARILEE.BRABSON@ACEGROUP.COM



                                                           WB04G
Phone:      215-640-4565 Ext.

SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                   NASHVILLE              TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:      615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY             ATLANTA                GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:      678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE          LAKE MARY              FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:      800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN

Total # of Active Claim Offices: 8




Last Updated: Wednesday, June 1, 2011                                             Page 22 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13193       ACIG INSURANCE COMPANY                         12222 MERIT DRIVE               DALLAS,                TX 75251     ACIGREGULATORY@ACIG.COM



                                                           SUITE 1660
Phone:      800-563-6051 Ext.

NOVAPRO RISK                                36-4550659     101 E KENNEDY BLVD              TAMPA                  FL 33602     KROGERS@NOVAPRORISK.COM


                                                           SUITE 870
Phone:      800-426-5990 Ext.
                                                                                                               Contact Name:   KAREN ROGERS
NOVAPRO RISK SOLUTIONS LP                   36-4550659     SIX CONCOURSE PARKWAY           ATLANTA                GA 30328     TKATER@NOVAPRORISK.COM


                                                           SUITE 1550
Phone:      678-731-9091 Ext. 252
                                                                                                               Contact Name:   TAMMIE KATER

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 23 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13176       ADVANTAGE WORKERS                              P O BOX 571918                  SALT LAKE CITY         UT 84157     CLAIMS@ADVANTAGEWC.COM
            COMPENSATION INSURANCE COMPANY



Phone:      888-595-8750 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE             TUCKER                 GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:      800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
SYNERGY COVERAGE SOLUTIONS                  04-3718801     3440 TORINGDON WAY              CHARLOTTE              NC 28277     JTHOMAS@SYNERGYINSURANCE.NET



Phone:      866-710-0908 Ext.
                                                                                                               Contact Name:   JIM THOMAS

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 24 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10066       AIU INSURANCE COMPANY                          175 WATER STREET                NEW YORK               NY 10038     ALGAWCFR@AIG.COM



                                                           18TH FLOOR
Phone:      212-458-7043 Ext.

CHARTIS CLAIMS                              13-2925174     P O BOX 1821                    ALPHARETTA             GA 30023     ALGAWCFR@AIG.COM



Phone:      800-448-9707 Ext.
                                                                                                               Contact Name:   ANNA COLBURN

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 25 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13202       ALEA NORTH AMERICA INSURANCE                   55 CAPITAL BLVD                 ROCKY HILL             CT 06067     ARLEEN.SIMMONS@ALEAGROUP.COM
            COMPANY



Phone:      877-775-8637 Ext.

CHUBB SERVICES CORPORATION                  22-3096895     3445 PEACHTREE ROAD NE          ATLANTA                GA 30326     KPILZ@CHUBB.COM


                                                           2 LIVE OAK CENTER #900
Phone:      404-266-4855 Ext.
                                                                                                               Contact Name:   KURT PILZ
CORVEL CORP                                 95-3382819     4820 LAKE BROOK DRIVE           GLEN ALLEN             VA 23058     MARCIA_MORGAN@CORVEL.COM


                                                           SUITE 150
Phone:      800-906-4461 Ext.
                                                                                                               Contact Name:   MARCIA MORGAN
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE             TUCKER                 GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:      800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI

Total # of Active Claim Offices: 3




Last Updated: Wednesday, June 1, 2011                                             Page 26 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10295       ALL AMERICA INSURANCE CO                       800 SOUTH WASHINGTON            VAN WERT               OH 45891     PWOIROL@CENTRAL-INSURANCE.COM
                                                           STREET



Phone:      800-736-7000 Ext. 2325

CENTRAL INSURANCE                           34-4202560     800 SOUTH WASHINGTON ST         VAN WERT               OH 45891     CLININGER@CENTRAL-INSURANCE.COM



Phone:      800-736-7000 Ext. 2380
                                                                                                               Contact Name:   CAROL LININGER

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 27 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13275       ALLIED EASTERN INDEMNITY COMPANY               P O BOX 83777                   LANCASTER              PA 17608     RIRONS@EAINS.COM




Phone:      -- Ext.

ALLIED EASTERN INDEMNITY COMPANY            26-0026993     P O BOX 83777                   LANCASTER              PA 17608     RIRONS@EAINS.COM



Phone:      888-654-7100 Ext.
                                                                                                               Contact Name:   RICHARD W IRONS

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 28 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13244       ALLIED PROPERTY AND CASUALTY                   ONE NATIONWIDE PLAZA            COLUMBUS               OH 43215     KINGJ4@NATIONWIDE.COM
            INSURANCE COMPANY

                                                           3-13-401
Phone:      -- Ext.

NATIONWIDE INSURANCE                        31-4177100     P O BOX 147061                  GAINESVILLE            FL 32614     FERRANT@NATIONWIDE.COM



Phone:      800-985-7078 Ext.
                                                                                                               Contact Name:   TOM FERRANTE

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 29 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13293       ALLMERICA FINANCIAL BENEFIT                    440 LINCOLN STREET              WORCESTER              MA 01653     EBESHAI@HANOVER.COM
            INSURANCE COMPANY



Phone:      -- Ext.

HANOVER INSURANCE COMPANY                   13-5129825     440 LINCOLN STREET              WORCESTER              MA 01653     EBESHAI@HANOVER.COM



Phone:      800-628-0250 Ext.
                                                                                                               Contact Name:   ELIZABETH BESHAI

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 30 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13245       AMCO INSURANCE COMPANY                         ONE NATIONWIDE PLAZA            COLUMBUS               OH 43215     KINGJ4@NATIONWIDE.COM



                                                           3-13-401
Phone:      -- Ext.

NATIONWIDE INSURANCE                        31-4177100     P O BOX 147061                  GAINESVILLE            FL 32614     FERRANT@NATIONWIDE.COM



Phone:      800-985-7078 Ext.
                                                                                                               Contact Name:   TOM FERRANTE

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 31 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13122       AMERICAN ALTERNATIVE INSURANCE                 555 COLLEGE ROAD EAST           PRINCETON              NJ 08543     CKROH@MUNICHREAMERICAN.COM
            CORPORPATION



Phone:      800-305-4954 Ext.

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD           ATLANTA                GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:      800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE             TUCKER                 GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:      800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
RISK ENTERPRISE MANAGEMENT                  13-3832689     1140 HAMMOND DR                 ATLANTA                GA 30328     JANET.GREER@REMLTD.COM
LIMITED

                                                           SUITE J-2075
Phone:      800-347-4494 Ext.
                                                                                                               Contact Name:   JANET GREER

Total # of Active Claim Offices: 3




Last Updated: Wednesday, June 1, 2011                                             Page 32 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10006       AMERICAN AUTOMOBILE INSURANCE                  777 SAN MARIN DRIVE             NOVATO                 CA 94998     LMNUSON@FFIC.COM
            COMPANY



Phone:      800-227-1700 Ext.

FIREMAN'S FUND CLAIMS CENTER                58-1373156     P O BOX 740174                  ATLANTA                GA 30374     KLOCKE@FFIC.COM



Phone:      678-393-4550 Ext.
                                                                                                               Contact Name:   KEN LOCKE
FIREMAN'S FUND INSURANCE CO                 94-1610280     11475 GREAT OAKS WAY            ALPHARETTA             GA 30022     JUDY.OWEN@AFFIC.COM


                                                           ROYAL CTR 3 STE 200
Phone:      678-393-4584 Ext.
                                                                                                               Contact Name:   JUDY OWEN

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 33 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10007      AMERICAN CASUALTY COMPANY OF                    333 S WABASH AVENUE             CHICAGO                IL 60604     DEBRA.RETEL@CNA.COM
           READING PENNSYLVANIA

                                                           28 SOUTH
Phone:     312-822-3874 Ext.

CAMBRIDGE INTEGRATED                        23-2731565     1775 THE EXCHANGE               ATLANTA                GA 30339     DAVID.HAYS@CAMBRIDGE-NA.COM


                                                           SUITE 360
Phone:     800-862-4252 Ext.
                                                                                                               Contact Name:   DAVID HAYES
CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD          POMPANO BEACH          FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:     877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD
CNA CLAIMS PLUS                             16-1633560     2435 COMMERCE AVENUE            DULUTH                 GA 30096     GASTATEICNUMBERS@CNA.COM


                                                           BDG 2200 SATELLITE PLACE
Phone:     800-283-2318 Ext. 3574
                                                                                                               Contact Name:   TAMARA WILLIAMS
CONTINENTAL CASUALTY COMPANY                36-2114545     333 SOUTH WABASH                CHICAGO                IL   60604   GASTATEICNUMBERS@CNA.COM


                                                           38S
Phone:     312-822-2331 Ext.
                                                                                                               Contact Name:   COLETTE TURNER
COTTINGHAM & BUTLER CLAIM                   20-5233506     P O BOX 28                      DUBUQUE                IA 52004     DUNMACHT@CBCSCLAIMS.COM
SERVICES

Phone:     877-241-6121 Ext.
                                                                                                               Contact Name:   DAN UNMACHT


Last Updated: Wednesday, June 1, 2011                                             Page 34 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10007      AMERICAN CASUALTY COMPANY OF                    333 S WABASH AVENUE             CHICAGO                IL 60604     DEBRA.RETEL@CNA.COM
           READING PENNSYLVANIA

                                                           28 SOUTH
Phone:     312-822-3874 Ext.

ESIS INC                                    95-2008390     500 COLONIAL PARKWAY            ROSWELL                GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY           DULUTH                 GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES
GALLAGHER BASSET SERVICES                   36-3365500     222 W LAS COLINAS BLVD          IRVING                 TX 75039     TERRY_TARTER@GBTPA.COM


                                                           STE 250E
Phone:     800-787-6750 Ext.
                                                                                                               Contact Name:   TERRY TARTER
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE             TUCKER                 GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY           DULUTH                 GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER


Last Updated: Wednesday, June 1, 2011                                             Page 35 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10007      AMERICAN CASUALTY COMPANY OF                    333 S WABASH AVENUE             CHICAGO                IL 60604     DEBRA.RETEL@CNA.COM
           READING PENNSYLVANIA

                                                           28 SOUTH
Phone:     312-822-3874 Ext.

RISK ENTERPRISE MANAGEMENT                  13-3832689     1140 HAMMOND DR                 ATLANTA                GA 30328     JANET.GREER@REMLTD.COM
LIMITED

                                                           SUITE J-2075
Phone:     800-347-4494 Ext.
                                                                                                               Contact Name:   JANET GREER
RISK ENTERPRISE MANAGEMENT                  13-3832689     565 MARRIOTT DRIVE              NASHVILLE              TN 37214     JANICE.GUIDRY@REMLTD.COM
LIMITED

                                                           SUITE 725
Phone:     800-871-6670 Ext.
                                                                                                               Contact Name:   JANICE GUIDRY
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 60000                   ATLANTA                GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM



Phone:     770-901-3121 Ext.
                                                                                                               Contact Name:   MARY D'AGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                   NASHVILLE              TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY             ATLANTA                GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO


Last Updated: Wednesday, June 1, 2011                                             Page 36 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10007       AMERICAN CASUALTY COMPANY OF                   333 S WABASH AVENUE             CHICAGO                IL 60604     DEBRA.RETEL@CNA.COM
            READING PENNSYLVANIA

                                                           28 SOUTH
Phone:      312-822-3874 Ext.

SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE          LAKE MARY              FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:      800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN

Total # of Active Claim Offices: 16




Last Updated: Wednesday, June 1, 2011                                             Page 37 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13271       AMERICAN COMPENSATION INSURANCE                8500 NORMANDALE LAKE            BLOOMINGTON            MN 55437     MARSHALL.LIN@RTWI.COM
            COMPANY                                        BLVD #1400



Phone:      -- Ext.

CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR             MAITLAND               FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

Phone:      866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 38 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10262       AMERICAN ECONOMY INS CO                        CO LICENSING T-18               SEATTLE                WA 98185     CORPORATESECRETARY@LIBERTYMUTUAL.COM



                                                           SAFECO PLAZA
Phone:      206-675-3609 Ext.

SAFECO                                      91-0742148     2055 SUGARLOAF CIRCLE           DULUTH                 GA 30097     MARPOO@SAFECO.COM


                                                           SAFECO PLAZA
Phone:      678-417-3654 Ext.
                                                                                                               Contact Name:   MARLENA POOL

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 39 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13255       AMERICAN FAMILY INSURANCE                      6000 AMERICAN PARKWAY           MADISON                WI 53783     CGILB@AMFAM.COM
            COMPANY



Phone:      608-242-4100 Ext. 36100

AMERICAN FAMILY INSURANCE                   39-1835307     P O BOX 530                     SCHOFIELD              WI 55476     SLODHOLZ@AMFAM.COM
COMPANY CLAIMS

Phone:      800-692-6326 Ext. 41237
                                                                                                               Contact Name:   SANDY LODHOLZ

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 40 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10011       AMERICAN FIRE & CASUALTY COMPANY               9450 SEWARD ROAD                FAIRFIELD              OH 45014     CORPORATESECRETARY@LIBERTYMUTUAL.COM




Phone:      800-843-6446 Ext.

MONTGOMERY INSURANCE CLAIM                  52-0424870     P O BOX 49130                   CHARLOTTE              NC 28277     CHRISTINE.JONES@MONTGOMERY-INS.COM
CENTER

Phone:      800-334-0078 Ext. 214
                                                                                                               Contact Name:   CHRISTINE JONES
OHIO CASUALTY INSURANCE COMPANY             -              9450 SEWARD RD                  FAIRFIELD              OH 45014



Phone:      -- Ext.
                                                                                                               Contact Name:
OHIO CASUALTY INSURANCE COMPANY             -              P O BOX 399                     HOLLY SPRINGS          GA 30142



Phone:      -- Ext.
                                                                                                               Contact Name:

Total # of Active Claim Offices: 3




Last Updated: Wednesday, June 1, 2011                                             Page 41 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10013      AMERICAN GUARANTEE & LIABILITY                  1400 AMERICAN LANE              SCHAUMBURG             IL 60196     TIM.GRAHAM@ZURICHNA.COM
           INSURANCE COMPANY



Phone:     800-340-8602 Ext. 8613

AMERICAN GUARANTEE AND LIABILITY            36-6071400     1001 SUMMIT BLVD                ATLANTA                GA 30319     CHRIS.CALLOWAY@ZURICHNA.COM
COMPANY

                                                           SUITE 800
Phone:     404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY
AMERICAN GUARANTEE AND LIABILITY            36-6071400     1900 SUMMIT TOWER BLVD          ORLANDO                FL 32810     CHRIS.CALLOWAY@ZURICHNA.COM
COMPANY

                                                           SUITE 600
Phone:     404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY
GALLAGHER BASSETT SERVICES                  36-3365500     P O BOX 279310                  MIRAMAR                FL 33027     KRISTY_SANDS@GBTPA.COM



Phone:     800-473-9009 Ext.
                                                                                                               Contact Name:   KRISTY SANDS
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 292109                  NASHVILLE              TN 37229     GALE_LESIEUR@GBTPA.COM



Phone:     800-288-9843 Ext. 201
                                                                                                               Contact Name:   GALE LESIEUR
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE             TUCKER                 GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI


Last Updated: Wednesday, June 1, 2011                                             Page 42 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10013      AMERICAN GUARANTEE & LIABILITY                  1400 AMERICAN LANE              SCHAUMBURG             IL 60196     TIM.GRAHAM@ZURICHNA.COM
           INSURANCE COMPANY



Phone:     800-340-8602 Ext. 8613

GALLAGHER BASSETT SERVICES INC              36-3365500     2600 MCCORMICK DR #110          CLEARWATER             FL 33758     CANDICE_BUCHANAN@GBTPA.COM


                                                           ONE PRESTIGE PLACE
Phone:     800-226-8002 Ext.
                                                                                                               Contact Name:   CANDICE BUCHANAN
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 21227                   TAMPA                  FL 33622     WILLIAM_KIMBROUGH@GBTPA.COM



Phone:     866-428-0283 Ext.
                                                                                                               Contact Name:   WILLIAM KIMBROUGH
GALLAGHER BASSETT SERVICES INC              36-3365500     601 VESTAVIA PARKWAY            BIRMINGHAM             AL 35266     CHRIS_ROCK@GBTPA.COM


                                                           SUITE 251
Phone:     800-762-3486 Ext.
                                                                                                               Contact Name:   CHRIS ROCK
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 785071                  ORLANDO                FL 32878     KEITH_LEAHY@GBTPA.COM



Phone:     800-843-8999 Ext.
                                                                                                               Contact Name:   KEITH LEAHY
GALLAGHER BASSETT SERVICES INC              36-3365500     1301 INTERNATIONAL              SUNRISE                FL 33323     ANDREA_HUMPHRIES@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 230
Phone:     800-889-6764 Ext. 201
                                                                                                               Contact Name:   ANDREA HUMPHRIES


Last Updated: Wednesday, June 1, 2011                                             Page 43 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10013      AMERICAN GUARANTEE & LIABILITY                  1400 AMERICAN LANE              SCHAUMBURG             IL 60196     TIM.GRAHAM@ZURICHNA.COM
           INSURANCE COMPANY



Phone:     800-340-8602 Ext. 8613

GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY           DULUTH                 GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
GALLAGHER BASSETT SERVICES INC              36-3365500     1096 ASSEMBLY DRIVE             FT MILL                SC 29716     JULIE_MCCOY-LINCOLN@GBTPA.COM


                                                           SUITE 210
Phone:     866-814-1740 Ext. 201
                                                                                                               Contact Name:   JULIE MCCOY-LINCOLN
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKEVIEW                    NASHVILLE              TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-493-5802 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY             ATLANTA                GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE          LAKE MARY              FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:     800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN


Last Updated: Wednesday, June 1, 2011                                             Page 44 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10013       AMERICAN GUARANTEE & LIABILITY                 1400 AMERICAN LANE              SCHAUMBURG             IL 60196     TIM.GRAHAM@ZURICHNA.COM
            INSURANCE COMPANY



Phone:      800-340-8602 Ext. 8613

ZURICH NORTH AMERICA                        36-3839542     P.O. BOX 2769                   SCHAUMBERG             IL   60666   USZ_GA_WC_CLAIM_NOTICES@ZURICHNA.COM



Phone:      404-851-3208 Ext.
                                                                                                               Contact Name:   SHELLY HAYES
ZURICH SERVICES CORPORATION                 36-3839542     1001 SUMMIT BLVD                ATLANTA                GA 30319     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM


                                                           SUITE 800
Phone:      404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY

Total # of Active Claim Offices: 17




Last Updated: Wednesday, June 1, 2011                                             Page 45 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10015      AMERICAN HOME ASSURANCE                         175 WATER STREET                NEW YORK               NY 10038     ALGAWCFR@AIG.COM
           COMPANY

                                                           18TH FLOOR
Phone:     -- Ext.

ALTERNATIVE SERVICE CONCEPTS LLC            43-1954328     3135 AVALON RIDGE PLACE         NORCROSS               GA 30071     SUE.LORANCE@ASCRISK.COM
DBA ASC

                                                           SUITE 650
Phone:     678-447-0200 Ext. 302
                                                                                                               Contact Name:   SUE LORANCE
AVIZENT FKA FRANK GATES SERVICE             31-4359765     THIS IS NOT A CLAIMS            EDI USE ONLY           OH 43017     RKARIKAS@AVIZENTRISK.COM
                                                           OFFICE

Phone:     614-766-8747 Ext.
                                                                                                               Contact Name:   REBECCA KARIKAS
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA           BIRMINGHAM             AL 35209     DMCCLOSKEY@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 29106
                                                                                                               Contact Name:   DAVIDA MCCLOSKEY
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA           BIRMINGHAM             AL 35209     CMULLINS@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 20104
                                                                                                               Contact Name:   CHRISTINA MULLINS
BROADSPIRE INC                              36-3917295     P O BOX 926240                  NORCROSS               GA 30010     ATLANTA@CHOOSEBROADSPIRE.COM



Phone:     678-969-7337 Ext.
                                                                                                               Contact Name:   LORRAINE SHRINER


Last Updated: Wednesday, June 1, 2011                                             Page 46 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10015      AMERICAN HOME ASSURANCE                         175 WATER STREET                NEW YORK               NY 10038     ALGAWCFR@AIG.COM
           COMPANY

                                                           18TH FLOOR
Phone:     -- Ext.

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD           ATLANTA                GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
CAMBRIDGE INTEGRATED SERVICE                23-2731565     809 GLEN EAGLES COURT           TOWSON                 MD 21286     BRIAN.WALSH@US.XCHANGING.COM
GROUP INC

                                                           SUITE 210
Phone:     419-847-6323 Ext.
                                                                                                               Contact Name:   BRIAN WALSH
CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD          POMPANO BEACH          FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:     877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD
CAMBRIDGE INTEGRATED SERVICES               23-2731565     6300 CENTER HILL ROAD           CINCINNATI             OH 45224     NICOLE.DEWITT@US.XCHANGING.COM
GROUP INC

Phone:     800-235-1134 Ext. 5
                                                                                                               Contact Name:   NICOLE DEWITT
CAMBRIDGE INTEGRATED SERVICES               23-2731565     6300 CENTER HILL ROAD           CINCINNATI             OH 45224     NICOLE.DEWITT@US.EXCHANGING.COM
GROUP INC

Phone:     800-235-1134 Ext. 5
                                                                                                               Contact Name:   NICOLE DEWITT


Last Updated: Wednesday, June 1, 2011                                             Page 47 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10015      AMERICAN HOME ASSURANCE                         175 WATER STREET                NEW YORK               NY 10038     ALGAWCFR@AIG.COM
           COMPANY

                                                           18TH FLOOR
Phone:     -- Ext.

CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR             MAITLAND               FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

Phone:     866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN
CHARTIS CLAIMS                              13-2925174     P O BOX 1821                    ALPHARETTA             GA 30023     ALGAWCFR@AIG.COM



Phone:     800-448-9707 Ext.
                                                                                                               Contact Name:   ANNA COLBURN
CLAIMETRICS                                 20-1604010     PO BOX 22478                    OKLAHOMA CITY          OK 73123     LAUREN.TOPPINS@CLAIMETRICS.COM



Phone:     405-728-5544 Ext. 2326
                                                                                                               Contact Name:   LAUREN TOPPINS
CONSTITUTION STATE SERVICES                 06-1501229     1000 WINDWARD                   ALPHARETTA             GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           STE 100
Phone:     770-352-2978 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
COTTINGHAM & BUTLER CLAIM                   20-5233506     P O BOX 28                      DUBUQUE                IA 52004     DUNMACHT@CBCSCLAIMS.COM
SERVICES

Phone:     877-241-6121 Ext.
                                                                                                               Contact Name:   DAN UNMACHT


Last Updated: Wednesday, June 1, 2011                                             Page 48 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10015      AMERICAN HOME ASSURANCE                         175 WATER STREET                NEW YORK               NY 10038     ALGAWCFR@AIG.COM
           COMPANY

                                                           18TH FLOOR
Phone:     -- Ext.

ESIS INC                                    95-2008390     500 COLONIAL PARKWAY            ROSWELL                GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
F A RICHARD (FARA)                          72-0837383     1625 WEST CAUSEWAY              MANDEVILLE             LA 70471     GEORGIA.NOTICES@FARA.COM
                                                           APPROACH

Phone:     985-624-6739 Ext.
                                                                                                               Contact Name:   CHAD RANFLE
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY           DULUTH                 GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 785071                  ORLANDO                FL 32878     KEITH_LEAHY@GBTPA.COM



Phone:     800-843-8999 Ext.
                                                                                                               Contact Name:   KEITH LEAHY
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY           DULUTH                 GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER


Last Updated: Wednesday, June 1, 2011                                             Page 49 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10015      AMERICAN HOME ASSURANCE                         175 WATER STREET                NEW YORK               NY 10038     ALGAWCFR@AIG.COM
           COMPANY

                                                           18TH FLOOR
Phone:     -- Ext.

PMA MANAGEMENT CORPORATION                  23-2652239     1100 ABERNATHY ROAD NE          ATLANTA                GA 30328     ADOLPHUS_DRAIN@PMAGROUP.COM


                                                           SUITE 650 500 NORTH PARK TOWN CENTER
Phone:     888-888-8136 Ext.
                                                                                                               Contact Name:   ADOLPHUS DRAIN
RISK ENTERPRISE MANAGEMENT                  13-3832689     1140 HAMMOND DR                 ATLANTA                GA 30328     JANET.GREER@REMLTD.COM
LIMITED

                                                           SUITE J-2075
Phone:     800-347-4494 Ext.
                                                                                                               Contact Name:   JANET GREER
SEDGWICK CLAIMS MANAGEMENT                  71-0738006     THIS IS NOT A CLAIMS            BENTONVILLE            AR 72756     TINA.HUDNALL@CMIW.COM
                                                           OFFICE

                                                           EDI USE ONLY
Phone:     479-621-2900 Ext. 1279
                                                                                                               Contact Name:   TINA HUDNALL
SEDGWICK CMS                                36-2685608     3700 CRESTWOOD PARKWAY          DULUTH                 GA 30096     ATLANTA.GA@SEDGWICKCMS.COM


                                                           SUITE 600
Phone:     678-628-1318 Ext.
                                                                                                               Contact Name:   RONETTA WILSON
SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER           ATLANTA                GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN


Last Updated: Wednesday, June 1, 2011                                             Page 50 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10015      AMERICAN HOME ASSURANCE                         175 WATER STREET                NEW YORK               NY 10038     ALGAWCFR@AIG.COM
           COMPANY

                                                           18TH FLOOR
Phone:     -- Ext.

SEDGWICK CMS                                36-2685608     1100 RIDGEWAY LOOP ROAD         MEMPHIS                TN 38120     APULLEN@SEDGWICKCMS.COM



Phone:     241-922-0638 Ext.
                                                                                                               Contact Name:   ANTHONY PULLEN
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                   NASHVILLE              TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 14151                   LEXINGTON              KY 40512     DANIELLE.MINNIEHAN@SRSCONNECT.COM



Phone:     800-541-0139 Ext. 35832
                                                                                                               Contact Name:   DANIELLE MINNIEHAN
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY             ATLANTA                GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE          LAKE MARY              FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:     800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN


Last Updated: Wednesday, June 1, 2011                                             Page 51 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 30




Last Updated: Wednesday, June 1, 2011                                             Page 52 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10016       AMERICAN INSURANCE COMPANY                     777 SAN MARTIN DRIVE            NOVATO                 CA 94998     ESAYERS@FFIC.COM




Phone:      800-227-1700 Ext.

FIREMAN'S FUND CLAIMS CENTER                58-1373156     P O BOX 740174                  ATLANTA                GA 30374     KLOCKE@FFIC.COM



Phone:      678-393-4550 Ext.
                                                                                                               Contact Name:   KEN LOCKE
FIREMAN'S FUND INSURANCE CO                 94-1610280     11475 GREAT OAKS WAY            ALPHARETTA             GA 30022     JUDY.OWEN@AFFIC.COM


                                                           ROYAL CTR 3 STE 200
Phone:      678-393-4584 Ext.
                                                                                                               Contact Name:   JUDY OWEN
SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER           ATLANTA                GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:      800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN

Total # of Active Claim Offices: 3




Last Updated: Wednesday, June 1, 2011                                             Page 53 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13021       AMERICAN INTERSTATE INSURANCE                  2301 HIGHWAY 190 WEST           DERIDDER               LA 70634     PMCCRANEY@AMERISAFE.COM
            COMPANY



Phone:      800-256-9052 Ext.

AMERISAFE RISK SERVICES INC                 58-1181498     2301 HWY 190 WEST               DERIDDER               LA 70634     GASTATEBOARD@AMERISAFE.COM



Phone:      800-256-3462 Ext.
                                                                                                               Contact Name:   JOYCE BISTOK
AMERISAFE RISK SERVICES INC                 72-1274075     555 OLD NORCROSS RD             LAWRENCEVILLE          GA 30045     JBISTOK@AMERISAFE.COM


                                                           SUITE 200
Phone:      770-339-9878 Ext.
                                                                                                               Contact Name:   JOYCE BISTOK

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 54 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13296       AMERICAN MINING INSURANCE                      P O BOX 660847                  BIRMINGHAM             AL 35266     MCARNEY@AMERICANMINING.COM
            COMPANY INC



Phone:      -- Ext.

CRAWFORD & COMPANY                          58-0506554     1001 SUMMIT BLVD                ATLANTA                GA 30319     ATLANTA.GA@US.CRAWCO.COM



Phone:      -- Ext.
                                                                                                               Contact Name:   STUART TUCKER

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 55 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13007       AMERICAN RESOURCES INS CO                      111 HILLCREST ROAD               MOBILE                AL 36695     MBRADY@ARIC.CC




Phone:      800-711-4413 Ext.

AMTRUST NORTH AMERICA                       34-1965476     11330 LAKEFIELD DRIVE            JOHNS CREEK           GA 30097     50STATENOTICES@AMTRUSTGROUP.COM


                                                           BUILDING II SUITE 100
Phone:      678-258-8000 Ext.
                                                                                                               Contact Name:   PHIL PUCKETT

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                              Page 56 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13124       AMERICAN RISK FUNDING                          12222 MERIT DRIVE               DALLAS                 TX 75251



                                                           SUITE 1660
Phone:      800-563-6051 Ext.

CNA CLAIMS PLUS                             -              P O BOX 105497                  ATLANTA                GA 30348



Phone:      800-283-2318 Ext.
                                                                                                               Contact Name:   DEE SMITH

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 57 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13223       AMERICAN SAFETY CASUALTY                       100 GALLERIA PARKWAY SE         ATLANTA                GA 30339     TRUDD@AMSAFETY.COM
            INSURANCE

                                                           SUITE 700
Phone:      800-388-3647 Ext.

RISK ENTERPRISE MANAGEMENT                  13-3832689     1140 HAMMOND DR                 ATLANTA                GA 30328     JANET.GREER@REMLTD.COM
LIMITED

                                                           SUITE J-2075
Phone:      800-347-4494 Ext.
                                                                                                               Contact Name:   JANET GREER

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 58 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10254       AMERICAN STATES INSURANCE                      SAFECO PLAZA                    SEATTLE                WA 98185     CORPORATESECRETARY@LIBERTYMUTUAL.COM
            COMPANY

                                                           1001 4TH AVENUE
Phone:      206-675-3609 Ext.

SAFECO                                      91-0742148     2055 SUGARLOAF CIRCLE           DULUTH                 GA 30097     MARPOO@SAFECO.COM


                                                           SAFECO PLAZA
Phone:      678-417-3654 Ext.
                                                                                                               Contact Name:   MARLENA POOL
TRAVELERS CASUALTY & SURETY                 06-0907370     1000 WINDWARD                   ALPHARETTA             GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
COMPANY OF AMERICA                                         CONCOURSE

                                                           SUITE 100
Phone:      800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
TRAVELERS CASUALTY & SURETY                 06-0907370     10401 HIGHLAND MANOR            TAMPA                  FL 33610     DBRYSON@TRAVELERS.COM
COMPANY OF AMERICA                                         DRIVE

                                                           BUILDING V SUITE 200
Phone:      888-329-6259 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON

Total # of Active Claim Offices: 3




Last Updated: Wednesday, June 1, 2011                                             Page 59 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10244       AMERICAN STATES INSURANCE                      SAFECO PLAZA                    SEATTLE                WA 98154     CORPORATESECRETARY@LIBERTYMUTUAL.COM
            COMPANY OF TEXAS

                                                           1001 4TH AVENUE
Phone:      206-675-3609 Ext.

SAFECO                                      91-0742148     2055 SUGARLOAF CIRCLE           DULUTH                 GA 30097     MARPOO@SAFECO.COM


                                                           SAFECO PLAZA
Phone:      678-417-3654 Ext.
                                                                                                               Contact Name:   MARLENA POOL

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 60 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12077      AMERICAN ZURICH INSURANCE                       1400 AMERICAN LANE              SCHAUMBURG             IL 60196     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM
           COMPANY



Phone:     407-667-8613 Ext.

AMERICAN ZURICH INSURANCE                   36-3141762     1900 SUMMIT TOWER BLVD          ORLANDO                FL 32810     CHRIS.CALLOWAY@ZURICHNA.COM
COMPANY

                                                           SUITE 600
Phone:     404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY
AMERICAN ZURICH INSURANCE                   36-3141762     1001 SUMMIT BLVVD               ATLANTA                GA 30319     CHRIS.CALLOWAY@ZURICHNA.COM
COMPANY

                                                           SUITE 800
Phone:     404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY
BROADSPIRE CLAIMS                           36-3917295     CALL BOX 30539                  TAMPA                  FL 33630     KRISTIN.CANNELL@CHOOSEBROADSPIRE.COM



Phone:     800-258-1811 Ext.
                                                                                                               Contact Name:   KRISTIN CANNELL
BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD           ATLANTA                GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD          POMPANO BEACH          FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:     877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD


Last Updated: Wednesday, June 1, 2011                                             Page 61 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12077      AMERICAN ZURICH INSURANCE                       1400 AMERICAN LANE              SCHAUMBURG             IL 60196     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM
           COMPANY



Phone:     407-667-8613 Ext.

CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR             MAITLAND               FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

Phone:     866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN
CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR             MAITLAND               FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

                                                           SUITE 225
Phone:     866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN
CHESTERFIELD SERVICES INC                   34-1709723     3520 FOREST LAKE DRIVE          UNIONTOWN              OH 44685     ITALO.GROSSI@TPA4TSA.COM



Phone:     330-896-4311 Ext.
                                                                                                               Contact Name:   ITALO GROSSI
CONSTITUTION STATE SERVICES                 06-1501229     1000 WINDWARD                   ALPHARETTA             GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           STE 100
Phone:     770-352-2978 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
COTTINGHAM & BUTLER CLAIM                   20-5233506     P O BOX 28                      DUBUQUE                IA 52004     DUNMACHT@CBCSCLAIMS.COM
SERVICES

Phone:     877-241-6121 Ext.
                                                                                                               Contact Name:   DAN UNMACHT


Last Updated: Wednesday, June 1, 2011                                             Page 62 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12077      AMERICAN ZURICH INSURANCE                       1400 AMERICAN LANE              SCHAUMBURG             IL 60196     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM
           COMPANY



Phone:     407-667-8613 Ext.

COTTINGHAM AND BUTLER CLAIM                 20-5233506     P O BOX 28                      DUBUQUE                IA 52004     DUNMACHT@CBCSCLAIMS.COM
SERVICES

Phone:     877-241-6121 Ext.
                                                                                                               Contact Name:   DAN UNMACHT
CREATIVE RISK SOLUTIONS                     20-0989430     P O BOX 9207                    WHITESBURG             GA 30185     NLYMAN@YOURCLAIMS.COM



Phone:     770-577-9657 Ext.
                                                                                                               Contact Name:   NANCY LYMAN
ESIS INC                                    95-2008390     500 COLONIAL PARKWAY            ROSWELL                GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
F A RICHARD (FARA)                          72-0837383     1625 WEST CAUSEWAY              MANDEVILLE             LA 70471     GEORGIA.NOTICES@FARA.COM
                                                           APPROACH

Phone:     985-624-6739 Ext.
                                                                                                               Contact Name:   CHAD RANFLE
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY           DULUTH                 GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES


Last Updated: Wednesday, June 1, 2011                                             Page 63 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12077      AMERICAN ZURICH INSURANCE                       1400 AMERICAN LANE              SCHAUMBURG             IL 60196     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM
           COMPANY



Phone:     407-667-8613 Ext.

GALLAGHER BASSETT SERVICES                  36-3365500     P O BOX 279310                  MIRAMAR                FL 33027     KRISTY_SANDS@GBTPA.COM



Phone:     800-473-9009 Ext.
                                                                                                               Contact Name:   KRISTY SANDS
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 292109                  NASHVILLE              TN 37229     GALE_LESIEUR@GBTPA.COM



Phone:     800-288-9843 Ext. 201
                                                                                                               Contact Name:   GALE LESIEUR
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE             TUCKER                 GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 21227                   TAMPA                  FL 33622     WILLIAM_KIMBROUGH@GBTPA.COM



Phone:     866-428-0283 Ext.
                                                                                                               Contact Name:   WILLIAM KIMBROUGH
GALLAGHER BASSETT SERVICES INC              36-3365500     601 VESTAVIA PARKWAY            BIRMINGHAM             AL 35266     CHRIS_ROCK@GBTPA.COM


                                                           SUITE 251
Phone:     800-762-3486 Ext.
                                                                                                               Contact Name:   CHRIS ROCK


Last Updated: Wednesday, June 1, 2011                                             Page 64 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12077      AMERICAN ZURICH INSURANCE                       1400 AMERICAN LANE              SCHAUMBURG             IL 60196     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM
           COMPANY



Phone:     407-667-8613 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 785071                  ORLANDO                FL 32878     KEITH_LEAHY@GBTPA.COM



Phone:     800-843-8999 Ext.
                                                                                                               Contact Name:   KEITH LEAHY
GALLAGHER BASSETT SERVICES INC              36-3365500     1301 INTERNATIONAL              SUNRISE                FL 33323     ANDREA_HUMPHRIES@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 230
Phone:     800-889-6764 Ext. 201
                                                                                                               Contact Name:   ANDREA HUMPHRIES
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY           DULUTH                 GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
GALLAGHER BASSETT SERVICES INC              36-3365500     1096 ASSEMBLY DRIVE             FT MILL                SC 29716     JULIE_MCCOY-LINCOLN@GBTPA.COM


                                                           SUITE 210
Phone:     866-814-1740 Ext. 201
                                                                                                               Contact Name:   JULIE MCCOY-LINCOLN
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 4840                    CLEARWATER             FL 33758     KIM_BUCHANAN@GBTPA.COM



Phone:     800-226-8002 Ext.
                                                                                                               Contact Name:   KIM BUCHANAN


Last Updated: Wednesday, June 1, 2011                                             Page 65 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12077      AMERICAN ZURICH INSURANCE                       1400 AMERICAN LANE              SCHAUMBURG             IL 60196     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM
           COMPANY



Phone:     407-667-8613 Ext.

MATRIX ABSENCE MANAGEMENT                   77-0493584     P O BOX 10156                   WILMINGTON             NC 28404     GEORGIAWORKERSCOMPENSATION@MATRIXCO
                                                                                                                               S.COM

Phone:     800-896-3079 Ext.
                                                                                                               Contact Name:   ANDREA DULEY
MATRIX ABSENCE MANAGEMENT                   77-0493584     P O BOX 3448                    PLANT CITY             FL 33563     GEORGIAWORKERSCOMPENSATION@MATRIXCO
                                                                                                                               S.COM

Phone:     888-878-0005 Ext.
                                                                                                               Contact Name:   KIMBERLY SMITH
MATRIX ABSENCE MANAGEMENT                   77-0493584     11221 N 28TH DRIVE              PHONEIX                AZ 85029     EDICOORDINATOR@MATRIXCOS.COM


                                                           E-100
Phone:     800-866-2301 Ext.
                                                                                                               Contact Name:   RAQUEL GARCIA
MATRIX ABSENCE MANAGEMENT                   77-0493584     P O BOX 1468                    SAN JOSE               CA 95109     GEORGIAWORKERSCOMPENSATION@MATRIXCO
                                                                                                                               S.COM

Phone:     888-878-0005 Ext.
                                                                                                               Contact Name:   RENATA MCCOOMER
NOVAPRO RISK                                36-4550659     101 E KENNEDY BLVD              TAMPA                  FL 33602     KROGERS@NOVAPRORISK.COM


                                                           SUITE 870
Phone:     800-426-5990 Ext.
                                                                                                               Contact Name:   KAREN ROGERS


Last Updated: Wednesday, June 1, 2011                                             Page 66 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12077      AMERICAN ZURICH INSURANCE                       1400 AMERICAN LANE              SCHAUMBURG             IL 60196     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM
           COMPANY



Phone:     407-667-8613 Ext.

NOVAPRO RISK SOLUTIONS LP                   36-4550659     SIX CONCOURSE PARKWAY           ATLANTA                GA 30328     TKATER@NOVAPRORISK.COM


                                                           SUITE 1550
Phone:     678-731-9091 Ext. 252
                                                                                                               Contact Name:   TAMMIE KATER
PMA MANAGEMENT CORPORATION                  23-2652239     1100 ABERNATHY ROAD NE          ATLANTA                GA 30328     ADOLPHUS_DRAIN@PMAGROUP.COM


                                                           SUITE 650 500 NORTH PARK TOWN CENTER
Phone:     888-888-8136 Ext.
                                                                                                               Contact Name:   ADOLPHUS DRAIN
RISK ENTERPRISE MANAGEMENT                  13-3832689     1140 HAMMOND DR                 ATLANTA                GA 30328     JANET.GREER@REMLTD.COM
LIMITED

                                                           SUITE J-2075
Phone:     800-347-4494 Ext.
                                                                                                               Contact Name:   JANET GREER
SEDGWICK CMS                                36-2685608     2000 CENTER POINT DRIVE         COLUMBIA               SC 29210     JCONNOR@SEDGWICKCMS.COM


                                                           SUITE 2350
Phone:     800-426-2885 Ext.
                                                                                                               Contact Name:   JIM CONNOR
SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER           ATLANTA                GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN


Last Updated: Wednesday, June 1, 2011                                             Page 67 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12077      AMERICAN ZURICH INSURANCE                       1400 AMERICAN LANE              SCHAUMBURG             IL 60196     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM
           COMPANY



Phone:     407-667-8613 Ext.

SEDGWICK CMS                                36-2685608     8649 BAYPINE ROAD               JACKSONVILLE           FL 32256     MARILYN.SANDERS@SEDGWICKCMS.COM


                                                           BLDG 7 SUITE 300
Phone:     888-784-3470 Ext.
                                                                                                               Contact Name:   MARILYN SANDERS
SEDGWICK CMS                                36-2685608     255 PRIMERA BLVD                LAKE MARY              FL 32746     GASTATEBOARDINBOX@SEDGWICKCMS.COM


                                                           SUITE 400
Phone:     800-548-1373 Ext.
                                                                                                               Contact Name:   GEORGE CINTRON
SEDGWICK CMS                                36-2685608     5260 PARKWAY PLAZA BLVD         CHARLOTTE              NC 28217     MYRA.NORMAN@SEDGWICKCMS.COM


                                                           SUITE 190
Phone:     800-822-4469 Ext.
                                                                                                               Contact Name:   MYRA NORMAN
SEDGWICK CMS                                36-2685608     1100 RIDGEWAY LOOP ROAD         MEMPHIS                TN 38120     APULLEN@SEDGWICKCMS.COM



Phone:     241-922-0638 Ext.
                                                                                                               Contact Name:   ANTHONY PULLEN
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                   NASHVILLE              TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS


Last Updated: Wednesday, June 1, 2011                                             Page 68 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12077      AMERICAN ZURICH INSURANCE                       1400 AMERICAN LANE              SCHAUMBURG             IL 60196     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM
           COMPANY



Phone:     407-667-8613 Ext.

SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY             ATLANTA                GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
TRAVELERS INDEMNITY CO OF CT                06-0336212     1000 WINDWARD                   ALPHARETTA             GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           SUITE 100
Phone:     800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
TRAVELERS INDEMNITY CO OF CT                06-0336212     10401 HIGHLAND MANOR            TAMPA                  FL 33610     DBRYSON@TRAVELERS.COM
                                                           DRIVE

                                                           BUILDING V SUITE 200
Phone:     888-329-6259 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON
TRAVELERS INDEMNITY COMPANY                 06-0566050     1000 WINDWARD                   ALPHARETTA             GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           SUITE 100
Phone:     800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
TRAVELERS INDEMNITY COMPANY                 06-0566050     1000 WINDWARD                   ALPHARETTA             GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           SUITE 100
Phone:     800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON


Last Updated: Wednesday, June 1, 2011                                             Page 69 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12077      AMERICAN ZURICH INSURANCE                       1400 AMERICAN LANE              SCHAUMBURG             IL 60196     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM
           COMPANY



Phone:     407-667-8613 Ext.

TRAVELERS INDEMNITY COMPANY                 06-0566050     10401 HIGHLAND MANOR            TAMPA                  FL 33610     DBRYSON@TRAVELERS.COM
                                                           DRIVE

                                                           BUILDING V SUITE 200
Phone:     888-329-6259 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON
TRAVELERS INDEMNITY COMPANY                 06-0566050     1000 FIANA WAY                  FT SMITH               AR 72919     MWHITE@TRAVELERS.COM



Phone:     800-842-5612 Ext. 4611
                                                                                                               Contact Name:   MELISSA WHITE
TRAVELERS INDEMNITY COMPANY OF              58-6020487     10401 HIGHLAND MANOR            TAMPA                  FL 33610     DBRYSON@TRAVELERS.COM
AMERICA                                                    DRIVE

                                                           BUILDING V SUITE 200
Phone:     888-329-6259 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON
ZURICH SERVICES CORPORATION                 36-3839542     1001 SUMMIT BLVD                ATLANTA                GA 30319     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM


                                                           SUITE 800
Phone:     404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY




Last Updated: Wednesday, June 1, 2011                                             Page 70 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 49




 SBWC #     Name                            FEIN            Address                                                            Email


12022       AMERISURE INSURANCE COMPANY                    26777 HALSTED ROAD              FARMINGTON             MI 48331     CORPLEGAL@AMERISURE.COM
                                                                                           HILLS



Phone:      800-257-1900 Ext.

AMERISURE INSURANCE COMPANY                 38-1869912     2160 SATELLITE BLVD             DULUTH                 GA 30097     KSWAN@AMERISURE.COM


                                                           STE 200
Phone:      800-230-9338 Ext.
                                                                                                               Contact Name:   KEVIN SWAN
AMERISURE MUTUAL                            38-0829210     2160 SATELLITE BLVD             DULUTH                 GA 30097     CPUZA@AMERISURE.COM


                                                           SUITE 200
Phone:      770-813-3302 Ext.
                                                                                                               Contact Name:   CAROL PUZA

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 71 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10106       AMERISURE MUTUAL INSURANCE                     26777 HALSTED ROAD              FARMINGTON             MI 48331     CORPLEGAL@AMERISURE.COM
            COMPANY                                                                        HILLS



Phone:      800-257-1900 Ext.

AMERISURE INSURANCE COMPANY                 38-1869912     2160 SATELLITE BLVD             DULUTH                 GA 30097     KSWAN@AMERISURE.COM


                                                           STE 200
Phone:      800-230-9338 Ext.
                                                                                                               Contact Name:   KEVIN SWAN
AMERISURE MUTUAL                            38-0829210     2160 SATELLITE BLVD             DULUTH                 GA 30097     CPUZA@AMERISURE.COM


                                                           SUITE 200
Phone:      770-813-3302 Ext.
                                                                                                               Contact Name:   CAROL PUZA

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 72 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13167      AMGUARD INSURANCE COMPANY                       P O BOX A-H                     WILKES-BARRE           PA 18703     ESOLA@GUARD.COM




Phone:     800-673-2465 Ext.

AMGUARD                                     23-2240321     P O Box 1368                    WILKES-BARRE           PA 18703     CLAIMS3@GUARD.COM



Phone:     800-673-2465 Ext. 8110
                                                                                                               Contact Name:   BELINDA DIAMOND
AMGURAD INSURANCE COMPANY                   23-2240321     294 SOUTH MAIN STREET           ALPHARARETTA           GA 30009     BDIAMOND@GUARD.COM


                                                           SUITE 600
Phone:     800-673-2465 Ext. 8110
                                                                                                               Contact Name:   BELINDA DIAMOND
GUARD INSURANCE GROUP                       23-2240322     P O BOX A - H                   WILKES-BARRE           PA 18703     CLAIMS3@GUARD.COM



Phone:     800-673-2465 Ext. 8110
                                                                                                               Contact Name:   BELINDA DIAMOND
GUARD INSURANCE GROUP                       -              P O Box 1368                    WILKES-BARRE           PA 18703     CLAIMS3@GUARD.COM



Phone:     678-581-0589 Ext.
                                                                                                               Contact Name:   KEVIN FOLEY
GUARD INSURANCE GROUP                       23-2240322     102 WEST PENNSYLVANIA           TOWSON                 MD 21204     CLAIMS3@GUARD.COM
                                                           AVE

                                                           SUITE 206
Phone:     800-673-2465 Ext. 8302
                                                                                                               Contact Name:   LENWOOD HALL


Last Updated: Wednesday, June 1, 2011                                             Page 73 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 5




 SBWC #     Name                            FEIN            Address                                                            Email


13095       AMTRUST INSURANCE COMPANY OF                   P O BOX 650665                   DALLAS                TX 75265     KFAIRRIS@AMTRUSTGROUP.COM
            KANSAS INC



Phone:      800-777-2249 Ext.

AMTRUST NORTH AMERICA                       34-1965476     11330 LAKEFIELD DRIVE            JOHNS CREEK           GA 30097     50STATENOTICES@AMTRUSTGROUP.COM


                                                           BUILDING II SUITE 100
Phone:      678-258-8000 Ext.
                                                                                                               Contact Name:   PHIL PUCKETT

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                              Page 74 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13210       ANSUR AMERICA INSURANCE COMPANY                ONE MUTUAL AVENUE               FRANKENMUTH            MI 48787     JOHN.BENSON@FMINS.COM




Phone:      800-234-4433 Ext. 2914

ANSUR AMERICA INSURANCE COMPANY             38-3467437     ONE MUTUAL AVENUE               FRANKENMUTH            MI 48787     SUZANNE.COWAN@FMINS.COM



Phone:      800-234-1133 Ext.
                                                                                                               Contact Name:   SUZANNE COWAN
FRANKENMUTH MUTUAL INSURANCE                38-0555290     ONE MUTUAL AVE.                 FRANKENMUTH            MI 48787     SUZANNE.COWAN@FMINS.COM
COMPANY

Phone:      800-234-1122 Ext.
                                                                                                               Contact Name:   SUZANNE COWAN

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 75 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13183      ARCH INSURANCE COMPANY                          300 1ST STAMFORD PLACE          STAMFORD               CT 06902     JROEHRICH@ARCHINSURANCE.COM



                                                           5TH FLOOR
Phone:     877-258-7475 Ext.

AS&G CLAIMS ADMINISTRATION                  76-0516648     EDI HEADER ONLY                 NOT A CLAIM            00   77040   WBROWNING@ASG-ADJ.COM
                                                                                           OFFICE

                                                           EDI USE ONLY
Phone:     800-580-2334 Ext.
                                                                                                               Contact Name:   WANDA BROWNING
AS&G CLAIMS ADMINISTRATION INC              76-0516648     125 PARK OF COMMERCE            SAVANNAH               GA 31405     MREVELLE@ASG-ADJ.COM
                                                           DRIVE #B

Phone:     800-580-6912 Ext.
                                                                                                               Contact Name:   MICHELLE REVELLE
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA           BIRMINGHAM             AL 35209     CMULLINS@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 20104
                                                                                                               Contact Name:   CHRISTINA MULLINS
BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD           ATLANTA                GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
CNA CLAIMS PLUS                             16-1633560     2435 COMMERCE AVENUE            DULUTH                 GA 30096     GASTATEICNUMBERS@CNA.COM


                                                           BDG 2200 SATELLITE PLACE
Phone:     800-283-2318 Ext. 3574
                                                                                                               Contact Name:   TAMARA WILLIAMS


Last Updated: Wednesday, June 1, 2011                                             Page 76 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13183      ARCH INSURANCE COMPANY                          300 1ST STAMFORD PLACE          STAMFORD               CT 06902     JROEHRICH@ARCHINSURANCE.COM



                                                           5TH FLOOR
Phone:     877-258-7475 Ext.

ESIS INC                                    95-2008390     500 COLONIAL PARKWAY            ROSWELL                GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
F A RICHARD (FARA)                          72-0837383     1625 WEST CAUSEWAY              MANDEVILLE             LA 70471     GEORGIA.NOTICES@FARA.COM
                                                           APPROACH

Phone:     985-624-6739 Ext.
                                                                                                               Contact Name:   CHAD RANFLE
GAB ROBINS NORTH AMERICA INC                13-2747054     9 CAMPUS DIRVE                  PARSIPPANY             NJ 07054     ATLANTAR@GABROBINS.COM


                                                           SUITE 7
Phone:     800-422-4436 Ext.
                                                                                                               Contact Name:   DEWEY BARNES
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE             TUCKER                 GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY           DULUTH                 GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER


Last Updated: Wednesday, June 1, 2011                                             Page 77 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13183      ARCH INSURANCE COMPANY                          300 1ST STAMFORD PLACE          STAMFORD               CT 06902     JROEHRICH@ARCHINSURANCE.COM



                                                           5TH FLOOR
Phone:     877-258-7475 Ext.

SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER           ATLANTA                GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN
SEDGWICK CMS                                36-2685608     1100 RIDGEWAY LOOP ROAD         MEMPHIS                TN 38120     APULLEN@SEDGWICKCMS.COM



Phone:     241-922-0638 Ext.
                                                                                                               Contact Name:   ANTHONY PULLEN
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 60000                   ATLANTA                GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM



Phone:     770-901-3121 Ext.
                                                                                                               Contact Name:   MARY D'AGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                   NASHVILLE              TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY             ATLANTA                GA 30328     BETH.RODEE@SRSCONNECT.COM


                                                           SUITE 350
Phone:     770-901-3124 Ext.
                                                                                                               Contact Name:   BETH RODEE


Last Updated: Wednesday, June 1, 2011                                             Page 78 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13183       ARCH INSURANCE COMPANY                         300 1ST STAMFORD PLACE          STAMFORD               CT 06902     JROEHRICH@ARCHINSURANCE.COM



                                                           5TH FLOOR
Phone:      877-258-7475 Ext.

SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY             ATLANTA                GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:      678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE          LAKE MARY              FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:      800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN

Total # of Active Claim Offices: 17




Last Updated: Wednesday, June 1, 2011                                             Page 79 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10081       ARGONAUT GREAT CENTRAL                         10101 REUNION PLACE             SAN ANTONIO            TX 78216     MSMITH@ARGOGROUPUS.COM



                                                           SUTIE 500
Phone:      877-769-5953 Ext.

ARGONAUT GREAT CENTRAL                      37-0301640     3000 OLD ALABAMA ROAD           ALPHARETTA             GA 30022     CWILLIAMS@ARGOGROUPUS.COM
INSURANCE COMPANY

                                                           SUITE 119-301
Phone:      770-754-0424 Ext.
                                                                                                               Contact Name:   CAROL WILLIAMS

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 80 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10026      ARGONAUT INSURANCE COMPANY                      10101 REUNION PLACE             SAN ANTONIO            TX 78216     MSMITH@ARGOGROUPUS.COM



                                                           SUITE 500
Phone:     800-470-7958 Ext.

ARGONAUT GREAT CENTRAL                      37-0301640     3000 OLD ALABAMA ROAD           ALPHARETTA             GA 30022     CWILLIAMS@ARGOGROUPUS.COM
INSURANCE COMPANY

                                                           SUITE 119-301
Phone:     770-754-0424 Ext.
                                                                                                               Contact Name:   CAROL WILLIAMS
ARGONAUT INSURANCE                          94-1390273     P O BOX 152007                  IRVING                 TX 75015     CSTEVENS@ARGOGROUPUS.COM



Phone:     800-678-6766 Ext.
                                                                                                               Contact Name:   CHERYL STEVENS
ARGONAUT INSURANCE COMPANY                  94-1390273     255 W WASHINGTON                CHICAGO                IL   60606   CSURENS@ARGOGROUPUS.COM



Phone:     800-678-6766 Ext.
                                                                                                               Contact Name:   CHERYL STEVENS
BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD           ATLANTA                GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT




Last Updated: Wednesday, June 1, 2011                                             Page 81 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 4




Last Updated: Wednesday, June 1, 2011                                             Page 82 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12039      ARGONAUT MIDWEST INS CO                         10101 REUNION PLACE             SAN ANTONIO            TX 78216     MSMITH@ARGOGROUPUS.COM



                                                           SUITE 500
Phone:     800-470-7958 Ext. 8453

ARGONAUT GREAT CENTRAL                      37-0301640     3000 OLD ALABAMA ROAD           ALPHARETTA             GA 30022     CWILLIAMS@ARGOGROUPUS.COM
INSURANCE COMPANY

                                                           SUITE 119-301
Phone:     770-754-0424 Ext.
                                                                                                               Contact Name:   CAROL WILLIAMS
ARGONAUT INSURANCE                          94-1390273     P O BOX 152007                  IRVING                 TX 75015     CSTEVENS@ARGOGROUPUS.COM



Phone:     800-678-6766 Ext.
                                                                                                               Contact Name:   CHERYL STEVENS
ARGONAUT MIDWEST INSURANCE                  36-2489372     275 W WASHINGTON                CHICAGO                IL   60606   CSTEVENS@ARGOGROUP.COM
COMPANY

Phone:     800-678-6766 Ext.
                                                                                                               Contact Name:   CHERYL STEVENS
BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD           ATLANTA                GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT




Last Updated: Wednesday, June 1, 2011                                             Page 83 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 4




 SBWC #     Name                            FEIN            Address                                                            Email


10147       ARROWOOD INDEMNITY COMPANY                     3600 ARCO CORPORATE             CHARLOTTE              NC 28273     LLINDA.PETTIGREW@ARROWPOINTCAP.COM
                                                           DRIVE



Phone:      704-522-2744 Ext.

ARROWOOD INDEMNITY COMPANY                  13-5358230     3600 ARCO CORPORATE             CHARLOTTE              NC 28273     DEBBIE.SCHILLER@ARROWPOINTCAP.COM
                                                           DRIVE

Phone:      800-523-6235 Ext. 3
                                                                                                               Contact Name:   DEBBIE SCHILLER

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 84 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10027       ASSOCIATED INDEMNITY CORP                      777 SAN MARIN DRIVE             NOVATO                 CA 94998     LMUNSON@FFIC.COM




Phone:      800-227-1700 Ext.

FIREMAN'S FUND CLAIMS CENTER                58-1373156     P O BOX 740174                  ATLANTA                GA 30374     KLOCKE@FFIC.COM



Phone:      678-393-4550 Ext.
                                                                                                               Contact Name:   KEN LOCKE
FIREMAN'S FUND INSURANCE CO                 94-1610280     11475 GREAT OAKS WAY            ALPHARETTA             GA 30022     JUDY.OWEN@AFFIC.COM


                                                           ROYAL CTR 3 STE 200
Phone:      678-393-4584 Ext.
                                                                                                               Contact Name:   JUDY OWEN

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 85 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13115       ASSOCIATED INDUSTRIES INSURANCE                P O BOX 812319                   BOCA RATON            FL 33481     JSCHUESSLER@AMTRUSTGROUP.COM
            COMPANY INC



Phone:      800-866-1600 Ext. 2415

AMTRUST NORTH AMERICA                       34-1965476     11330 LAKEFIELD DRIVE            JOHNS CREEK           GA 30097     50STATENOTICES@AMTRUSTGROUP.COM


                                                           BUILDING II SUITE 100
Phone:      678-258-8000 Ext.
                                                                                                               Contact Name:   PHIL PUCKETT

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                              Page 86 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13173       ASSOCIATION CASUALTY INSURANCE                 3420 EXECUTIVE CENTER           AUSTIN                 TX 78731     FSHORE@COLINSGRP.COM
            COMPANY                                        DRIVE

                                                           #200
Phone:      800-848-6134 Ext. 1085

ASSOCIATION CASUALTY                        74-1958653     4370 PEACHTREE ROAD NE          ATLANTA                GA 30319     RPITTMAN@COLINSGRP.COM



Phone:      404-442-1174 Ext.
                                                                                                               Contact Name:   REGINALD PITTMAN
ASSOCIATION CASUALTY INSURANCE              74-1958653     P O BOX 618                     COLUMBIA               MO 65205     FSHORE@COLINSGRP.COM
CO

                                                           2102 WHITE GATE DR
Phone:      573-474-6193 Ext.
                                                                                                               Contact Name:   FRANK SHORE

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 87 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10144       ASSOCIATION INSURANCE COMPANY                  2410 PACES FERRY ROAD           ATLANTA                GA 30339     LMCMURRAY@BLDRS.COM




Phone:      800-883-9305 Ext.

BUILDERS INSURANCE GROUP                    58-2453325     P O BOX 723099                  ATLANTA                GA 30339     CLAIMSFORM@BLDRS.COM



Phone:      800-883-9305 Ext.
                                                                                                               Contact Name:   LINDA MCMURRAY
SYNERGY COVERAGE SOLUTIONS                  04-3718801     3440 TORINGDON WAY              CHARLOTTE              NC 28277     JTHOMAS@SYNERGYINSURANCE.NET



Phone:      866-710-0908 Ext.
                                                                                                               Contact Name:   JIM THOMAS

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 88 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10252       ASSURANCE COMPANY OF AMERICA                   1400 AMERICAN LANE              SCHAUMBURG             IL 60196     TIM.GRAHAM@ZURICHNA.COM




Phone:      800-340-8602 Ext. 8613

ASSURANCE COMPANY OF AMERICA                13-6081895     3003 SUMMIT BLVD                ATLANTA                GA 30319     CHRIS.CALLOWAY@ZURICHNA.COM


                                                           SUITE 1800
Phone:      404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY
ASSURANCE COMPANY OF AMERICA                13-6081895     1900 SUMMIT TOWER BLVD          ORLANDO                FL 32810     CHRIS.CALLOWAY@ZURICHNA.COM


                                                           SUITE 600
Phone:      404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY
ZURICH SERVICES CORPORATION                 36-3839542     1001 SUMMIT BLVD                ATLANTA                GA 30319     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM


                                                           SUITE 800
Phone:      404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY

Total # of Active Claim Offices: 3




Last Updated: Wednesday, June 1, 2011                                             Page 89 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10215       ATHENA ASSURANCE CO                            385 WASHINGTON STREET           ST PAUL                MN 55102     CURBANIA@TRAVELERS.COM




Phone:      800-328-2189 Ext.

ATHENA ASSURANCE COMPANY                    41-1435765     BLDG V STE 200                  TAMPA                  FL 33610     DBRYSON@TRAVELERS.COM


                                                           10401 HIGHLAND MANOR DR
Phone:      888-487-3492 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON
ATHENA ASSURANCE COMPANY                    41-1435765     1000 WINDWARD                   ALPHARETTA             GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           STE 100
Phone:      800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 90 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13154       ATLANTIC SPECIALTY INS CO                      ONE BEACON STREET               CANTON                 MA 02108     SHOLLAND@ONEBEACON.COM




Phone:      973-630-6601 Ext.

HD ONEBEACON INSURANCE                      23-1502700     THIS IS NOT A CLAIMS            CANTON                 ME 02021     PANDRADE@HANOVER.COM
                                                           OFFICE

                                                           EDI USE ONLY
Phone:      508-855-5893 Ext.
                                                                                                               Contact Name:   PAULA ANDRADE
ONEBEACON INSURANCE                         23-1502700     P O BOX 9155                    CANTON                 MA 02021     DDAVENPORT@ONEBEACON.COM



Phone:      800-203-9600 Ext. 9706
                                                                                                               Contact Name:   DENISE DAVENPORT

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 91 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13232       ATLANTIC STATES INSURANCE                      1195 RIVER ROAD                 MARIETTA               PA 17547     CYGREENYA@DONEGALGROUP.COM
            COMPANY

                                                           PO BOX 302
Phone:      -- Ext.

SOUTHERN INSURANCE COMPANY OF               54-0386765     3237 SATELLITE BLVD             DULUTH                 GA 30096     MIKEGORE@DONEGALGROUP.COM
VIRGINIA

                                                           SUITE 300
Phone:      800-277-7442 Ext. 1336
                                                                                                               Contact Name:   MICHAEL GORE

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 92 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12010       AUTOMOBILE INSURANCE COMPANY OF                ONE TOWER SQUARE                HARTFORD               CT 06183     KDAVIS@TRAVELERS.COM
            HARTFORD CT



Phone:      860-954-5660 Ext.

AUTOMOBILE INS CO OF HARTFORD CT            06-0848755     10401 HIGHLAND MANOR            TAMPA                  FL 33610     DBRYSON@TRAVELERS.COM
                                                           DRIVE

                                                           BUILDING V STE 200
Phone:      888-329-6259 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON
AUTOMOBILE INSURANCE COMPANY OF             06-0848755     1000 WINDWARD                   ALPHARETTA             GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
HARTFORD CT                                                CONCOURSE

                                                           SUITE 100
Phone:      800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 93 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10030       AUTO-OWNERS INSURANCE CO                       P O BOX 30660                   LANSING                MI 48909     AOHOCLAIMS@AOINS.NET




Phone:      800-346-0346 Ext.

AUTO OWNERS INSURANCE CO                    38-0315280     P O BOX 100044                  DULUTH                 GA 30096     GEORGIAWORKCOMP.CLM@AOINS.COM


                                                           1705 EXECUTIVE DRIVE
Phone:      770-931-7766 Ext. 201
                                                                                                               Contact Name:   JAY LANNIN
TRAVELERS INDEMNITY COMPANY                 06-0566050     1000 WINDWARD                   ALPHARETTA             GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           SUITE 100
Phone:      800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
TRAVELERS INDEMNITY COMPANY                 06-0566050     10401 HIGHLAND MANOR            TAMPA                  FL 33610     DBRYSON@TRAVELERS.COM
                                                           DRIVE

                                                           BUILDING V SUITE 200
Phone:      888-329-6259 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON

Total # of Active Claim Offices: 3




Last Updated: Wednesday, June 1, 2011                                             Page 94 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13074      BANCINSURE INC                                  P O BOX 26104                   OKLAHOMA CITY          OK 73126     BBAILEY@BANCINSURE.COM




Phone:     800-221-1825 Ext.

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD           ATLANTA                GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
CORVEL CORPORATION                          95-3382819     4820 LAKE BROOK DRIVE #150      GLEN ALLEN             VA 23058     MARCIA_MORGAN@CORVEL.COM



Phone:     -- Ext.
                                                                                                               Contact Name:   MARCIA MORGAN
CORVEL ENTERPRISES                          42-1704550     P O BOX 81029                   CHARLESTON             SC 29416     GLENN_MARTIN@CORVEL.COM



Phone:     866-434-2480 Ext.
                                                                                                               Contact Name:   GLENN MARTIN
IMPERIAL CASUALTY                           47-0412734     800 WARREN PARKWAY              FRISCO                 TX 75034     MMCCLELLAN@IMPERIALCASUALTY.COM


                                                           SUITE 300
Phone:     888-339-5736 Ext.
                                                                                                               Contact Name:   MIKE MCCLELLAN
IMPERIAL CASUALTY INDEMNITY                 47-0412734     P O BOX 2009                    FRISCO                 TX 75034     SUPPORT@IMPERIALCASUALTY.COM
COMPANY

Phone:     888-339-5736 Ext.
                                                                                                               Contact Name:   TERRY YOWELL


Last Updated: Wednesday, June 1, 2011                                             Page 95 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 5




 SBWC #     Name                            FEIN            Address                                                            Email


13299       BANKERS INSURANCE COMPANY                      11101 ROOSEVELT BLVD N          ST PETERSBURG          FL 33716     COMPLIANCE@BANKERSINSURANCE.COM




Phone:      -- Ext.

NOVAPRO RISK SOLUTIONS LP                   36-4550659     SIX CONCOURSE PARKWAY           ATLANTA                GA 30328     TKATER@NOVAPRORISK.COM


                                                           SUITE 1550
Phone:      678-731-9091 Ext. 252
                                                                                                               Contact Name:   TAMMIE KATER

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 96 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10269      BANKERS STANDARD FIRE AND MARINE                436 WALNUT STREET               PHILADELPHIA           PA 19106     MARILEE.BRABSON@ACEGROUP.COM
           COMPANY

                                                           WB04
Phone:     215-640-4565 Ext.

ESIS INC                                    95-2008390     500 COLONIAL PARKWAY            ROSWELL                GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY           DULUTH                 GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKEVIEW                    NASHVILLE              TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-493-5802 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY             ATLANTA                GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE          LAKE MARY              FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:     800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN


Last Updated: Wednesday, June 1, 2011                                             Page 97 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 5




Last Updated: Wednesday, June 1, 2011                                             Page 98 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13071      BANKERS STANDARD INSURANCE                      436 WALNUT STREET               PHILADELPHIA           PA 19106     MARILEE.BRABSON@ACEGROUP.COM
           COMPANY

                                                           WB04G
Phone:     215-640-4565 Ext.

ESIS INC                                    95-2008390     500 COLONIAL PARKWAY            ROSWELL                GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY           DULUTH                 GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKEVIEW                    NASHVILLE              TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-493-5802 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY             ATLANTA                GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE          LAKE MARY              FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:     800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN


Last Updated: Wednesday, June 1, 2011                                             Page 99 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 5




 SBWC #     Name                            FEIN            Address                                                            Email


13077       BENCHMARK INSURANCE CO                         6405 METCALF AVENUE               OVERLAND PARK        KS 66202     JSPAIN@BENCHMARKINSCO.COM



                                                           SUITE 400
Phone:      913-722-0622 Ext.

AMTRUST NORTH AMERICA                       34-1965476     11330 LAKEFIELD DRIVE             JOHNS CREEK          GA 30097     50STATENOTICES@AMTRUSTGROUP.COM


                                                           BUILDING II SUITE 100
Phone:      678-258-8000 Ext.
                                                                                                               Contact Name:   PHIL PUCKETT
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY             DULUTH               GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:      866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                              Page 100 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13290       BERKLEY NATIONAL INSURANCE                     215 SHUMAN BLVD                  NAPERVILLE            IL 60563     LLARSEN@BUPLLC.COM
            COMPANY

                                                           SUITE 200
Phone:      -- Ext.

KEY RISK MANAGEMENT SERVICES LLC            56-1800954     3655 NORTH POINT PKWY            ALPHARETTA            GA 30005     JDUGGINS@KEYRISK.COM


                                                           SUITE 125
Phone:      800-366-1511 Ext. 7732
                                                                                                               Contact Name:   JANICE DUGGINS

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 101 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13298       BERKLEY REGIONAL INSURANCE                     215 SHURMAN BLVD                 NAPERVILLE            IL 60563     LLARSEN@BUPLLC.COM
            COMPANY

                                                           SUITE 200
Phone:      -- Ext.

KEY RISK MANAGEMENT SERVICES LLC            56-1800954     3655 NORTH POINT PKWY            ALPHARETTA            GA 30005     JDUGGINS@KEYRISK.COM


                                                           SUITE 125
Phone:      800-366-1511 Ext. 7732
                                                                                                               Contact Name:   JANICE DUGGINS

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 102 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10032       BITUMINOUS CASUALTY CORP                       329 18TH STREET                  ROCK ISLAND           IL 61201     BRAINEY@BITUMINOUSINSURANCE.COM




Phone:      800-475-4477 Ext.

BITUMINOUS CASUALTY CORP                    36-0810360     3700 CRESTWOOD PARKWAY           DULUTH                GA 30096     ROLSON@BITUMINOUSINSURANCE.COM


                                                           SUITE 650
Phone:      800-822-2905 Ext.
                                                                                                               Contact Name:   ROBERT OLSON

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 103 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10033       BITUMINOUS FIRE & MARINE                       320 18TH STREET                  ROCK ISLAND           IL 61201     BRAINEY@BITUMINOUSINSURANCE.COM
            INSURANCE CO



Phone:      800-475-4477 Ext.

BITUMINOUS CASUALTY CORP                    36-0810360     3700 CRESTWOOD PARKWAY           DULUTH                GA 30096     ROLSON@BITUMINOUSINSURANCE.COM


                                                           SUITE 650
Phone:      800-822-2905 Ext.
                                                                                                               Contact Name:   ROBERT OLSON
BITUMINOUS FIRE & MARINE INS CO             36-6054328     3700 CRESTWOOD PARKWAY           DULUTH                GA 30096     ROLSON@BITUMINOUSINSURANCE.COM


                                                           STE 650
Phone:      800-822-2905 Ext.
                                                                                                               Contact Name:   ROBERT OLSON

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 104 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13179       BRIDGEFIELD CASUALTY INSURANCE                 P O BOX 988                      LAKELAND              FL 38802     BOB.LARAMORE@SUMMITHOLDINGS.COM
            COMPANY



Phone:      800-282-7648 Ext.

BRIDGEFIELD CASUALTY INSURANCE              59-3269531     1380 BALLANTYNE CORP             CHARLOTTE             NC 28277     WARNER.MARSHALL@LIBERTYMUTUAL.COM
COMPANY                                                    PLACE

                                                           SUITE 200
Phone:      800-334-0078 Ext.
                                                                                                               Contact Name:   WARNER MARSHALL
SUMMIT CONSULTING INC.                      59-1683711     340 JESSE JEWELL PARKWAY         GAINESVILLE           GA 30501     STACEY.FEWOX@SUMMITHOLDINGS.COM
                                                           SE

                                                           STE 350
Phone:      800-971-2667 Ext.
                                                                                                               Contact Name:   STACEY FEWOX

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 105 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13286       BRIDGEFIELD EMPLOYERS INSURANCE                175 BERKELEY STREET              BOSTON                MA 02116     BOB.LARAMORE@SUMMITHHOLDINGS.COM
            COMPANY



Phone:      -- Ext.

SUMMIT CONSULTING INC.                      59-1683711     340 JESSE JEWELL PARKWAY         GAINESVILLE           GA 30501     STACEY.FEWOX@SUMMITHOLDINGS.COM
                                                           SE

                                                           STE 350
Phone:      800-971-2667 Ext.
                                                                                                               Contact Name:   STACEY FEWOX

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 106 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10031       BROTHERHOOD MUTUAL INSURANCE                   P O BOX 2227                     FORT WAYNE            IN 46801     DROESENER@BROTHERHOODMUTUAL.CO
            COMPANY



Phone:      800-333-3735 Ext.

BROTHERHOOD MUTUAL INSURANCE                35-0198580     P O BOX 2227                     FORT WAYNE            IN 46801     GALDRIDGE@BROTHERHOODMUTUAL.COM
COMPANLY

Phone:      800-333-3735 Ext.
                                                                                                               Contact Name:   GARY ALDRIDGE

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 107 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


40008       BUILDERS INSURANCE A MUTUAL                    2410 PACES FERRY ROAD            ATLANTA               GA 30339     CEDWARDS@BLDRS.COM
            CAPTIVE

                                                           SUITE 300
Phone:      678-309-4044 Ext.

BUILDERS INSURANCE GROUP                    58-2453325     P O BOX 723099                   ATLANTA               GA 30339     CLAIMSFORM@BLDRS.COM



Phone:      800-883-9305 Ext.
                                                                                                               Contact Name:   LINDA MCMURRAY

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 108 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13261       BUILDERS MUTUAL INSURANCE                      5608 CENTERVIEW DRIVE            RALEIGH               NC 27606     JVISINTINE@BMICO.COM
            COMPANY



Phone:      -- Ext.

AEGIS ADMINISTRATIVE SERVICES INC           56-1749798     P O BOX 150006                   RALEIGH               NC 27624     SGAY@BMICO.COM



Phone:      800-809-4861 Ext.
                                                                                                               Contact Name:   STEPHANIE GAY

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 109 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13234       CALIFORNIA INSURANCE COMPANY                   10805 OLD MILL ROAD              OMAHA                 NE 68103     SWILLNERD@AUW.COM




Phone:      -- Ext.

CALIFORNIA INSURANCE COMPANY                94-1627528     P O BOX 3804                     OMAHA                 NE 68103     NALBRECHT@AUW.COM



Phone:      877-234-4424 Ext.
                                                                                                               Contact Name:   NICOLE ALBRECHT

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 110 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10036       CAMDEN FIRE INSURANCE                          ONE BEACON LANE                  CANTON                MA 02021     SHOLLAND@ONEBEACON.COM
            ASSOCIATION



Phone:      800-203-9600 Ext. 9706

HD ONEBEACON INSURANCE                      23-1502700     THIS IS NOT A CLAIMS             CANTON                ME 02021     PANDRADE@HANOVER.COM
                                                           OFFICE

                                                           EDI USE ONLY
Phone:      508-855-5893 Ext.
                                                                                                               Contact Name:   PAULA ANDRADE
ONEBEACON INSURANCE                         23-1502700     P O BOX 9155                     CANTON                MA 02021     DDAVENPORT@ONEBEACON.COM



Phone:      800-203-9600 Ext. 9706
                                                                                                               Contact Name:   DENISE DAVENPORT

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 111 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13099       CANAL INSURANCE CO.                            P O BOX 7                        GREENVILLE            SC 29602




Phone:      678-259-3779 Ext.

ALTERNATIVE SERVICE CONCEPTS DBA            43-1954328     3135 AVALON RIDGE PLACE          NORCROSS              GA 30071     SUE.LORANCE@ASCRISK.COM
ASC LLC

                                                           SUITE 650
Phone:      678-447-0200 Ext. 302
                                                                                                               Contact Name:   SUE LORANCE
ALTERNATIVE SERVICE CONCEPTS DBA            43-1954328     3135 AVALON RIDGE PLACE          NORCROSS              GA 30071     SUE.LORANCE@ASCRISK.COM
ASC LLC

                                                           SUITE 650
Phone:      678-447-0200 Ext. 302
                                                                                                               Contact Name:   SUE LORANCE

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 112 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13048       CAPITAL CITY INS                               P O BOX 212157                   COLUMBIA              SC 29221     WWALTON@NPIC.COM




Phone:      888-717-6827 Ext.

SOUTHEASTERN CLAIMS SERVICES INC            57-0851047     P O BOX 27180                    MACON                 GA 31221     WMURRAY@SOUTHEASTERNCLAIMS.COM



Phone:      800-471-2103 Ext.
                                                                                                               Contact Name:   WAYNE MURRAY

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 113 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13078       CAROLINA CASUALTY INS                          12701 MARBLESTONE DRIVE          WOODBRIDGE            VA 22192     JBURKE@BERKLEYNET.COM



                                                           SUITE 250
Phone:      800-874-8053 Ext.

KEY RISK MANAGEMENT SERVICES                56-1800954     P O BOX 49129                    GREENSBORO            NC 27419     GHENEHAN@KEYRISK.COM



Phone:      336-668-9050 Ext. 7539
                                                                                                               Contact Name:   GEORGE HENEHAN

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 114 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12098       CASTLEPOINT NATIONAL INSURANCE                 222 SOUTH RIVERSIDE              CHICAGO               IL 60606     ROREN@TWRGRP.COM
            COMPANY FKA SUA INS CO                         PLAZA

                                                           SUITE 1600
Phone:      212-655-7330 Ext.

CASTLEPOINT NATIONAL INSURANCE              23-2182777     1111 HILLCREST ROAD              MOBILE                AL 36695     EWALLS@TWRGRP.COM
COMPANY

Phone:      800-711-4405 Ext.
                                                                                                               Contact Name:   EDDIE WELLS
SUA INSURANCE CLAIMS                        23-2182777     101 SOUTHHALL LANE, SUITE        MAITLAND              FL 32751     JBEASON@SUAINSURANCE.COM
                                                           365

Phone:      866-450-8608 Ext.
                                                                                                               Contact Name:   JEFFERY BEASON
SUA INSURANCE CO                            23-2182777     2222 S RIVERSIDE PLAZA           CHICAGO               IL   60606   NFLORES@SUAINSURANCE.COM


                                                           STE 1600
Phone:      888-782-4672 Ext.
                                                                                                               Contact Name:   NOLAN FLORES

Total # of Active Claim Offices: 3




Last Updated: Wednesday, June 1, 2011                                             Page 115 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10040       CENTRAL MUTUAL INSURANCE                       800 SOUTH WASHINGTON             VAN WERT              OH 45891     PWOIROL@CENTRAL-INSURANCE.COM
            COMPANY                                        STREET



Phone:      800-736-7000 Ext. 2325

CENTRAL INSURANCE                           34-4202560     800 SOUTH WASHINGTON ST          VAN WERT              OH 45891     CLININGER@CENTRAL-INSURANCE.COM



Phone:      800-736-7000 Ext. 2380
                                                                                                               Contact Name:   CAROL LININGER

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 116 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10267      CENTURY INDEMNITY COMPANY                       510 WALNUT STREET WB6B           PHILADELPHIA          PA 19106     PAUL.NEAFSEY@ACEGROUP.COM




Phone:     215-640-4565 Ext.

ESIS INC                                    95-2008390     500 COLONIAL PARKWAY             ROSWELL               GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKEVIEW                     NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-493-5802 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:     800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN




Last Updated: Wednesday, June 1, 2011                                             Page 117 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 4




 SBWC #     Name                            FEIN            Address                                                            Email


13171       CGU INSURANCE                                  ONE BEACON STREET                BOSTON                MA 02108




Phone:      617-725-9322 Ext.

MONTGOMERY INSURANCE                        -              3555 KOGER BLVD.                 DULUTH                GA 30096



Phone:      800-762-5573 Ext.
                                                                                                               Contact Name:   DENISE GIVENS

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 118 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10272       CHARTER OAK FIRE INSURANCE                     ONE TOWER SQUARE                 HARTFORD              CT 06183     KDAVIS@TRAVELERS.COM
            COMPANY



Phone:      860-954-5660 Ext.

CHARTER OAK FIRE INS CO                     06-0291290     BLDG V STE 200                   TAMPA                 FL 33610     DBRYSON@TRAVELERS.COM


                                                           10401 HIGHLAND MANOR DR
Phone:      888-329-6259 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON
CHARTER OAK FIRE INS CO                     06-0291290     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           STE 100
Phone:      800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 119 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10146      CHARTIS CASUALTY COMPANY                        175 WATER STREET                 NEW YORK              NY 10038     SMEETA.TECK@CHARTISINSURANCE.COM



                                                           18TH FLOOR
Phone:     212-458-7043 Ext.

BROADSPIRE INC                              36-3917295     P O BOX 926240                   NORCROSS              GA 30010     ATLANTA@CHOOSEBROADSPIRE.COM



Phone:     678-969-7337 Ext.
                                                                                                               Contact Name:   LORRAINE SHRINER
BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
CHARTIS CLAIMS                              13-2925174     P O BOX 1821                     ALPHARETTA            GA 30023     ALGAWCFR@AIG.COM



Phone:     800-448-9707 Ext.
                                                                                                               Contact Name:   ANNA COLBURN
CLAIMETRICS                                 20-1604010     PO BOX 22478                     OKLAHOMA CITY         OK 73123     LAUREN.TOPPINS@CLAIMETRICS.COM



Phone:     405-728-5544 Ext. 2326
                                                                                                               Contact Name:   LAUREN TOPPINS
CONSTITUTION STATE SERVICES                 06-1501229     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           STE 100
Phone:     770-352-2978 Ext.
                                                                                                               Contact Name:   KEVIN NELSON


Last Updated: Wednesday, June 1, 2011                                             Page 120 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10146      CHARTIS CASUALTY COMPANY                        175 WATER STREET                 NEW YORK              NY 10038     SMEETA.TECK@CHARTISINSURANCE.COM



                                                           18TH FLOOR
Phone:     212-458-7043 Ext.

CONSTITUTION STATE SERVICES                 06-1501229     10401 HIGHLAND MANOR DR          TAMPA                 FL 33612     GEORGIAWCBOARD@TRAVELERS.COM


                                                           STE 200
Phone:     770-934-3414 Ext.
                                                                                                               Contact Name:   JOSEPH CIBULSKI
CONSTITUTION STATE SERVICES                 06-1501229     10401 HIGHLAND MANOR DR          TAMPA                 FL 33610     DBRYSON@TRAVELERS.COM
                                                           #200

Phone:     888-329-6259 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON
ESIS INC                                    95-2008390     500 COLONIAL PARKWAY             ROSWELL               GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI


Last Updated: Wednesday, June 1, 2011                                             Page 121 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10146      CHARTIS CASUALTY COMPANY                        175 WATER STREET                 NEW YORK              NY 10038     SMEETA.TECK@CHARTISINSURANCE.COM



                                                           18TH FLOOR
Phone:     212-458-7043 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
HD LIBERTY MUTUAL INSURANCE                 04-1543470     THIS IS NOT A CLAIMS                                   01   03801
                                                           OFFICE

                                                           EDI USE ONLY
Phone:     -- Ext.
                                                                                                               Contact Name:   GEORGE POULIN
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 31204                    TAMPA                 FL 33618     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   CHARLES HUNNELL
NOVAPRO RISK                                36-4550659     101 E KENNEDY BLVD               TAMPA                 FL 33602     KROGERS@NOVAPRORISK.COM


                                                           SUITE 870
Phone:     800-426-5990 Ext.
                                                                                                               Contact Name:   KAREN ROGERS
SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER            ATLANTA               GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN


Last Updated: Wednesday, June 1, 2011                                             Page 122 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10146      CHARTIS CASUALTY COMPANY                        175 WATER STREET                 NEW YORK              NY 10038     SMEETA.TECK@CHARTISINSURANCE.COM



                                                           18TH FLOOR
Phone:     212-458-7043 Ext.

SEDGWICK CMS                                36-2685608     1100 RIDGEWAY LOOP ROAD          MEMPHIS               TN 38120     APULLEN@SEDGWICKCMS.COM



Phone:     241-922-0638 Ext.
                                                                                                               Contact Name:   ANTHONY PULLEN
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 14151                    LEXINGTON             KY 40512     DANIELLE.MINNIEHAN@SRSCONNECT.COM



Phone:     800-541-0139 Ext. 35832
                                                                                                               Contact Name:   DANIELLE MINNIEHAN
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKEVIEW                     NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-493-5802 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:     800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN


Last Updated: Wednesday, June 1, 2011                                             Page 123 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 20




Last Updated: Wednesday, June 1, 2011                                             Page 124 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10193      CHARTIS PROPERTY CASUALTY                       175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM
           COMPANY

                                                           18TH FLOOR
Phone:     212-458-7043 Ext.

CHARTIS CLAIMS                              13-2925174     P O BOX 1821                     ALPHARETTA            GA 30023     ALGAWCFR@AIG.COM



Phone:     800-448-9707 Ext.
                                                                                                               Contact Name:   ANNA COLBURN
CONSTITUTION STATE SERVICES                 06-1501229     10401 HIGHLAND MANOR DR          TAMPA                 FL 33610     DBRYSON@TRAVELERS.COM
                                                           #200

Phone:     888-329-6259 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON
SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER            ATLANTA               GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN
SEDGWICK CMS                                36-2685608     1100 RIDGEWAY LOOP ROAD          MEMPHIS               TN 38120     APULLEN@SEDGWICKCMS.COM



Phone:     241-922-0638 Ext.
                                                                                                               Contact Name:   ANTHONY PULLEN




Last Updated: Wednesday, June 1, 2011                                             Page 125 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 4




 SBWC #     Name                            FEIN            Address                                                            Email


13250       CHEROKEE INSURANCE COMPANY                     34200 MOUND ROAD                 STERLING HEIGHTS MI 48310          MMITTLESTAT@CHEROKEEINSURANCE.COM




Phone:      -- Ext.

CHEROKEE INSURANCE CO                       38-3464294     34200 MOUND ROAD                 STERLING HEIGHTS      MI 48310     MMROHN@CHEROKEEINSURANCE.COM



Phone:      800-201-0450 Ext. 3436
                                                                                                               Contact Name:   MARGARET ROHN

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 126 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13075      CHUBB INDEMNITY INSURANCE                       15 MOUNTAIN VIEW ROAD            WARREN                NJ 07061     PREMIUMTAXGROUP@CHUBB.COM
           COMPANY



Phone:     908-903-3287 Ext.

CHUBB SERVICES CORPORATION                  22-3096895     3445 PEACHTREE ROAD NE           ATLANTA               GA 30326     KPILZ@CHUBB.COM


                                                           2 LIVE OAK CENTER #900
Phone:     404-266-4855 Ext.
                                                                                                               Contact Name:   KURT PILZ
CORVEL CORPORATION                          95-3382819     4820 LAKE BROOK DRIVE #150       GLEN ALLEN            VA 23058     MARCIA_MORGAN@CORVEL.COM



Phone:     -- Ext.
                                                                                                               Contact Name:   MARCIA MORGAN
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 60000                    ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM



Phone:     770-901-3121 Ext.
                                                                                                               Contact Name:   MARY D'AGOSTINO


Last Updated: Wednesday, June 1, 2011                                             Page 127 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 5




Last Updated: Wednesday, June 1, 2011                                             Page 128 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13195      CHUBB NATIONAL INSURANCE                        15 MOUNTAIN VIEW ROAD            WARREN                NJ 07061     PREMIUMTAXGROUP@CHUBB.COM
           COMPANY



Phone:     908-903-3287 Ext.

CHUBB SERVICES CORPORATION                  22-3096895     3445 PEACHTREE ROAD NE           ATLANTA               GA 30326     KPILZ@CHUBB.COM


                                                           2 LIVE OAK CENTER #900
Phone:     404-266-4855 Ext.
                                                                                                               Contact Name:   KURT PILZ
CORVEL CORPORATION                          95-3382819     4820 LAKE BROOK DRIVE #150       GLEN ALLEN            VA 23058     MARCIA_MORGAN@CORVEL.COM



Phone:     -- Ext.
                                                                                                               Contact Name:   MARCIA MORGAN
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 60000                    ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM



Phone:     770-901-3121 Ext.
                                                                                                               Contact Name:   MARY D'AGOSTINO


Last Updated: Wednesday, June 1, 2011                                             Page 129 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 5




 SBWC #     Name                            FEIN            Address                                                            Email


10297       CHURCH MUTUAL INSURANCE                        3000 SCHUSTER LANE               MERRILL               WI 54452     DSEISER@CHURCHMUTUAL.COM
            COMPANY



Phone:      800-826-0006 Ext. 4557

CHURCH MUTUAL                               39-0712210     3000 SCHUSTER LANE               MERRILL               WI 54452     DSEISER@CHURCHMUTUAL.COM



Phone:      800-554-2642 Ext. 2
                                                                                                               Contact Name:   DAVID SEISER

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 130 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13014       CINCINNATI CASUALTY CO                         6200 S. GILMORE RD.              CINCINNATI            OH 45250     MARK_WELSH@CINFIN.COM



                                                           P O BOX 145496
Phone:      800-635-7521 Ext.

CINCINNATI INSURANCE COMPANY                31-0542366     P O BOX 920338                   NORCROSS              GA 30010     MIKE_THOMAS@CINFIN.COM



Phone:      770-662-8753 Ext.
                                                                                                               Contact Name:   MIKE THOMAS

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 131 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13060       CINCINNATI INDEMNITY COMPANY                   P O BOX 145496                   CINCINNATI            OH 45250     MARK_WELSH@CINFIN.COM




Phone:      800-635-7521 Ext.

CINCINNATI INSURANCE COMPANY                31-0542366     P O BOX 920338                   NORCROSS              GA 30010     MIKE_THOMAS@CINFIN.COM



Phone:      770-662-8753 Ext.
                                                                                                               Contact Name:   MIKE THOMAS

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 132 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10195      CINCINNATI INS CO THE                           P O BOX 145496                   CINCINNATI            OH 45250     MARK_WELSH@CINFIN.COM




Phone:     800-635-7521 Ext.

CINCINNATI INSURANCE COMPANY                31-0542366     P O BOX 920338                   NORCROSS              GA 30010     MIKE_THOMAS@CINFIN.COM



Phone:     770-662-8753 Ext.
                                                                                                               Contact Name:   MIKE THOMAS
TRAVELERS COMMERCIAL CASUALTY               95-3634110     10401 HIGHLAND MANOR             TAMPA                 FL 33610     DBRYSON@TRAVELERS.COM
COMPANY                                                    DRIVE

                                                           BUILDING V SUITE 200
Phone:     888-329-6259 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON
TRAVELERS INDEMNITY COMPANY                 06-0566050     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           SUITE 100
Phone:     800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
TRAVELERS INDEMNITY COMPANY                 06-0566050     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           SUITE 100
Phone:     800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON




Last Updated: Wednesday, June 1, 2011                                             Page 133 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 4




 SBWC #     Name                            FEIN            Address                                                            Email


10043       CITIZENS INSURANCE COMPANY OF                  440 LINCOLN STREET               WORCESTER             MA 01653     DAXMURPHY@HANOVER.COM
            AMERICA



Phone:      800-628-0250 Ext. 5118

HANOVER INSURANCE COMPANY                   13-5129825     440 LINCOLN STREET               WORCESTER             MA 01653     EBESHAI@HANOVER.COM



Phone:      800-628-0250 Ext.
                                                                                                               Contact Name:   ELIZABETH BESHAI

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 134 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12094       CLARENDON NATIONAL INS                         466 LEXINGTON AVE                NEW YORK              NY 10017     DNG@CLARENDON-INS.COM



                                                           19TH FLOOR
Phone:      800-797-2526 Ext.

ADJUSTMENT SERVICES INC.                    58-1623664     P O BOX 81306                    ATLANTA               GA 30366     SHARON@ADJUSTMENTSERVICES.COM



Phone:      800-772-8427 Ext.
                                                                                                               Contact Name:   SHARON STRUBE FERRER
NORTH AMERICAN RISK SERVICES INC            13-3901415     P O BOX 166002                   ALTAMONTE             FL 32716     MAILROOM@NARIK.COM
                                                                                            SPRINGS

Phone:      800-315-6090 Ext.
                                                                                                               Contact Name:   MELANIE STANISIC

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 135 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13181      COLONIAL AMERICAN CASUALTY &                    1400 AMERICAN LANE               SCHAUMBURG            IL 60196     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM
           SURETY COMPANY



Phone:     800-340-8602 Ext. 8613

ASSURANCE COMPANY OF AMERICA                13-6081895     3003 SUMMIT BLVD                 ATLANTA               GA 30319     CHRIS.CALLOWAY@ZURICHNA.COM


                                                           SUITE 1800
Phone:     404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY
COLONIAL AMERICAN CASUALTY AND              52-1096670     3003 SUMMIT BLVD                 ATLANTA               GA 30319     CHRIS.CALLOWAY@ZURICHNA.COM
SURETY

                                                           SUITE 1800
Phone:     404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY
COLONIAL AMERICAN CASUALTY AND              52-1096670     1900 SUMMIT TOWER BLVD           ORLANDO               FL 32810     CHRIS.CALLOWAY@ZURICHNA.COM
SURETY

                                                           SUITE 600
Phone:     404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY
ZURICH NA ATL CLAIMS                        36-4233459     3003 SUMMIT BLVD                 ATLANTA               GA 30319     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM


                                                           STE 1800
Phone:     404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY
ZURICH SERVICES CORPORATION                 36-3839542     1001 SUMMIT BLVD                 ATLANTA               GA 30319     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM


                                                           SUITE 800
Phone:     404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY


Last Updated: Wednesday, June 1, 2011                                             Page 136 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 5




 SBWC #     Name                            FEIN            Address                                                            Email


13221       COLORADO CASUALTY INSURANCE                    175 BERKELEY STREET              BOSTON                MA 02116     CORPORATESECRETARY@LIBERTYMUTUAL.COM
            COMPANY



Phone:      800-840-2242 Ext.

MONTGOMERY INSURANCE CLAIM                  52-0424870     P O BOX 49130                    CHARLOTTE             NC 28277     CHRISTINE.JONES@MONTGOMERY-INS.COM
CENTER

Phone:      800-334-0078 Ext. 214
                                                                                                               Contact Name:   CHRISTINE JONES

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 137 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13127       COLUMBIA MUTUAL                                2102 WHITE GATE DRIVE            COLUMBIA              MO 65202     FSHORE@COLINSGRP.COM




Phone:      800-877-3579 Ext.

COLUMBIA INSURANCE GROUP                    43-0926456     2295 PARKLAKE DR                 ATLANTA               GA 30345     FSHORE@COLINSGRP.COM


                                                           SUITE 100
Phone:      800-767-4080 Ext.
                                                                                                               Contact Name:   FRANK SHORE

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 138 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10010       COLUMBIA NATIONAL INSURANCE                    2102 WHITE GATE DRIVE            COLUMBIA              MO 65205     FSHORE@COLINSGRP.COM
            COMPANY



Phone:      800-877-3579 Ext.

COLUMBIA INSURANCE GROUP                    43-0926456     2295 PARKLAKE DR                 ATLANTA               GA 30345     FSHORE@COLINSGRP.COM


                                                           SUITE 100
Phone:      800-767-4080 Ext.
                                                                                                               Contact Name:   FRANK SHORE
COLUMBIA NATIONAL INS CO                    47-0685688     P O BOX 618                      COLUMBIA              MO 65205     FSHORE@COLINSGRP.COM



Phone:      573-474-6193 Ext.
                                                                                                               Contact Name:   FRANK SHORE

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 139 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10248      COMMERCE AND INDUSTRY INS                       175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM



                                                           18TH FLOOR
Phone:     212-458-7043 Ext.

CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD           POMPANO BEACH         FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:     877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD
CHARTIS CLAIMS                              13-2925174     P O BOX 1821                     ALPHARETTA            GA 30023     ALGAWCFR@AIG.COM



Phone:     800-448-9707 Ext.
                                                                                                               Contact Name:   ANNA COLBURN
CLAIMETRICS                                 20-1604010     PO BOX 22478                     OKLAHOMA CITY         OK 73123     LAUREN.TOPPINS@CLAIMETRICS.COM



Phone:     405-728-5544 Ext. 2326
                                                                                                               Contact Name:   LAUREN TOPPINS
ESIS INC                                    95-2008390     500 COLONIAL PARKWAY             ROSWELL               GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER


Last Updated: Wednesday, June 1, 2011                                             Page 140 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10248      COMMERCE AND INDUSTRY INS                       175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM



                                                           18TH FLOOR
Phone:     212-458-7043 Ext.

SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER            ATLANTA               GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN
SEDGWICK CMS                                36-2685608     1100 RIDGEWAY LOOP ROAD          MEMPHIS               TN 38120     APULLEN@SEDGWICKCMS.COM



Phone:     241-922-0638 Ext.
                                                                                                               Contact Name:   ANTHONY PULLEN
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 14151                    LEXINGTON             KY 40512     DANIELLE.MINNIEHAN@SRSCONNECT.COM



Phone:     800-541-0139 Ext. 35832
                                                                                                               Contact Name:   DANIELLE MINNIEHAN
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKEVIEW                     NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-493-5802 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO


Last Updated: Wednesday, June 1, 2011                                             Page 141 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10248       COMMERCE AND INDUSTRY INS                      175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM



                                                           18TH FLOOR
Phone:      212-458-7043 Ext.

SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:      800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN

Total # of Active Claim Offices: 11




Last Updated: Wednesday, June 1, 2011                                             Page 142 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13165       COMPANION COMMERCIAL INS                       PO BOX 100165                    COLUMBIA              SC 29202     CURTIS.STEWART@COMPANIONGROUP.COM




Phone:      800-845-2724 Ext.

COMPANION COMMERCIAL INS                    58-2292212     P O BOX 100165                   COLUMBIA              SC 29202     WCMAIL@COMPANIONGROUP.COM



Phone:      800-845-2724 Ext.
                                                                                                               Contact Name:   CHRIS DANIEL
COMPANION PROPERTY & CASUALTY               57-0768836     P O BOX 100165                   COLUMBIA              SC 29202     WCMAIL@COMPANIONGROUP.COM



Phone:      877-379-7389 Ext.
                                                                                                               Contact Name:   CHRIS DANIEL

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 143 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13000       COMPANION PROPERTY & CASUALTY                  PO BOX 100165                    COLUMBIA              SC 29202     CURTIS.STEWART@COMPANIONGROUP.COM




Phone:      800-845-2724 Ext.

COMPANION COMMERCIAL INS                    58-2292212     P O BOX 100165                   COLUMBIA              SC 29202     WCMAIL@COMPANIONGROUP.COM



Phone:      800-845-2724 Ext.
                                                                                                               Contact Name:   CHRIS DANIEL
COMPANION PROPERTY & CASUALTY               57-0768836     P O BOX 100165                   COLUMBIA              SC 29202     WCMAIL@COMPANIONGROUP.COM



Phone:      877-379-7389 Ext.
                                                                                                               Contact Name:   CHRIS DANIEL
JOHNSTON & ASSOCIATES INC                   62-1426686     1885 GENERAL GEORGE              FRANKLIN              TN 37067     KM@JOHNSTONANDASSOC.COM
                                                           PATTON DRIVE

Phone:      800-304-5035 Ext.
                                                                                                               Contact Name:   KIM MCCOIN

Total # of Active Claim Offices: 3




Last Updated: Wednesday, June 1, 2011                                             Page 144 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


40016       COMPTRUST AGC MUTUAL CAPTIVE                   1940 THE EXCHANGE                ATLANTA               GA 30339     BCOREY@AFFINITYSERVICEGROUP.COM
            INSURANCE CO

                                                           SUITE 200
Phone:      -- Ext.

AFFINITY SERVICE GROUP INC                  58-2438483     1940 THE EXCHANGE                ATLANTA               GA 30339     GDORSEY@AFFINITYSERVICEGROUP.COM


                                                           SUITE 200
Phone:      800-233-2436 Ext. 1897
                                                                                                               Contact Name:   GREG DORSEY

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 145 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10051      CONTINENTAL CASUALTY CO                         333 S WABASH AVENUE              CHICAGO               IL 60604     GASTATEICNUMBERS@CNA.COM



                                                           28 SOUTH
Phone:     312-822-3874 Ext.

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
CAMBRIDGE INTEGRATED                        23-2731565     1775 THE EXCHANGE                ATLANTA               GA 30339     DAVID.HAYS@CAMBRIDGE-NA.COM


                                                           SUITE 360
Phone:     800-862-4252 Ext.
                                                                                                               Contact Name:   DAVID HAYES
CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD           POMPANO BEACH         FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:     877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD
CNA CLAIMS PLUS                             16-1633560     2435 COMMERCE AVENUE             DULUTH                GA 30096     GASTATEICNUMBERS@CNA.COM


                                                           BDG 2200 SATELLITE PLACE
Phone:     800-283-2318 Ext. 3574
                                                                                                               Contact Name:   TAMARA WILLIAMS
CONTINENTAL CASUALTY COMPANY                36-2114545     333 SOUTH WABASH                 CHICAGO               IL   60604   GASTATEICNUMBERS@CNA.COM


                                                           38S
Phone:     312-822-2331 Ext.
                                                                                                               Contact Name:   COLETTE TURNER


Last Updated: Wednesday, June 1, 2011                                             Page 146 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10051      CONTINENTAL CASUALTY CO                         333 S WABASH AVENUE              CHICAGO               IL 60604     GASTATEICNUMBERS@CNA.COM



                                                           28 SOUTH
Phone:     312-822-3874 Ext.

COTTINGHAM AND BUTLER CLAIM                 20-5233506     P O BOX 28                       DUBUQUE               IA 52004     DUNMACHT@CBCSCLAIMS.COM
SERVICES

Phone:     877-241-6121 Ext.
                                                                                                               Contact Name:   DAN UNMACHT
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
TRAVELERS INDEMNITY CO OF CT                06-0336212     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           SUITE 100
Phone:     800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON


Last Updated: Wednesday, June 1, 2011                                             Page 147 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10051       CONTINENTAL CASUALTY CO                        333 S WABASH AVENUE              CHICAGO               IL 60604     GASTATEICNUMBERS@CNA.COM



                                                           28 SOUTH
Phone:      312-822-3874 Ext.

TRAVELERS INDEMNITY CO OF CT                06-0336212     10401 HIGHLAND MANOR             TAMPA                 FL 33610     DBRYSON@TRAVELERS.COM
                                                           DRIVE

                                                           BUILDING V SUITE 200
Phone:      888-329-6259 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON
TRAVELERS INDEMNITY COMPANY                 06-0566050     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           SUITE 100
Phone:      800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
TRAVELERS INDEMNITY COMPANY                 06-0566050     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           SUITE 100
Phone:      800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON

Total # of Active Claim Offices: 13




Last Updated: Wednesday, June 1, 2011                                             Page 148 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10052      CONTINENTAL INSURANCE CO                        333 S WABASH AVENUE              CHICAGO               IL 60604     DEBRA.RETEL@CNA.COM



                                                           28 SOUTH
Phone:     312-822-3874 Ext.

CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD           POMPANO BEACH         FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:     877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD
CNA CLAIMS PLUS                             16-1633560     2435 COMMERCE AVENUE             DULUTH                GA 30096     GASTATEICNUMBERS@CNA.COM


                                                           BDG 2200 SATELLITE PLACE
Phone:     800-283-2318 Ext. 3574
                                                                                                               Contact Name:   TAMARA WILLIAMS
CONSTITUTION STATE SERVICES                 06-1501229     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           STE 100
Phone:     770-352-2978 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
CONTINENTAL CASUALTY COMPANY                36-2114545     333 SOUTH WABASH                 CHICAGO               IL   60604   GASTATEICNUMBERS@CNA.COM


                                                           38S
Phone:     312-822-2331 Ext.
                                                                                                               Contact Name:   COLETTE TURNER
TRAVELERS INDEMNITY COMPANY                 06-0566050     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           SUITE 100
Phone:     800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON


Last Updated: Wednesday, June 1, 2011                                             Page 149 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 5




 SBWC #     Name                            FEIN            Address                                                            Email


13225       CONTINENTAL WESTERN INS CO                     11201 DOUGLAS                    URBANDALE             IA 50322     SGEILS@USIC.COM




Phone:      -- Ext.

UNION STANDARD                              47-0547953     122 W CARPENTER FREEWAY          IRVING                TX 75039     SRICHARDSON@USIC.COM


                                                           SUITE 350
Phone:      800-444-0049 Ext.
                                                                                                               Contact Name:   SUZANNE RICHARDSON

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 150 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13295       CORNHUSKER CASUALTY COMPANY                    3333 FARNAM STREET               OMAHA                 NE 68131     NWILSON@BHHC.COM



                                                           SUITE 300
Phone:      -- Ext.

CORNHUSKER CASUALTY COMPANY                 -              1725 WINDWARD                    ALPHARETTA            GA 30005     NWILSON@BHHC.COM
                                                           CONCOURSE

                                                           SUITE 200
Phone:      877-212-3816 Ext. 253
                                                                                                               Contact Name:   NAOMI WILSON

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 151 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13037       CRUM & FORSTER INDEMNITY                       305 MADISON AVENUE               MORRISTOWN            NJ 07962     GEORGE_ROBERTS@CFINS.COM
            COMPANY



Phone:      800-690-5520 Ext.

UNITED STATES FIRE INSURANCE                13-5459190     1064 GREENWOOD BLVD              LAKE MARY             FL 32795     DENVER_CHEEK@CFINS.COM
COMPANY

                                                           SUITE 300
Phone:      800-423-3060 Ext. 6301
                                                                                                               Contact Name:   DENVER L CHEEK

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 152 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13109       CYPRESS INSURANCE COMPANY                      3333 FRNAM STREET                OMAHA                 NE 68131     DALTMAN@BHHC.COM



                                                           SUITE 300
Phone:      800-488-2930 Ext. 3166

CYPRESS INSURANCE                           95-6042929     1725 WINDWARD                    ALPHARETTA            GA 30005     CBARNES@BHHC.COM
                                                           CONCOURSE

                                                           SUITE 200
Phone:      877-212-3816 Ext. 230
                                                                                                               Contact Name:   COURTNEY BARNES

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 153 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13265       DAKOTA TRUCK UNDERWRITERS                      300 CHERAPA PLACE #401           SIOUX FALLS           SD 30319     ROB.HOLLAN@RASCOMPANIES.COM




Phone:      -- Ext.

CRAWFORD & COMPANY                          58-0506554     P O BOX 5056                     ATLANTA               GA 30302     SHARI_BRANSON@US.CRAWCO.COM



Phone:      404-300-1250 Ext.
                                                                                                               Contact Name:   SHARI BRANSON

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 154 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13228       DALLAS NATIONAL INSURANCE                      14160 DALLAS PARKWAY             DALLAS                TX 75254     JOSEB@ASPENADMININC.COM
            COMPANY

                                                           SUITE 500
Phone:      -- Ext.

COLLINS & COMPANY                           62-0882150     P O BOX 6429                     DALTON                GA 30722     AGRIME@COLLINSANDCO.COM



Phone:      706-277-1253 Ext.
                                                                                                               Contact Name:   ANGELA GRIME

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 155 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13177       DELTA FIRE & CASUALTY INS                      4370 PEACHTREE RD NE             ATLANTA               GA 30319     KSLONINA@ATLAM.COM




Phone:      800-282-0480 Ext.

GEORGIA CASUALTY & SURETY                   58-0537066     4370 PEACHTREE ROAD NE           ATLANTA               GA 30319     FSHORE@COLINSGRP.COM



Phone:      800-877-3579 Ext.
                                                                                                               Contact Name:   FRANK SHORE

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 156 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13243       DEPOSITORS INSURANCE COMPANY                   1100 LOCUST STREET               DES MOINES            IA 50391




Phone:      -- Ext.

DEPOSITORS INSURANCE COMPANY                42-1207150     1100 LOCUST STREET               DES MOINES            IA 50391     PORTERK@NATIONWIDE.COM



Phone:      800-532-1436 Ext. 3340
                                                                                                               Contact Name:   KRISTY PORTER
NATIONWIDE INSURANCE                        31-4177100     P O BOX 147061                   GAINESVILLE           FL 32614     FERRANT@NATIONWIDE.COM



Phone:      800-985-7078 Ext.
                                                                                                               Contact Name:   TOM FERRANTE

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 157 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13281       DIAMOND STATE INSURANCE COMPANY                THREE BALA PLAZA EAST            BALA CYNWYD           PA 19004     GSEGELKEN@UAI-GROUP.COM



                                                           SUITE 300
Phone:      -- Ext.

RISK ENTERPRISE MANAGEMENT                  13-3832689     1140 HAMMOND DR                  ATLANTA               GA 30328     JANET.GREER@REMLTD.COM
LIMITED

                                                           SUITE J-2075
Phone:      800-347-4494 Ext.
                                                                                                               Contact Name:   JANET GREER

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 158 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10198      DISCOVER PROPERTY & CASUALTY                    385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

ALTERNATIVE SERVICE CONCEPTS DBA            43-1954328     3135 AVALON RIDGE PLACE          NORCROSS              GA 30071     SUE.LORANCE@ASCRISK.COM
ASC LLC

                                                           SUITE 650
Phone:     678-447-0200 Ext. 302
                                                                                                               Contact Name:   SUE LORANCE
ALTERNATIVE SERVICE CONCEPTS LLC            43-1954328     3135 AVALON RIDGE PLACE          NORCROSS              GA 30071     SUE.LORANCE@ASCRISK.COM
DBA ASC

                                                           SUITE 650
Phone:     678-447-0200 Ext. 302
                                                                                                               Contact Name:   SUE LORANCE
AS&G CLAIMS ADMINISTRATION                  76-0516648     EDI HEADER ONLY                  NOT A CLAIM           00   77040   WBROWNING@ASG-ADJ.COM
                                                                                            OFFICE

                                                           EDI USE ONLY
Phone:     800-580-2334 Ext.
                                                                                                               Contact Name:   WANDA BROWNING
AS&G CLAIMS ADMINISTRATION INC              76-0516648     125 PARK OF COMMERCE             SAVANNAH              GA 31405     MREVELLE@ASG-ADJ.COM
                                                           DRIVE #B

Phone:     800-580-6912 Ext.
                                                                                                               Contact Name:   MICHELLE REVELLE
AVIZENT                                     31-4359765     701 INTERNATIONAL                LAKE MARY             FL 32746     TWELDON@AVIZENTRISK.COM
                                                           PARKWAY

                                                           SUITE 175
Phone:     800-755-1441 Ext.
                                                                                                               Contact Name:   TAMMY WELDON


Last Updated: Wednesday, June 1, 2011                                             Page 159 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10198      DISCOVER PROPERTY & CASUALTY                    385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA            BIRMINGHAM            AL 35209     DMCCLOSKEY@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 29106
                                                                                                               Contact Name:   DAVIDA MCCLOSKEY
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA            BIRMINGHAM            AL 35209     CMULLINS@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 20104
                                                                                                               Contact Name:   CHRISTINA MULLINS
BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD           POMPANO BEACH         FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:     877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD
CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR              MAITLAND              FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

Phone:     866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN


Last Updated: Wednesday, June 1, 2011                                             Page 160 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10198      DISCOVER PROPERTY & CASUALTY                    385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR              MAITLAND              FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

                                                           SUITE 225
Phone:     866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN
COTTINGHAM & BUTLER CLAIM                   20-5233506     P O BOX 28                       DUBUQUE               IA 52004     DUNMACHT@CBCSCLAIMS.COM
SERVICES

Phone:     877-241-6121 Ext.
                                                                                                               Contact Name:   DAN UNMACHT
COTTINGHAM AND BUTLER CLAIM                 20-5233506     P O BOX 28                       DUBUQUE               IA 52004     DUNMACHT@CBCSCLAIMS.COM
SERVICES

Phone:     877-241-6121 Ext.
                                                                                                               Contact Name:   DAN UNMACHT
DISCOVER PROPERTY & CASUALTY INS            36-2999370     1000 WINWARD CONCOURSE           ALPHARETTA            GA 30005     GEORGIA.WC.BOARD@TRAVELERS.COM
CO

                                                           STE 100
Phone:     800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
DISCOVER PROPERTY & CASUALTY                36-2999370     1000 FIANA WAY                   FT SMITH              AR 72919     MJWHITE@TRAVELERS.COM
INSURANCE COMPANY

Phone:     800-842-5612 Ext. 4611
                                                                                                               Contact Name:   MELISSA WHITE


Last Updated: Wednesday, June 1, 2011                                             Page 161 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10198      DISCOVER PROPERTY & CASUALTY                    385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

DISCOVER PROPERTY & CASUALTY                36-2999370     6640 CAROTHERS PARKWAY           FRANKLIN              TN 37067     LCRAFT@TRAVELERS.COM
INSURANCE COMPANY

                                                           SUITE 300
Phone:     615-660-6258 Ext.
                                                                                                               Contact Name:   LUCIE CRAFT
DISCOVER PROPERTY & CASUALTY                36-2999370     11440 CARMEL COMMONS             CHARLOTTE             NC 28226     MWLANE@TRAVELERS.COM
INSURANCE COMPANY                                          BLVD

Phone:     800-759-6194 Ext.
                                                                                                               Contact Name:   MELISSA LANE
DISCOVER PROPERTY & CASUALTY                36-2999370     10401 HIGHLAND MANOR             TAMPA                 FL 33610     DBRYSON@TRAVELERS.COM
INSURANCE COMPANY                                          DRIVE

                                                           BUILDING V SUITE 200
Phone:     888-329-6259 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON
DISCOVER PROPERTY & CASUALTY                36-2999370     2420 LAKEMONT AVENUE             ORLANDO               FL 32814
INSURANCE COMPANY

Phone:     -- Ext.
                                                                                                               Contact Name:   PAULA YOAKUM
ESIS                                        95-2008390     500 COLONIAL CENTER              ROSWELL               GA 30076     MARK.IRWIN@ESIS.COM
                                                           PARKWAY

                                                           SUITE 200
Phone:     678-795-4500 Ext.
                                                                                                               Contact Name:   MARK G IRWIN


Last Updated: Wednesday, June 1, 2011                                             Page 162 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10198      DISCOVER PROPERTY & CASUALTY                    385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

ESIS INC                                    95-2008390     500 COLONIAL PARKWAY             ROSWELL               GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 292109                   NASHVILLE             TN 37229     GALE_LESIEUR@GBTPA.COM



Phone:     800-288-9843 Ext. 201
                                                                                                               Contact Name:   GALE LESIEUR
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 21227                    TAMPA                 FL 33622     WILLIAM_KIMBROUGH@GBTPA.COM



Phone:     866-428-0283 Ext.
                                                                                                               Contact Name:   WILLIAM KIMBROUGH


Last Updated: Wednesday, June 1, 2011                                             Page 163 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10198      DISCOVER PROPERTY & CASUALTY                    385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 785071                   ORLANDO               FL 32878     KEITH_LEAHY@GBTPA.COM



Phone:     800-843-8999 Ext.
                                                                                                               Contact Name:   KEITH LEAHY
GALLAGHER BASSETT SERVICES INC              36-3365500     1301 INTERNATIONAL               SUNRISE               FL 33323     ANDREA_HUMPHRIES@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 230
Phone:     800-889-6764 Ext. 201
                                                                                                               Contact Name:   ANDREA HUMPHRIES
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 31204                    TAMPA                 FL 33618     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   CHARLES HUNNELL
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 31204                    TAMPA                 FL 33631     HEATHER.STANFORD@LIBERTYMUTUAL.COM
LLC

Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   HEATHER STANFORD


Last Updated: Wednesday, June 1, 2011                                             Page 164 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10198      DISCOVER PROPERTY & CASUALTY                    385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

MATRIX ABSENCE MANAGEMENT                   77-0493584     P O BOX 10156                    WILMINGTON            NC 28404     GEORGIAWORKERSCOMPENSATION@MATRIXCO
                                                                                                                               S.COM

Phone:     800-896-3079 Ext.
                                                                                                               Contact Name:   ANDREA DULEY
MATRIX ABSENCE MANAGEMENT                   77-0493584     P O BOX 1479                     OWING MILLS           MD 21117     GEORGIAWORKERSCOMPENSATION@MATRIXCO
                                                                                                                               S.COM

Phone:     866-654-4001 Ext.
                                                                                                               Contact Name:   MICHELLE WOODSON
MATRIX ABSENCE MANAGEMENT                   77-0493584     P O BOX 3448                     PLANT CITY            FL 33563     GEORGIAWORKERSCOMPENSATION@MATRIXCO
                                                                                                                               S.COM

Phone:     888-878-0005 Ext.
                                                                                                               Contact Name:   KIMBERLY SMITH
MATRIX ABSENCE MANAGEMENT                   77-0493584     11221 N 28TH DRIVE               PHONEIX               AZ 85029     EDICOORDINATOR@MATRIXCOS.COM


                                                           E-100
Phone:     800-866-2301 Ext.
                                                                                                               Contact Name:   RAQUEL GARCIA
MATRIX ABSENCE MANAGEMENT                   77-0493584     P O BOX 1468                     SAN JOSE              CA 95109     GEORGIAWORKERSCOMPENSATION@MATRIXCO
                                                                                                                               S.COM

Phone:     888-878-0005 Ext.
                                                                                                               Contact Name:   RENATA MCCOOMER


Last Updated: Wednesday, June 1, 2011                                             Page 165 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10198      DISCOVER PROPERTY & CASUALTY                    385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

PMA MANAGEMENT CORPORATION                  23-2652239     1100 ABERNATHY ROAD NE           ATLANTA               GA 30328     ADOLPHUS_DRAIN@PMAGROUP.COM


                                                           SUITE 650 500 NORTH PARK TOWN CENTER
Phone:     888-888-8136 Ext.
                                                                                                               Contact Name:   ADOLPHUS DRAIN
RISK ENTERPRISE MANAGEMENT                  13-3832689     1140 HAMMOND DR                  ATLANTA               GA 30328     JANET.GREER@REMLTD.COM
LIMITED

                                                           SUITE J-2075
Phone:     800-347-4494 Ext.
                                                                                                               Contact Name:   JANET GREER
RISK ENTERPRISE MANAGEMENT                  13-3832689     565 MARRIOTT DRIVE               NASHVILLE             TN 37214     JANICE.GUIDRY@REMLTD.COM
LIMITED

                                                           SUITE 725
Phone:     800-871-6670 Ext.
                                                                                                               Contact Name:   JANICE GUIDRY
RISK ENTERPRISES MANAGEMENT                 13-3832689     565 MARRIOTT DRIVE               NASHVILLE             TN 37214     JANICE.GUIDRY@REMLTD.COM
LIMITED

                                                           SUITE 725
Phone:     800-871-6670 Ext.
                                                                                                               Contact Name:   JANICE GUIDRY
SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER            ATLANTA               GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN


Last Updated: Wednesday, June 1, 2011                                             Page 166 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10198      DISCOVER PROPERTY & CASUALTY                    385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

SEDGWICK CMS                                36-2685608     5260 PARKWAY PLAZA BLVD          CHARLOTTE             NC 28217     MYRA.NORMAN@SEDGWICKCMS.COM


                                                           SUITE 190
Phone:     800-822-4469 Ext.
                                                                                                               Contact Name:   MYRA NORMAN
SENTRY INSURANCE A MUTUAL                   39-0333950     P O BOX 26263                    RICHMOND              VA 23260     WCCLAIMSEAST@SENTRY.COM
COMPANY

Phone:     800-338-2487 Ext. 4616
                                                                                                               Contact Name:   TIM O'BRIEN
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 60000                    ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM



Phone:     770-901-3121 Ext.
                                                                                                               Contact Name:   MARY D'AGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 14151                    LEXINGTON             KY 40512     DANIELLE.MINNIEHAN@SRSCONNECT.COM



Phone:     800-541-0139 Ext. 35832
                                                                                                               Contact Name:   DANIELLE MINNIEHAN
UNITED SELF INSURED SERVICES                20-4580645     P O BOX 616648                   ORLANDO               FL 32861     SAM.BOONE@USIS-TPA.COM



Phone:     800-444-9098 Ext. 214
                                                                                                               Contact Name:   LINDA HAMILTON


Last Updated: Wednesday, June 1, 2011                                             Page 167 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 45




 SBWC #     Name                            FEIN            Address                                                            Email


13287       DONEGAL MUTUAL INSURANCE                       P O BOX 302                      MARIETTA              PA 17547     WAYNESMITH@DONEGALGROUP.COM
            COMPANY



Phone:      -- Ext.

DONEGAL INSURANCE GROUP                     -              3097 SATELLITE BLVD              DULUTH                GA 30096     MIKEGORE@DONEGALGROUP.COM


                                                           SUITE 230
Phone:      800-277-7442 Ext.
                                                                                                               Contact Name:   MIKE GORE

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 168 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13276       EASTERN ADVANTAGE ASSURANCE                    P O BOX 83777                    LANCASTER             PA 17608     RIRONS@EAINS.COM
            COMPANY



Phone:      -- Ext.

EASTERN ADVANTAGE ASSURANCE                 65-1316719     P O BOX 83777                    LANCASTER             PA 17608     RIRONS@EAINS.COM
COMPANY

Phone:      888-654-7100 Ext.
                                                                                                               Contact Name:   RICHARD W IRONS

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 169 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13249       EASTERN ALLIANCE INSURANCE CO                  P O BOX 83777                    LANCASTER             PA 17608     RIRONS@EAINS.COM




Phone:      -- Ext.

EASTERN ALLIANCE                            23-2900463     P O BOX 83777                    LANCASTER             PA 17608     KCHAPMAN@EAINS.COM



Phone:      888-654-7100 Ext.
                                                                                                               Contact Name:   KELLI CHAPMAN

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 170 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13168      EASTGUARD INSURANCE COMPANY                     P O BOX A-H                      WILKES-BARRE          PA 18703     ESOLA@GUARD.COM




Phone:     800-673-2465 Ext.

AMGUARD                                     23-2240321     P O Box 1368                     WILKES-BARRE          PA 18703     CLAIMS3@GUARD.COM



Phone:     800-673-2465 Ext. 8110
                                                                                                               Contact Name:   BELINDA DIAMOND
EASTGUARD INSURANCE COMPANY                 01-0125870     294 S MAIN STREET                ALPHARETTA            GA 30009     BDIAMOND@GUARD.COM


                                                           SUITE 600
Phone:     800-673-2465 Ext. 8110
                                                                                                               Contact Name:   BELINDA DIAMOND
GUARD INSURANCE GROUP                       23-2240322     P O BOX A - H                    WILKES-BARRE          PA 18703     CLAIMS3@GUARD.COM



Phone:     800-673-2465 Ext. 8110
                                                                                                               Contact Name:   BELINDA DIAMOND
GUARD INSURANCE GROUP                       -              P O Box 1368                     WILKES-BARRE          PA 18703     CLAIMS3@GUARD.COM



Phone:     678-581-0589 Ext.
                                                                                                               Contact Name:   KEVIN FOLEY
GUARD INSURANCE GROUP                       23-2240322     102 WEST PENNSYLVANIA            TOWSON                MD 21204     CLAIMS3@GUARD.COM
                                                           AVE

                                                           SUITE 206
Phone:     800-673-2465 Ext. 8302
                                                                                                               Contact Name:   LENWOOD HALL


Last Updated: Wednesday, June 1, 2011                                             Page 171 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 5




 SBWC #     Name                            FEIN            Address                                                            Email


13072       ELECTRIC INSURANCE COMPANY                     75 SAM FONZO DRIVE               BEVERLY               MA 01915     STEPHEN.PALENSCAR@ELECTRICINSURANCE.COM




Phone:      800-227-2757 Ext. 5210

SEDGWICK CMS                                36-2685608     PO BOX 15065                     ALBANY                NY 12212     PNICKEL@EDGE.ELECTRICINSURANCE.COM



Phone:      800-434-8331 Ext.
                                                                                                               Contact Name:   PAT NICKEL

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 172 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10017       EMC PROPERTY & CASUALTY COMPANY                P O BOX 712                      DES MOINES            IA 50306




Phone:      800-247-2128 Ext. 2658

EMPLOYERS MUTUAL CASUALTY                   42-0234980     P O BOX 1568                     BIRMINGHAM            AL 35201     TERRY.L.HARDESTY@EMCINS.COM
COMPANY

Phone:      800-239-1407 Ext. 301
                                                                                                               Contact Name:   TERRY HARDESTY

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 173 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13152       EMCASCO INSURANCE COMPANY                      P O BOX 712                      DES MOINES            IA 50306     KEVIN.J.HOVICK@EMCINS.COM




Phone:      800-247-2128 Ext. 2658

EMPLOYERS MUTUAL CASUALTY                   42-0234980     P O BOX 1568                     BIRMINGHAM            AL 35201     TERRY.L.HARDESTY@EMCINS.COM
COMPANY

Phone:      800-239-1407 Ext. 301
                                                                                                               Contact Name:   TERRY HARDESTY

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 174 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13117       EMPLOYERS ASSURANCE COMPANY                    10375 PROFESSIONAL               RENO                  NV 89521     REGULATORY@EMPLOYERS.COM
                                                           CIRCLE



Phone:      800-226-1898 Ext.

EMPLOYERS ASSURANCE COMPANY                 61-0477370     14120 BALLANTYNE                 CHARLOTTE             NC 28277     EASTIMAGING@EMPLOYERS.COM
                                                           CORPORATE PL

                                                           SUITE 100
Phone:      800-992-1072 Ext.
                                                                                                               Contact Name:   RICHARD ALLISON

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 175 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10196       EMPLOYERS FIRE INS CO THE                      ONE BEACON STREET                CANTON                MA 02021     SHOLLAND@ONEBEACON.COM




Phone:      973-630-6601 Ext.

HD ONEBEACON INSURANCE                      23-1502700     THIS IS NOT A CLAIMS             CANTON                ME 02021     PANDRADE@HANOVER.COM
                                                           OFFICE

                                                           EDI USE ONLY
Phone:      508-855-5893 Ext.
                                                                                                               Contact Name:   PAULA ANDRADE
ONEBEACON INSURANCE                         23-1502700     P O BOX 9155                     CANTON                MA 02021     DDAVENPORT@ONEBEACON.COM



Phone:      800-203-9600 Ext. 9706
                                                                                                               Contact Name:   DENISE DAVENPORT

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 176 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10189       EMPLOYERS INSURANCE CO OF                      175 BERKELEY STREET              BOSTON                MA 02116     CORPORATESECRETARY@LIBERTYMUTUAL.COM
            WAUSAU



Phone:      800-344-0198 Ext.

EMPLOYERS INS CO OF WAUSAU                  39-0264050     P O BOX 49000                    CHARLOTTE             NC 28277     CHARLES.HUNNELL@LIBERTYMUTUAL.COM



Phone:      704-759-2580 Ext.
                                                                                                               Contact Name:   CHARLES HUNNELL
EMPLOYERS INS CO OF WAUSAU                  39-0264050     3901 PREMIER NORTH DR            TAMPA                 FL 33618     CHARLES.HUNNELL@LIBERTYMUTUAL.COM



Phone:      813-264-6588 Ext.
                                                                                                               Contact Name:   CHARLES HUNNELL

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 177 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10241       EMPLOYERS MUTUAL CASUALTY CO                   P O BOX 712                      DES MOINES            IA 50306     KEVIN.J.HOVICK@EMCINS.COM




Phone:      800-247-2128 Ext. 2658

EMPLOYERS MUTUAL CASUALTY                   42-0234980     P O BOX 1568                     BIRMINGHAM            AL 35201     TERRY.L.HARDESTY@EMCINS.COM
COMPANY

Phone:      800-239-1407 Ext. 301
                                                                                                               Contact Name:   TERRY HARDESTY

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 178 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13126       EMPLOYERS PREFERRED INSURANCE                  10375 PROFESSIONAL               RENO                  NV 89521     REGULATORY@EMPLOYERS.COM
            COMPANY                                        CIRCLE



Phone:      800-749-1898 Ext.

EMPLOYERS ASSURANCE COMPANY                 61-0477370     14120 BALLANTYNE                 CHARLOTTE             NC 28277     EASTIMAGING@EMPLOYERS.COM
                                                           CORPORATE PL

                                                           SUITE 100
Phone:      800-992-1072 Ext.
                                                                                                               Contact Name:   RICHARD ALLISON

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 179 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13188       ENCOMPASS HOME AND AUTO INS.                   CNA CENTER-28TH FLOOR            CHICAGO,              IL 60604     NEIFIA.DORITY@CNA.COM



                                                           333 SO. WABASH
Phone:      312-822-4314 Ext.

CNA CLAIMS PLUS                             16-1633560     2435 COMMERCE AVENUE             DULUTH                GA 30096     GASTATEICNUMBERS@CNA.COM


                                                           BDG 2200 SATELLITE PLACE
Phone:      800-283-2318 Ext. 3574
                                                                                                               Contact Name:   TAMARA WILLIAMS

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 180 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13189       ENCOMPASS INDEPENDENT INS. CO.                 CNA CENTER-28TH FLOOR            CHICAGO,              IL 60604     NEFIA.DORITY@CNA.COM



                                                           333 SO. WABASH
Phone:      312-822-4314 Ext.

CNA CLAIMS PLUS                             16-1633560     2435 COMMERCE AVENUE             DULUTH                GA 30096     GASTATEICNUMBERS@CNA.COM


                                                           BDG 2200 SATELLITE PLACE
Phone:      800-283-2318 Ext. 3574
                                                                                                               Contact Name:   TAMARA WILLIAMS

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 181 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13190       ENCOMPASS INS.CO. OF AMERICA                   CNA CENTER-28TH FLOOR            CHICAGO,              IL 60604     NEIFIA.DORITY@CNA.COM



                                                           333 SO. WABASH
Phone:      312-822-4314 Ext.

CNA CLAIMS PLUS                             16-1633560     2435 COMMERCE AVENUE             DULUTH                GA 30096     GASTATEICNUMBERS@CNA.COM


                                                           BDG 2200 SATELLITE PLACE
Phone:      800-283-2318 Ext. 3574
                                                                                                               Contact Name:   TAMARA WILLIAMS

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 182 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13191       ENCOMPASS PROPERTY & CASUALTY                  CNA CENTER-28TH FLOOR            CHICAGO,              IL 60604     NEIFIA.DORITY@CNA.COM



                                                           333 SO WABASH
Phone:      312-822-4314 Ext.

CNA CLAIMS PLUS                             16-1633560     2435 COMMERCE AVENUE             DULUTH                GA 30096     GASTATEICNUMBERS@CNA.COM


                                                           BDG 2200 SATELLITE PLACE
Phone:      800-283-2318 Ext. 3574
                                                                                                               Contact Name:   TAMARA WILLIAMS

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 183 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13082      EVEREST NATIONAL INSURANCE CO                   477 MARTINSVILLE RD.             LIBERTY CORNER        NJ 07938     LORRAINE.DAY@EVERESTRE.COM



                                                           PO BOX 830
Phone:     800-438-4375 Ext.

CAMBRIDGE INTEGRATED SERVICE                23-2731565     809 GLEN EAGLES COURT            TOWSON                MD 21286     BRIAN.WALSH@US.XCHANGING.COM
GROUP INC

                                                           SUITE 210
Phone:     419-847-6323 Ext.
                                                                                                               Contact Name:   BRIAN WALSH
CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD           POMPANO BEACH         FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:     877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD
CAMBRIDGE INTEGRATED SERVICES               23-2731565     6300 CENTER HILL ROAD            CINCINNATI            OH 45224     NICOLE.DEWITT@US.EXCHANGING.COM
GROUP INC

Phone:     800-235-1134 Ext. 5
                                                                                                               Contact Name:   NICOLE DEWITT
EVEREST NATIONAL INSURANCE                  22-2660372     P O BOX 1620                     ALPHARETTA            GA 30009     CHIP.CRAZE@ESICINSURANCE.COM
COMPANY

Phone:     678-942-2330 Ext.
                                                                                                               Contact Name:   CHIP CRAZE
F A RICHARD (FARA)                          72-0837383     1625 WEST CAUSEWAY               MANDEVILLE            LA 70471     GEORGIA.NOTICES@FARA.COM
                                                           APPROACH

Phone:     985-624-6739 Ext.
                                                                                                               Contact Name:   CHAD RANFLE


Last Updated: Wednesday, June 1, 2011                                             Page 184 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13082      EVEREST NATIONAL INSURANCE CO                   477 MARTINSVILLE RD.             LIBERTY CORNER        NJ 07938     LORRAINE.DAY@EVERESTRE.COM



                                                           PO BOX 830
Phone:     800-438-4375 Ext.

F A RICHARD (FARA)                          72-0837383     7000 EXECUTIVE CENTER            BRENTWOOD             TN 37027     GEORGIA.NOTICES@FARA.COM
                                                           DRIVE

                                                           SUITE 320
Phone:     800-675-2771 Ext. 225
                                                                                                               Contact Name:   KAREN PORTER
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 785071                   ORLANDO               FL 32878     KEITH_LEAHY@GBTPA.COM



Phone:     800-843-8999 Ext.
                                                                                                               Contact Name:   KEITH LEAHY
GALLAGHER BASSETT SERVICES INC              36-3365500     1301 INTERNATIONAL               SUNRISE               FL 33323     ANDREA_HUMPHRIES@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 230
Phone:     800-889-6764 Ext. 201
                                                                                                               Contact Name:   ANDREA HUMPHRIES
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER


Last Updated: Wednesday, June 1, 2011                                             Page 185 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13082      EVEREST NATIONAL INSURANCE CO                   477 MARTINSVILLE RD.             LIBERTY CORNER        NJ 07938     LORRAINE.DAY@EVERESTRE.COM



                                                           PO BOX 830
Phone:     800-438-4375 Ext.

PBOA (PROFESSIONAL BUSINESS                 65-0923856     P O BOX 49468                    SARASOTA              FL 34230     AWARD@PBOA.COM
OWNERS ASSN INC)

Phone:     800-595-2255 Ext.
                                                                                                               Contact Name:   ANITA WARD
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                    NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 14151                    LEXINGTON             KY 40512     DANIELLE.MINNIEHAN@SRSCONNECT.COM



Phone:     800-541-0139 Ext. 35832
                                                                                                               Contact Name:   DANIELLE MINNIEHAN
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKEVIEW                     NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-493-5802 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO


Last Updated: Wednesday, June 1, 2011                                             Page 186 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13082       EVEREST NATIONAL INSURANCE CO                  477 MARTINSVILLE RD.             LIBERTY CORNER        NJ 07938     LORRAINE.DAY@EVERESTRE.COM



                                                           PO BOX 830
Phone:      800-438-4375 Ext.

SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:      800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN

Total # of Active Claim Offices: 16




Last Updated: Wednesday, June 1, 2011                                             Page 187 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13180      EVEREST SECURITY INSURANCE                      925 NORTH POINT                  ALPHARETTA            GA 30005     CHIP.CRAZE@ESICINSURANCE.COM
                                                           PARKWAY

                                                           SUITE 400
Phone:     800-546-7742 Ext.

EVEREST NATIONAL INSURANCE                  22-2660372     477 MARTINSVILLE ROAD            LIBERTY CORNER        NJ 07938     ELENA.BITNER@EVERESTRE.COM



Phone:     800-438-4375 Ext.
                                                                                                               Contact Name:   ELENA BITNER
F A RICHARD (FARA)                          72-0837383     7000 EXECUTIVE CENTER            BRENTWOOD             TN 37027     GEORGIA.NOTICES@FARA.COM
                                                           DRIVE

                                                           SUITE 320
Phone:     800-675-2771 Ext. 225
                                                                                                               Contact Name:   KAREN PORTER
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER




Last Updated: Wednesday, June 1, 2011                                             Page 188 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 4




 SBWC #     Name                            FEIN            Address                                                            Email


12023       EXCELSIOR INSURANCE CO                         62 MAPLE AVENUE                  KEENE                 NH 03431     CORPORATESECRETARY@LIBERTYMUTUAL.COM




Phone:      800-826-6189 Ext.

MONTGOMERY INSURANCE CLAIM                  52-0424870     P O BOX 49130                    CHARLOTTE             NC 28277     CHRISTINE.JONES@MONTGOMERY-INS.COM
CENTER

Phone:      800-334-0078 Ext. 214
                                                                                                               Contact Name:   CHRISTINE JONES

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 189 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13091      EXECUTIVE RISK INDEMNITY INC                    15 MOUNTAIN VIEW ROAD            WARREN                NJ 07061     PREMIUMTAXGROUP@CHUBB.COM




Phone:     908-903-3287 Ext.

CHUBB SERVICES CORPORATION                  22-3096895     3445 PEACHTREE ROAD NE           ATLANTA               GA 30326     KPILZ@CHUBB.COM


                                                           2 LIVE OAK CENTER #900
Phone:     404-266-4855 Ext.
                                                                                                               Contact Name:   KURT PILZ
EXECUTIVE RISK INDEMNITY                    13-2912259     2 LIVE OAK CENTER SUITE 900      ATLANTA               GA 30326     KPILZ@CHUBB.COM


                                                           3445 PEACHTREE ROAD
Phone:     404-266-4127 Ext.
                                                                                                               Contact Name:   KURT PILZ
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO


Last Updated: Wednesday, June 1, 2011                                             Page 190 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 5




 SBWC #     Name                            FEIN            Address                                                            Email


13128       FAIRFIELD INSURANCE COMPANY                    695 EAST MAIN STREET             STAMFORD              CT 06904     DSPRAGUE@GENRE.COM




Phone:      800-431-9994 Ext.

CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR              MAITLAND              FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

Phone:      866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 191 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10214       FAIRMONT PREMIER INSURANCE                     250 COMMERCIAL STREET            MANCHESTER            NH 03101     BRENDA_VAN_HIRTUM@TRG.COM
            COMPANY

                                                           SUITE 5000
Phone:      972-831-5076 Ext.

RISK ENTERPRISE MANAGEMENT                  13-3832689     1140 HAMMOND DR                  ATLANTA               GA 30328     JANET.GREER@REMLTD.COM
LIMITED

                                                           SUITE J-2075
Phone:      800-347-4494 Ext.
                                                                                                               Contact Name:   JANET GREER
RISK ENTERPRISE MANAGEMENT                  13-3832689     565 MARRIOTT DRIVE               NASHVILLE             TN 37214     JANICE.GUIDRY@REMLTD.COM
LIMITED

                                                           SUITE 725
Phone:      800-871-6670 Ext.
                                                                                                               Contact Name:   JANICE GUIDRY
TIG WORK COMP CLAIMS                        -              250 COMMERCIAL STREET            MANCHESTER            NH 03101     BRENDA_VAN_HIRTUM@TRG.COM


                                                           SUITE 5000
Phone:      888-805-9184 Ext.
                                                                                                               Contact Name:   BRENDA VAN HIRTUM

Total # of Active Claim Offices: 3




Last Updated: Wednesday, June 1, 2011                                             Page 192 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10230       FAIRMONT SPECIALTY INSURANCE                   250 COMMERCIAL STREET            MANCHESTER            NH 03101     BRENDA_VAN_HIRTUN@TRG.COM
            COMPANY

                                                           SUITE 5000
Phone:      800-392-1970 Ext.

CNA CLAIMS PLUS                             -              P O BOX 105497                   ATLANTA               GA 30348



Phone:      800-283-2318 Ext.
                                                                                                               Contact Name:   DEE SMITH

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 193 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13009       FARMINGTON CASUALTY COMPANY                    ONE TOWER SQUARE                 HARTFORD              CT 06183     KDAVIS@TRAVELERS.COM




Phone:      860-954-5660 Ext.

FARMINGTON CASUALTY COMPANY                 06-1067463     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           SUITE 100
Phone:      800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
FARMINGTON CASUALTY COMPANY                 06-1067463     10401 HIGHLAND MANOR             TAMPA                 FL 33610     DBRYSON@TRAVELERS.COM
                                                           DRIVE

                                                           BUILDING V SUITE 200
Phone:      888-329-6259 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 194 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13142       FARMLAND MUTUAL INSURANCE                      1100 LOCUST STREET               DES MOINES            IA 50391     LARSENS@NATIONWIDE.COM
            COMPANY

                                                           DEPT 0301
Phone:      515-508-4921 Ext.

NATIONWIDE AGRIBUSINESS                     42-1015537     1100 LOCUST ST.                  DES MOINES            IA 50391     NEWCLAIM@NATIONWIDE.COM


                                                           DEPT 3010
Phone:      800-532-1436 Ext. 4344
                                                                                                               Contact Name:   STEVE LARSEN

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 195 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13153       FCCI INSURANCE COMPANY                         6300 UNIVERSITY PARKWAY          SARASOTA              FL 34240     COMPLIANCEDEPT@FCCI-GROUP.COM




Phone:      800-226-3224 Ext. 3309

FCCI SERVICES                               59-1968027     P O BOX 58004                    SARASOTA              FL 34232     FCCICLAIMSEDI@FCCI-GROUP.COM



Phone:      800-226-3243 Ext. 5729
                                                                                                               Contact Name:   TINA YENNA
FCCI SERVICES INC                           59-1968027     6300 UNIVERSITY                  SARASOTA              FL 34240     FCCICLAIMSEDI@FCCI-GROUP.COM



Phone:      800-226-3243 Ext. 5729
                                                                                                               Contact Name:   TINA YENNA

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 196 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10062      FEDERAL INSURANCE COMPANY                       15 MOUNTAIN VIEW ROAD            WARREN                NJ 07061     PREMIUMTAXGROUP@CHUBB.COM




Phone:     908-903-3287 Ext. 5156

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
FEDERAL INSURANCE COMPANY                   13-1963496     2 LIVE OAK CNTR #900             ATLANTA               GA 30326     KPILZ@CHUBB.COM


                                                           3445 PEACHTREE ROAD
Phone:     404-266-4127 Ext.
                                                                                                               Contact Name:   KURT PILZ
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES
GAB ROBINS NORTH AMERICA INC                13-2747054     9 CAMPUS DIRVE                   PARSIPPANY            NJ 07054     ATLANTAR@GABROBINS.COM


                                                           SUITE 7
Phone:     800-422-4436 Ext.
                                                                                                               Contact Name:   DEWEY BARNES
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PKWY               DULUTH                GA 33622     LASKYM@GABROBINS.COM


                                                           SUITE 900
Phone:     770-823-0997 Ext. 230
                                                                                                               Contact Name:   MICHAEL LASKY


Last Updated: Wednesday, June 1, 2011                                             Page 197 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10062      FEDERAL INSURANCE COMPANY                       15 MOUNTAIN VIEW ROAD            WARREN                NJ 07061     PREMIUMTAXGROUP@CHUBB.COM




Phone:     908-903-3287 Ext. 5156

GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 21227                    TAMPA                 FL 33622     WILLIAM_KIMBROUGH@GBTPA.COM



Phone:     866-428-0283 Ext.
                                                                                                               Contact Name:   WILLIAM KIMBROUGH
GALLAGHER BASSETT SERVICES INC              36-3365500     1301 INTERNATIONAL               SUNRISE               FL 33323     ANDREA_HUMPHRIES@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 230
Phone:     800-889-6764 Ext. 201
                                                                                                               Contact Name:   ANDREA HUMPHRIES
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 4840                     CLEARWATER            FL 33758     KIM_BUCHANAN@GBTPA.COM



Phone:     800-226-8002 Ext.
                                                                                                               Contact Name:   KIM BUCHANAN


Last Updated: Wednesday, June 1, 2011                                             Page 198 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10062      FEDERAL INSURANCE COMPANY                       15 MOUNTAIN VIEW ROAD            WARREN                NJ 07061     PREMIUMTAXGROUP@CHUBB.COM




Phone:     908-903-3287 Ext. 5156

SPECIALTY RISK SERVICES                     20-0730592     P O BOX 60000                    ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM



Phone:     770-901-3121 Ext.
                                                                                                               Contact Name:   MARY D'AGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                    NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:     800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN




Last Updated: Wednesday, June 1, 2011                                             Page 199 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 14




 SBWC #     Name                            FEIN            Address                                                            Email


10064       FEDERATED MUTUAL INS CO                        121 EAST PARK SQUARE             OWATONNA              MN 55060     TLHANEY@FEDINS.COM




Phone:      800-533-0472 Ext.

FEDERATED MUTUAL INSURANCE                  41-0417460     P O BOX 31716                    TAMPA                 FL 33634     CLVOLLENWEIDER@FEDINS.COM
COMPANY

Phone:      800-237-8292 Ext. 8253
                                                                                                               Contact Name:   CHRISTINE VOLLENWEIDER
FEDERATED MUTUAL INSURANCE                  -              20 PERIMETER SUMMIT BLVD         ATLANTA               GA 30319
COMPANY                                                    NE

                                                           SUITE 1900
Phone:      800-241-4945 Ext.
                                                                                                               Contact Name:

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 200 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12059       FEDERATED RURAL ELECTRIC                       PO BOX 15147                     LENEXA                KS 66285
            INSURANCE EXCHANGE



Phone:      800-356-8360 Ext.

CRAWFORD & COMPANY                          58-0506554     P O BOX 5056                     ATLANTA               GA 30302     SHARI_BRANSON@US.CRAWCO.COM



Phone:      404-300-1250 Ext.
                                                                                                               Contact Name:   SHARI BRANSON
CRAWFORD & COMPANY                          58-0506554     P O BOX 41                       GAINESVILLE           GA 30503     GREG_HODSON@US.CRAWCO.COM



Phone:      404-992-3845 Ext.
                                                                                                               Contact Name:   GREG HODSON

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 201 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13130      FEDERATED SERVICE INSURANCE                     121 E PARK SQUARE                OWATONNA              MN 55060     ACKELLY@FEDINS.COM
           COMPANY



Phone:     800-533-0472 Ext.

FEDERATED MUTUAL INSURANCE                  41-0417460     P O BOX 31716                    TAMPA                 FL 33634     CLVOLLENWEIDER@FEDINS.COM
COMPANY

Phone:     800-237-8292 Ext. 8253
                                                                                                               Contact Name:   CHRISTINE VOLLENWEIDER
HARTFORD ACCIDENT & INDEMNITY CO            06-0383030     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD CASUALTY INS CO                    06-0294398     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD CASUALTY INS CO                    06-0294398     300 SOUTH STATE STREET           SYRACUSE              NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                                                                                               ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD FIRE INS CO                        06-0383750     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA


Last Updated: Wednesday, June 1, 2011                                             Page 202 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13130      FEDERATED SERVICE INSURANCE                     121 E PARK SQUARE                OWATONNA              MN 55060     ACKELLY@FEDINS.COM
           COMPANY



Phone:     800-533-0472 Ext.

HARTFORD FIRE INS CO                        06-0383750     300 SOUTH STATE STREET           SYRACUSE              NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                                                                                               ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD INS CO OF THE SE                   06-1013048     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD UNDERWRITERS INS CO                06-1222527     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
PROPERTY & CASUALTY INS CO OF               06-1276326     300 SOUTH STATE STREET           SYRACAUSE             NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
HARTFORD                                                                                                                       ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKEVIEW                     NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-493-5802 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS


Last Updated: Wednesday, June 1, 2011                                             Page 203 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13130       FEDERATED SERVICE INSURANCE                    121 E PARK SQUARE                OWATONNA              MN 55060     ACKELLY@FEDINS.COM
            COMPANY



Phone:      800-533-0472 Ext.

SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:      678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:      800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN
TWIN CITY FIRE INS CO                       06-0732738     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:      407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA

Total # of Active Claim Offices: 13




Last Updated: Wednesday, June 1, 2011                                             Page 204 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13146       FFVA MUTUAL                                    PO BOX 948239                    MAITLAND              FL 32794     ALAN.HAIR@FFVA.COM




Phone:      321-214-5350 Ext.

FFVA MUTUAL CLAIMS                          59-6828087     800 TRAFALGAR COURT              MAITLAND              FL 32751     SHALAGH.MAXWELL@FFVA.COM


                                                           SUITE 200
Phone:      800-346-4825 Ext.
                                                                                                               Contact Name:   SHALAGH MAXWELL

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 205 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13229       FHM INSURANCE COMPANY FKA                      4601 TOUCHTON ROAD               JACKSONVILLE          FL 32246     COO@FHMIC.COM
            FLORIDA HOSPITALITY MUTUAL INS CO              EAST

                                                           SUITE 3150 BUILDING 300
Phone:      800-329-4340 Ext.

UNITED SELF INSURED SERVICES                20-4580645     P O BOX 616648                   ORLANDO               FL 32861     SAM.BOONE@USIS-TPA.COM



Phone:      800-444-9098 Ext. 214
                                                                                                               Contact Name:   LINDA HAMILTON

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 206 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10299      FIDELITY & GUARANTY INSURANCE CO                385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

ALTERNATIVE SERVICE CONCEPTS DBA            43-1954328     3135 AVALON RIDGE PLACE          NORCROSS              GA 30071     SUE.LORANCE@ASCRISK.COM
ASC LLC

                                                           SUITE 650
Phone:     678-447-0200 Ext. 302
                                                                                                               Contact Name:   SUE LORANCE
ALTERNATIVE SERVICE CONCEPTS DBA            43-1954328     3135 AVALON RIDGE PLACE          NORCROSS              GA 30071     SUE.LORANCE@ASCRISK.COM
ASC LLC

                                                           SUITE 650
Phone:     678-447-0200 Ext. 302
                                                                                                               Contact Name:   SUE LORANCE
ALTERNATIVE SERVICE CONCEPTS LLC            43-1954328     3135 AVALON RIDGE PLACE          NORCROSS              GA 30071     SUE.LORANCE@ASCRISK.COM
DBA ASC

                                                           SUITE 650
Phone:     678-447-0200 Ext. 302
                                                                                                               Contact Name:   SUE LORANCE
AS&G CLAIMS ADMINISTRATION                  76-0516648     EDI HEADER ONLY                  NOT A CLAIM           00   77040   WBROWNING@ASG-ADJ.COM
                                                                                            OFFICE

                                                           EDI USE ONLY
Phone:     800-580-2334 Ext.
                                                                                                               Contact Name:   WANDA BROWNING
AS&G CLAIMS ADMINISTRATION INC              76-0516648     125 PARK OF COMMERCE             SAVANNAH              GA 31405     MREVELLE@ASG-ADJ.COM
                                                           DRIVE #B

Phone:     800-580-6912 Ext.
                                                                                                               Contact Name:   MICHELLE REVELLE


Last Updated: Wednesday, June 1, 2011                                             Page 207 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10299      FIDELITY & GUARANTY INSURANCE CO                385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

AVIZENT                                     31-4359765     701 INTERNATIONAL                LAKE MARY             FL 32746     TWELDON@AVIZENTRISK.COM
                                                           PARKWAY

                                                           SUITE 175
Phone:     800-755-1441 Ext.
                                                                                                               Contact Name:   TAMMY WELDON
AVIZENT FKA FRANK GATES SERVICE             31-4359765     THIS IS NOT A CLAIMS             EDI USE ONLY          OH 43017     RKARIKAS@AVIZENTRISK.COM
                                                           OFFICE

Phone:     614-766-8747 Ext.
                                                                                                               Contact Name:   REBECCA KARIKAS
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA            BIRMINGHAM            AL 35209     DMCCLOSKEY@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 29106
                                                                                                               Contact Name:   DAVIDA MCCLOSKEY
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA            BIRMINGHAM            AL 35209     CMULLINS@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 20104
                                                                                                               Contact Name:   CHRISTINA MULLINS
BROADSPIRE CLAIMS                           36-3917295     CALL BOX 30539                   TAMPA                 FL 33630     KRISTIN.CANNELL@CHOOSEBROADSPIRE.COM



Phone:     800-258-1811 Ext.
                                                                                                               Contact Name:   KRISTIN CANNELL


Last Updated: Wednesday, June 1, 2011                                             Page 208 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10299      FIDELITY & GUARANTY INSURANCE CO                385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

BROADSPIRE INC                              36-3917295     P O BOX 926240                   NORCROSS              GA 30010     ATLANTA@CHOOSEBROADSPIRE.COM



Phone:     678-969-7337 Ext.
                                                                                                               Contact Name:   LORRAINE SHRINER
BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
BROADSPIRE SERVICES INC.                    36-3917295     9502 WILLIAMSBURG PLACE          LOUISVILLE            KY 40222     TOM.WEBER@CHOOSEBROADSPIRE.COM


                                                           SUITE 200
Phone:     800-742-4248 Ext.
                                                                                                               Contact Name:   TOM WEBER
CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD           POMPANO BEACH         FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:     877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD
CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR              MAITLAND              FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

Phone:     866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN


Last Updated: Wednesday, June 1, 2011                                             Page 209 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10299      FIDELITY & GUARANTY INSURANCE CO                385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR              MAITLAND              FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

                                                           SUITE 225
Phone:     866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN
COTTINGHAM & BUTLER CLAIM                   20-5233506     P O BOX 28                       DUBUQUE               IA 52004     DUNMACHT@CBCSCLAIMS.COM
SERVICES

Phone:     877-241-6121 Ext.
                                                                                                               Contact Name:   DAN UNMACHT
COTTINGHAM AND BUTLER CLAIM                 20-5233506     P O BOX 28                       DUBUQUE               IA 52004     DUNMACHT@CBCSCLAIMS.COM
SERVICES

Phone:     877-241-6121 Ext.
                                                                                                               Contact Name:   DAN UNMACHT
DISCOVER RE MANAGERS INC.                   06-1288492     5 BATTERSON PARK                 FARMINGTON            CT 06032     EDOUGLAS@DISCOVER-RE.COM



Phone:     866-657-2827 Ext.
                                                                                                               Contact Name:   ERIKA DOUGLAS
ESIS                                        95-2008390     500 COLONIAL CENTER              ROSWELL               GA 30076     MARK.IRWIN@ESIS.COM
                                                           PARKWAY

                                                           SUITE 200
Phone:     678-795-4500 Ext.
                                                                                                               Contact Name:   MARK G IRWIN


Last Updated: Wednesday, June 1, 2011                                             Page 210 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10299      FIDELITY & GUARANTY INSURANCE CO                385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

ESIS INC                                    95-2008390     500 COLONIAL PARKWAY             ROSWELL               GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
FIDELITY & GUARANTY INSURANCE               42-1091525     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
COMPANY                                                    CONCOURSE

                                                           SUITE 100
Phone:     800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
FIDELITY & GUARANTY INSURANCE               43-1091525     1000 FIANA WAY                   FT SMITH              AR 72919     MJWHITE@TRAVELERS.COM
COMPANY

Phone:     800-842-5612 Ext. 4611
                                                                                                               Contact Name:   MELISSA WHITE
FIDELITY & GUARANTY INSURANCE               42-1091525     11440 CARMEL COMMONS             CHARLOTTE             NC 28226     MWLANE@TRAVELERS.COM
COMPANY                                                    BLVD

Phone:     800-759-6194 Ext. 3298
                                                                                                               Contact Name:   MELISSA LANE
FIDELITY & GUARANTY INSURANCE               42-1091525     6640 CAROTHERS PARKWAY           FRANKLIN              TN 37067     LCRAFT@TRAVELERS.COM
COMPANY

                                                           SUITE 300
Phone:     615-660-6258 Ext.
                                                                                                               Contact Name:   LUCIE CRAFT


Last Updated: Wednesday, June 1, 2011                                             Page 211 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10299      FIDELITY & GUARANTY INSURANCE CO                385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

FIDELITY & GUARANTY INSURANCE               42-1091525     2420 LAKEMONT AVENUE             ORLANDO               FL 32814     PYOAKUM@TRAVELERS.COM
COMPANY

Phone:     407-388-2587 Ext.
                                                                                                               Contact Name:   PAULA YOAKUM
FIDELITY & GUARANTY INSURANCE               42-1091525     10401 HIGHLAND MANOR             TAMPA                 FL 33610     DBRYSON@TRAVELERS.COM
COMPANY                                                    DRIVE

                                                           BUILDING V SUITE 200
Phone:     888-329-6259 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON
FIDELITY & GUARANTY INSURANCE               52-0616768     2420 LAKEMONT AVENUE             ORLANDO               FL 32814     PYOAKUM@TRAVELERS.COM
UNDERWRITERS INC

Phone:     470-388-2587 Ext.
                                                                                                               Contact Name:   PAULA YOAKUM
FIDELITY & GUARANTY INSURANCE               52-0616768     6640 CAROTHERS PARKWAY           FRANKLIN              TN 37067     LCRAFT@TRAVELERS.COM
UNDERWRITERS INC

                                                           SUITE 300
Phone:     615-660-6258 Ext.
                                                                                                               Contact Name:   LUCIE CRAFT
FIDELITY & GUARANTY INSURANCE               52-0616768     10401 HIGHLAND MANOR             TAMPA                 FL 33610     DBRYSON@TRAVELERS.COM
UNDERWRITERS INC                                           DRIVE

                                                           BUILDING V SUITE 200
Phone:     888-329-6259 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON


Last Updated: Wednesday, June 1, 2011                                             Page 212 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10299      FIDELITY & GUARANTY INSURANCE CO                385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

FIDELITY & GUARANTY INSURANCE               52-0616768     11440 CARMEL COMMONS             CHARLOTTE             NC 28226     MWLANE@TRAVELERS.COM
UNDERWRITERS INC                                           BLVD

Phone:     800-759-6194 Ext. 3298
                                                                                                               Contact Name:   MELISSA LANE
FIDELITY & GUARANTY INSURANCE               52-0616768     1000 FIANA WAY                   FT SMITH              AR 72919     MJWHITE@TRAVELERS.COM
UNDERWRITERS INC

Phone:     800-842-5612 Ext. 4611
                                                                                                               Contact Name:   MELISSA WHITE
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 292109                   NASHVILLE             TN 37229     GALE_LESIEUR@GBTPA.COM



Phone:     800-288-9843 Ext. 201
                                                                                                               Contact Name:   GALE LESIEUR
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI


Last Updated: Wednesday, June 1, 2011                                             Page 213 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10299      FIDELITY & GUARANTY INSURANCE CO                385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     2600 MCCORMICK DR #110           CLEARWATER            FL 33758     CANDICE_BUCHANAN@GBTPA.COM


                                                           ONE PRESTIGE PLACE
Phone:     800-226-8002 Ext.
                                                                                                               Contact Name:   CANDICE BUCHANAN
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 21227                    TAMPA                 FL 33622     WILLIAM_KIMBROUGH@GBTPA.COM



Phone:     866-428-0283 Ext.
                                                                                                               Contact Name:   WILLIAM KIMBROUGH
GALLAGHER BASSETT SERVICES INC              36-3365500     601 VESTAVIA PARKWAY             BIRMINGHAM            AL 35266     CHRIS_ROCK@GBTPA.COM


                                                           SUITE 251
Phone:     800-762-3486 Ext.
                                                                                                               Contact Name:   CHRIS ROCK
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 785071                   ORLANDO               FL 32878     KEITH_LEAHY@GBTPA.COM



Phone:     800-843-8999 Ext.
                                                                                                               Contact Name:   KEITH LEAHY
GALLAGHER BASSETT SERVICES INC              36-3365500     1301 INTERNATIONAL               SUNRISE               FL 33323     ANDREA_HUMPHRIES@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 230
Phone:     800-889-6764 Ext. 201
                                                                                                               Contact Name:   ANDREA HUMPHRIES


Last Updated: Wednesday, June 1, 2011                                             Page 214 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10299      FIDELITY & GUARANTY INSURANCE CO                385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
GATES MCDONALD                              31-4187660     P O BOX 945150                   MAITLAND              FL 32794



Phone:     407-916-8580 Ext.
                                                                                                               Contact Name:   DANA ELYARD
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 31204                    TAMPA                 FL 33618     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   CHARLES HUNNELL
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 49000                    CHARLOTTE             NC 28277     CMC550CHARLOTTE2@LIBERTYMUTUAL.COM



Phone:     800-532-7706 Ext.
                                                                                                               Contact Name:   ANGELA EVANS
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 31204                    TAMPA                 FL 33631     HEATHER.STANFORD@LIBERTYMUTUAL.COM
LLC

Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   HEATHER STANFORD


Last Updated: Wednesday, June 1, 2011                                             Page 215 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10299      FIDELITY & GUARANTY INSURANCE CO                385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

MATRIX ABSENCE MANAGEMENT                   77-0493584     P O BOX 10156                    WILMINGTON            NC 28404     GEORGIAWORKERSCOMPENSATION@MATRIXCO
                                                                                                                               S.COM

Phone:     800-896-3079 Ext.
                                                                                                               Contact Name:   ANDREA DULEY
MATRIX ABSENCE MANAGEMENT                   77-0493584     P O BOX 1479                     OWING MILLS           MD 21117     GEORGIAWORKERSCOMPENSATION@MATRIXCO
                                                                                                                               S.COM

Phone:     866-654-4001 Ext.
                                                                                                               Contact Name:   MICHELLE WOODSON
MATRIX ABSENCE MANAGEMENT                   77-0493584     P O BOX 3448                     PLANT CITY            FL 33563     GEORGIAWORKERSCOMPENSATION@MATRIXCO
                                                                                                                               S.COM

Phone:     888-878-0005 Ext.
                                                                                                               Contact Name:   KIMBERLY SMITH
MATRIX ABSENCE MANAGEMENT                   77-0493584     11221 N 28TH DRIVE               PHONEIX               AZ 85029     EDICOORDINATOR@MATRIXCOS.COM


                                                           E-100
Phone:     800-866-2301 Ext.
                                                                                                               Contact Name:   RAQUEL GARCIA
MATRIX ABSENCE MANAGEMENT                   77-0493584     P O BOX 1468                     SAN JOSE              CA 95109     GEORGIAWORKERSCOMPENSATION@MATRIXCO
                                                                                                                               S.COM

Phone:     888-878-0005 Ext.
                                                                                                               Contact Name:   RENATA MCCOOMER


Last Updated: Wednesday, June 1, 2011                                             Page 216 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10299      FIDELITY & GUARANTY INSURANCE CO                385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

PMA MANAGEMENT CORPORATION                  23-2652239     1100 ABERNATHY ROAD NE           ATLANTA               GA 30328     ADOLPHUS_DRAIN@PMAGROUP.COM


                                                           SUITE 650 500 NORTH PARK TOWN CENTER
Phone:     888-888-8136 Ext.
                                                                                                               Contact Name:   ADOLPHUS DRAIN
RISK ENTERPRISE MANAGEMENT                  13-3832689     1140 HAMMOND DR                  ATLANTA               GA 30328     JANET.GREER@REMLTD.COM
LIMITED

                                                           SUITE J-2075
Phone:     800-347-4494 Ext.
                                                                                                               Contact Name:   JANET GREER
RISK ENTERPRISE MANAGEMENT                  13-3832689     565 MARRIOTT DRIVE               NASHVILLE             TN 37214     JANICE.GUIDRY@REMLTD.COM
LIMITED

                                                           SUITE 725
Phone:     800-871-6670 Ext.
                                                                                                               Contact Name:   JANICE GUIDRY
RISK ENTERPRISES MANAGEMENT                 13-3832689     565 MARRIOTT DRIVE               NASHVILLE             TN 37214     JANICE.GUIDRY@REMLTD.COM
LIMITED

                                                           SUITE 725
Phone:     800-871-6670 Ext.
                                                                                                               Contact Name:   JANICE GUIDRY
SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER            ATLANTA               GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN


Last Updated: Wednesday, June 1, 2011                                             Page 217 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10299      FIDELITY & GUARANTY INSURANCE CO                385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

SEDGWICK CMS                                36-2685608     255 PRIMERA BLVD                 LAKE MARY             FL 32746     GASTATEBOARDINBOX@SEDGWICKCMS.COM


                                                           SUITE 400
Phone:     800-548-1373 Ext.
                                                                                                               Contact Name:   GEORGE CINTRON
SEDGWICK CMS                                36-2685608     5260 PARKWAY PLAZA BLVD          CHARLOTTE             NC 28217     MYRA.NORMAN@SEDGWICKCMS.COM


                                                           SUITE 190
Phone:     800-822-4469 Ext.
                                                                                                               Contact Name:   MYRA NORMAN
SEDGWICK CMS                                36-2685608     1100 RIDGEWAY LOOP ROAD          MEMPHIS               TN 38120     APULLEN@SEDGWICKCMS.COM



Phone:     241-922-0638 Ext.
                                                                                                               Contact Name:   ANTHONY PULLEN
SEDGWICK CMS                                36-2685608     5260 PARKWAY PLAZA BLVD          CHARLOTTE             NC 28217     MYRA.NORMAN@SEGWICKCMS.COM


                                                           SUITE 190
Phone:     800-822-4469 Ext.
                                                                                                               Contact Name:   MYRA NORMAN
SENTRY INSURANCE A MUTUAL                   39-0333950     P O BOX 26263                    RICHMOND              VA 23260     WCCLAIMSEAST@SENTRY.COM
COMPANY

Phone:     800-338-2487 Ext. 4616
                                                                                                               Contact Name:   TIM O'BRIEN


Last Updated: Wednesday, June 1, 2011                                             Page 218 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10299      FIDELITY & GUARANTY INSURANCE CO                385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM




Phone:     800-328-2189 Ext.

SPECIALTY RISK SERVICES                     20-0730592     P O BOX 60000                    ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM



Phone:     770-901-3121 Ext.
                                                                                                               Contact Name:   MARY D'AGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                    NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 14151                    LEXINGTON             KY 40512     DANIELLE.MINNIEHAN@SRSCONNECT.COM



Phone:     800-541-0139 Ext. 35832
                                                                                                               Contact Name:   DANIELLE MINNIEHAN
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
UNITED SELF INSURED SERVICES                20-4580645     P O BOX 616648                   ORLANDO               FL 32861     SAM.BOONE@USIS-TPA.COM



Phone:     800-444-9098 Ext. 214
                                                                                                               Contact Name:   LINDA HAMILTON


Last Updated: Wednesday, June 1, 2011                                             Page 219 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 65




Last Updated: Wednesday, June 1, 2011                                             Page 220 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10257      FIDELITY AND DEPOSIT CO OF                      1400 AMERICAN LANE               SCHAUMBURG            IL 60196     TIM.GRAHAM@ZURICHNA.COM
           MARYLAND



Phone:     800-340-8602 Ext. 8613

FIDELITY AND DEPOSIT COMPANY OF             13-3046577     3003 SUMMIT BLVD                 ATLANTA               GA 30319     CHRIS.CALLOWAY@ZURICHNA.COM
MARYLAND

                                                           SUITE 1800
Phone:     404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY
FIDELITY AND DEPOSIT COMPANY OF             13-3046577     1900 SUMMIT TOWER BLVD           ORLANDO               FL 32810     CHRIS.CALLOWAY@ZURICHNA.COM
MARYLAND

                                                           SUITE 600
Phone:     404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY
ZURICH SERVICES CORP                        36-3839542     3003 SUMMIT BLVD                 ATLANTA               GA 30319     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM


                                                           STE 1800
Phone:     404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY
ZURICH SERVICES CORPORATION                 36-3839542     1001 SUMMIT BLVD                 ATLANTA               GA 30319     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM


                                                           SUITE 800
Phone:     404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY




Last Updated: Wednesday, June 1, 2011                                             Page 221 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 4




Last Updated: Wednesday, June 1, 2011                                             Page 222 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10197      FIDELITY AND GUARANTY                           385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM
           UNDERWRITERS INSURANCE



Phone:     800-328-2189 Ext.

ALTERNATIVE SERVICE CONCEPTS DBA            43-1954328     3135 AVALON RIDGE PLACE          NORCROSS              GA 30071     SUE.LORANCE@ASCRISK.COM
ASC LLC

                                                           SUITE 650
Phone:     678-447-0200 Ext. 302
                                                                                                               Contact Name:   SUE LORANCE
ALTERNATIVE SERVICE CONCEPTS DBA            43-1954328     3135 AVALON RIDGE PLACE          NORCROSS              GA 30071     SUE.LORANCE@ASCRISK.COM
ASC LLC

                                                           SUITE 650
Phone:     678-447-0200 Ext. 302
                                                                                                               Contact Name:   SUE LORANCE
AS&G CLAIMS ADMINISTRATION                  76-0516648     EDI HEADER ONLY                  NOT A CLAIM           00   77040   WBROWNING@ASG-ADJ.COM
                                                                                            OFFICE

                                                           EDI USE ONLY
Phone:     800-580-2334 Ext.
                                                                                                               Contact Name:   WANDA BROWNING
AS&G CLAIMS ADMINISTRATION INC              76-0516648     125 PARK OF COMMERCE             SAVANNAH              GA 31405     MREVELLE@ASG-ADJ.COM
                                                           DRIVE #B

Phone:     800-580-6912 Ext.
                                                                                                               Contact Name:   MICHELLE REVELLE
AVIZENT                                     31-4359765     701 INTERNATIONAL                LAKE MARY             FL 32746     TWELDON@AVIZENTRISK.COM
                                                           PARKWAY

                                                           SUITE 175
Phone:     800-755-1441 Ext.
                                                                                                               Contact Name:   TAMMY WELDON


Last Updated: Wednesday, June 1, 2011                                             Page 223 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10197      FIDELITY AND GUARANTY                           385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM
           UNDERWRITERS INSURANCE



Phone:     800-328-2189 Ext.

AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA            BIRMINGHAM            AL 35209     DMCCLOSKEY@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 29106
                                                                                                               Contact Name:   DAVIDA MCCLOSKEY
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA            BIRMINGHAM            AL 35209     CMULLINS@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 20104
                                                                                                               Contact Name:   CHRISTINA MULLINS
BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD           POMPANO BEACH         FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:     877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD
CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR              MAITLAND              FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

Phone:     866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN


Last Updated: Wednesday, June 1, 2011                                             Page 224 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10197      FIDELITY AND GUARANTY                           385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM
           UNDERWRITERS INSURANCE



Phone:     800-328-2189 Ext.

CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR              MAITLAND              FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

                                                           SUITE 225
Phone:     866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN
COTTINGHAM & BUTLER CLAIM                   20-5233506     P O BOX 28                       DUBUQUE               IA 52004     DUNMACHT@CBCSCLAIMS.COM
SERVICES

Phone:     877-241-6121 Ext.
                                                                                                               Contact Name:   DAN UNMACHT
COTTINGHAM AND BUTLER CLAIM                 20-5233506     P O BOX 28                       DUBUQUE               IA 52004     DUNMACHT@CBCSCLAIMS.COM
SERVICES

Phone:     877-241-6121 Ext.
                                                                                                               Contact Name:   DAN UNMACHT
ESIS                                        95-2008390     500 COLONIAL CENTER              ROSWELL               GA 30076     MARK.IRWIN@ESIS.COM
                                                           PARKWAY

                                                           SUITE 200
Phone:     678-795-4500 Ext.
                                                                                                               Contact Name:   MARK G IRWIN
ESIS INC                                    95-2008390     500 COLONIAL PARKWAY             ROSWELL               GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN


Last Updated: Wednesday, June 1, 2011                                             Page 225 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10197      FIDELITY AND GUARANTY                           385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM
           UNDERWRITERS INSURANCE



Phone:     800-328-2189 Ext.

FIDELITY & GUARANTY INSURANCE               42-1091525     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
COMPANY                                                    CONCOURSE

                                                           SUITE 100
Phone:     800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
FIDELITY & GUARANTY INSURANCE               43-1091525     1000 FIANA WAY                   FT SMITH              AR 72919     MJWHITE@TRAVELERS.COM
COMPANY

Phone:     800-842-5612 Ext. 4611
                                                                                                               Contact Name:   MELISSA WHITE
FIDELITY & GUARANTY INSURANCE               42-1091525     11440 CARMEL COMMONS             CHARLOTTE             NC 28226     MWLANE@TRAVELERS.COM
COMPANY                                                    BLVD

Phone:     800-759-6194 Ext. 3298
                                                                                                               Contact Name:   MELISSA LANE
FIDELITY & GUARANTY INSURANCE               42-1091525     2420 LAKEMONT AVENUE             ORLANDO               FL 32814     PYOAKUM@TRAVELERS.COM
COMPANY

Phone:     407-388-2587 Ext.
                                                                                                               Contact Name:   PAULA YOAKUM
FIDELITY & GUARANTY INSURANCE               52-0616768     2420 LAKEMONT AVENUE             ORLANDO               FL 32814     PYOAKUM@TRAVELERS.COM
UNDERWRITERS INC

Phone:     470-388-2587 Ext.
                                                                                                               Contact Name:   PAULA YOAKUM


Last Updated: Wednesday, June 1, 2011                                             Page 226 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10197      FIDELITY AND GUARANTY                           385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM
           UNDERWRITERS INSURANCE



Phone:     800-328-2189 Ext.

FIDELITY & GUARANTY INSURANCE               52-0616768     6640 CAROTHERS PARKWAY           FRANKLIN              TN 37067     LCRAFT@TRAVELERS.COM
UNDERWRITERS INC

                                                           SUITE 300
Phone:     615-660-6258 Ext.
                                                                                                               Contact Name:   LUCIE CRAFT
FIDELITY & GUARANTY INSURANCE               52-0616768     10401 HIGHLAND MANOR             TAMPA                 FL 33610     DBRYSON@TRAVELERS.COM
UNDERWRITERS INC                                           DRIVE

                                                           BUILDING V SUITE 200
Phone:     888-329-6259 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON
FIDELITY & GUARANTY INSURANCE               52-0616768     11440 CARMEL COMMONS             CHARLOTTE             NC 28226     MWLANE@TRAVELERS.COM
UNDERWRITERS INC                                           BLVD

Phone:     800-759-6194 Ext. 3298
                                                                                                               Contact Name:   MELISSA LANE
FIDELITY & GUARANTY INSURANCE               52-0616768     1000 FIANA WAY                   FT SMITH              AR 72919     MJWHITE@TRAVELERS.COM
UNDERWRITERS INC

Phone:     800-842-5612 Ext. 4611
                                                                                                               Contact Name:   MELISSA WHITE
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES


Last Updated: Wednesday, June 1, 2011                                             Page 227 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10197      FIDELITY AND GUARANTY                           385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM
           UNDERWRITERS INSURANCE



Phone:     800-328-2189 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 292109                   NASHVILLE             TN 37229     GALE_LESIEUR@GBTPA.COM



Phone:     800-288-9843 Ext. 201
                                                                                                               Contact Name:   GALE LESIEUR
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 21227                    TAMPA                 FL 33622     WILLIAM_KIMBROUGH@GBTPA.COM



Phone:     866-428-0283 Ext.
                                                                                                               Contact Name:   WILLIAM KIMBROUGH
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 785071                   ORLANDO               FL 32878     KEITH_LEAHY@GBTPA.COM



Phone:     800-843-8999 Ext.
                                                                                                               Contact Name:   KEITH LEAHY
GALLAGHER BASSETT SERVICES INC              36-3365500     1301 INTERNATIONAL               SUNRISE               FL 33323     ANDREA_HUMPHRIES@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 230
Phone:     800-889-6764 Ext. 201
                                                                                                               Contact Name:   ANDREA HUMPHRIES


Last Updated: Wednesday, June 1, 2011                                             Page 228 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10197      FIDELITY AND GUARANTY                           385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM
           UNDERWRITERS INSURANCE



Phone:     800-328-2189 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 31204                    TAMPA                 FL 33618     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   CHARLES HUNNELL
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 31204                    TAMPA                 FL 33631     HEATHER.STANFORD@LIBERTYMUTUAL.COM
LLC

Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   HEATHER STANFORD
MATRIX ABSENCE MANAGEMENT                   77-0493584     P O BOX 10156                    WILMINGTON            NC 28404     GEORGIAWORKERSCOMPENSATION@MATRIXCO
                                                                                                                               S.COM

Phone:     800-896-3079 Ext.
                                                                                                               Contact Name:   ANDREA DULEY
MATRIX ABSENCE MANAGEMENT                   77-0493584     P O BOX 1479                     OWING MILLS           MD 21117     GEORGIAWORKERSCOMPENSATION@MATRIXCO
                                                                                                                               S.COM

Phone:     866-654-4001 Ext.
                                                                                                               Contact Name:   MICHELLE WOODSON


Last Updated: Wednesday, June 1, 2011                                             Page 229 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10197      FIDELITY AND GUARANTY                           385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM
           UNDERWRITERS INSURANCE



Phone:     800-328-2189 Ext.

MATRIX ABSENCE MANAGEMENT                   77-0493584     P O BOX 3448                     PLANT CITY            FL 33563     GEORGIAWORKERSCOMPENSATION@MATRIXCO
                                                                                                                               S.COM

Phone:     888-878-0005 Ext.
                                                                                                               Contact Name:   KIMBERLY SMITH
MATRIX ABSENCE MANAGEMENT                   77-0493584     11221 N 28TH DRIVE               PHONEIX               AZ 85029     EDICOORDINATOR@MATRIXCOS.COM


                                                           E-100
Phone:     800-866-2301 Ext.
                                                                                                               Contact Name:   RAQUEL GARCIA
MATRIX ABSENCE MANAGEMENT                   77-0493584     P O BOX 1468                     SAN JOSE              CA 95109     GEORGIAWORKERSCOMPENSATION@MATRIXCO
                                                                                                                               S.COM

Phone:     888-878-0005 Ext.
                                                                                                               Contact Name:   RENATA MCCOOMER
PMA MANAGEMENT CORPORATION                  23-2652239     1100 ABERNATHY ROAD NE           ATLANTA               GA 30328     ADOLPHUS_DRAIN@PMAGROUP.COM


                                                           SUITE 650 500 NORTH PARK TOWN CENTER
Phone:     888-888-8136 Ext.
                                                                                                               Contact Name:   ADOLPHUS DRAIN
RISK ENTERPRISE MANAGEMENT                  13-3832689     1140 HAMMOND DR                  ATLANTA               GA 30328     JANET.GREER@REMLTD.COM
LIMITED

                                                           SUITE J-2075
Phone:     800-347-4494 Ext.
                                                                                                               Contact Name:   JANET GREER


Last Updated: Wednesday, June 1, 2011                                             Page 230 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10197      FIDELITY AND GUARANTY                           385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM
           UNDERWRITERS INSURANCE



Phone:     800-328-2189 Ext.

RISK ENTERPRISE MANAGEMENT                  13-3832689     565 MARRIOTT DRIVE               NASHVILLE             TN 37214     JANICE.GUIDRY@REMLTD.COM
LIMITED

                                                           SUITE 725
Phone:     800-871-6670 Ext.
                                                                                                               Contact Name:   JANICE GUIDRY
SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER            ATLANTA               GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN
SEDGWICK CMS                                36-2685608     5260 PARKWAY PLAZA BLVD          CHARLOTTE             NC 28217     MYRA.NORMAN@SEDGWICKCMS.COM


                                                           SUITE 190
Phone:     800-822-4469 Ext.
                                                                                                               Contact Name:   MYRA NORMAN
SENTRY INSURANCE A MUTUAL                   39-0333950     P O BOX 26263                    RICHMOND              VA 23260     WCCLAIMSEAST@SENTRY.COM
COMPANY

Phone:     800-338-2487 Ext. 4616
                                                                                                               Contact Name:   TIM O'BRIEN
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 60000                    ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM



Phone:     770-901-3121 Ext.
                                                                                                               Contact Name:   MARY D'AGOSTINO


Last Updated: Wednesday, June 1, 2011                                             Page 231 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10197       FIDELITY AND GUARANTY                          385 WASHINGTON STREET            ST PAUL               MN 55102     CURBANIA@TRAVELERS.COM
            UNDERWRITERS INSURANCE



Phone:      800-328-2189 Ext.

SPECIALTY RISK SERVICES                     20-0730592     10735 DAVID TAYLOR DRIVE         CHARLOTTE             NC 28262     JENNIFER.REEVE@SRSCONNECT.COM


                                                           SUITE 400
Phone:      877-300-6187 Ext.
                                                                                                               Contact Name:   JENNFER REEVE
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 14151                    LEXINGTON             KY 40512     DANIELLE.MINNIEHAN@SRSCONNECT.COM



Phone:      800-541-0139 Ext. 35832
                                                                                                               Contact Name:   DANIELLE MINNIEHAN
UNITED SELF INSURED SERVICES                20-4580645     P O BOX 616648                   ORLANDO               FL 32861     SAM.BOONE@USIS-TPA.COM



Phone:      800-444-9098 Ext. 214
                                                                                                               Contact Name:   LINDA HAMILTON

Total # of Active Claim Offices: 48




Last Updated: Wednesday, June 1, 2011                                             Page 232 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10067       FIREMAN'S FUND INS CO                          777 SAN MARIN DRIVE              NOVATO                CA 94998     ESAYERS@FFIC.COM




Phone:      800-227-1700 Ext.

FIREMAN'S FUND CLAIMS CENTER                58-1373156     P O BOX 740174                   ATLANTA               GA 30374     KLOCKE@FFIC.COM



Phone:      678-393-4550 Ext.
                                                                                                               Contact Name:   KEN LOCKE
FIREMAN'S FUND INSURANCE CO                 94-1610280     11475 GREAT OAKS WAY             ALPHARETTA            GA 30022     JUDY.OWEN@AFFIC.COM


                                                           ROYAL CTR 3 STE 200
Phone:      678-393-4584 Ext.
                                                                                                               Contact Name:   JUDY OWEN

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 233 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12029       FIREMAN'S FUND INSURANCE CO OF                 777 SAN MARINE DR                NOVATO                CA 94998
            GEORGIA



Phone:      800-227-1700 Ext.

FIREMAN'S FUND CLAIMS CENTER                58-1373156     P O BOX 740174                   ATLANTA               GA 30374     KLOCKE@FFIC.COM



Phone:      678-393-4550 Ext.
                                                                                                               Contact Name:   KEN LOCKE

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 234 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13066      FIRST LIBERTY INSURANCE                         175 BERKELEY STREET              BOSTON                MA 02116     CORPORATESECRETARY@LIBERTYMUTUAL.COM
           CORPORATION



Phone:     800-344-0197 Ext.

FIRST LIBERTY INSURANCE                     04-3058503     P O BOX 49000                    CHARLOTTE             NC 28277     CMC550CHARLOTE2@LIBERTYMUTUAL.COM
CORPORATION

Phone:     800-532-7706 Ext.
                                                                                                               Contact Name:   STEVEN SHORE
FIRST LIBERTY INSURANCE                     04-3058503     P O BOX 31204                    TAMPA                 FL 33631     CMC555TAMPA@LIBERTYMUTUAL.COM
CORPORATION

Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   DAVID KLOSSNER
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 31204                    TAMPA                 FL 33618     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   CHARLES HUNNELL
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 49000                    CHARLOTTE             NC 28277     CMC550CHARLOTTE2@LIBERTYMUTUAL.COM



Phone:     800-532-7706 Ext.
                                                                                                               Contact Name:   ANGELA EVANS
LIBERTY INSURANCE CORPORATION               03-0316876     P O BOX 31204                    TAMPA                 FL 33631     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   DAVID KLOSSNER


Last Updated: Wednesday, June 1, 2011                                             Page 235 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13066       FIRST LIBERTY INSURANCE                        175 BERKELEY STREET              BOSTON                MA 02116     CORPORATESECRETARY@LIBERTYMUTUAL.COM
            CORPORATION



Phone:      800-344-0197 Ext.

LIBERTY MUTUAL FIRE INSURANCE               04-1924000     P O BOX 31204                    TAMPA                 FL 33631     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:      800-282-6218 Ext.
                                                                                                               Contact Name:   DAVID KLOSSNER
LIBERTY MUTUAL GROUP                        04-1543470     P O BOX 31204                    TAMPA                 FL 33631     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:      800-282-6218 Ext.
                                                                                                               Contact Name:   DAVID KLOSSNER

Total # of Active Claim Offices: 7




Last Updated: Wednesday, June 1, 2011                                             Page 236 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10292       FIRST NATIONAL INSURANCE COMPANY               SAFECO PLAZA                     SEATTLE               WA 98154     CORPORATESCRETARY@LIBERTYMUTUAL.COM
            OF AMERICA

                                                           1901 FOURTH AVENUE
Phone:      206-675-3609 Ext.

SAFECO                                      91-0742148     2055 SUGARLOAF CIRCLE            DULUTH                GA 30097     MARPOO@SAFECO.COM


                                                           SAFECO PLAZA
Phone:      678-417-3654 Ext.
                                                                                                               Contact Name:   MARLENA POOL

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 237 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13174      FLORISTS INSURANCE COMPANY                      P O BOX 428                      EDWARDSVILLE          IL 62025     LTUCKER@HORTICA-INSURANCE.COM




Phone:     800-851-7740 Ext.

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
CRAWFORD & COMPANY                          58-0506554     160-3130 SUGARLOAF               LAWRENCEVILLE         GA 30045     SHARI_BRANSON@CRAWCO.COM
                                                           PARKWAY

                                                           SUITE 1100
Phone:     678-377-5654 Ext.
                                                                                                               Contact Name:   SHARI BRANSON
CRAWFORD & COMPANY                          58-0506554     1001 SUMMIT BLVD                 ATLANTA               GA 30319     ATLANTA.GA@US.CRAWCO.COM



Phone:     -- Ext.
                                                                                                               Contact Name:   STUART TUCKER
HORTICA                                     -              5840A SOUTH SEMORAN              ORLANDO               FL 32822     BKEMP@HORTICA-INSURANCE.COM
                                                           BLVD

Phone:     800-566-5458 Ext.
                                                                                                               Contact Name:




Last Updated: Wednesday, June 1, 2011                                             Page 238 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 4




Last Updated: Wednesday, June 1, 2011                                             Page 239 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10259      FLORISTS MUTUAL INSURANCE                       PO BOX 428                       EDWARDSVILLE          IL 62025     LTUCKER@HORTICA-INSURANCE.COM
           COMPANY



Phone:     800-851-7740 Ext.

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
CRAWFORD & COMPANY                          58-0506554     160-3130 SUGARLOAF               LAWRENCEVILLE         GA 30045     SHARI_BRANSON@CRAWCO.COM
                                                           PARKWAY

                                                           SUITE 1100
Phone:     678-377-5654 Ext.
                                                                                                               Contact Name:   SHARI BRANSON
CRAWFORD & COMPANY                          58-0506554     1001 SUMMIT BLVD                 ATLANTA               GA 30319     ATLANTA.GA@US.CRAWCO.COM



Phone:     -- Ext.
                                                                                                               Contact Name:   STUART TUCKER
HORTICA                                     -              5840A SOUTH SEMORAN              ORLANDO               FL 32822     BKEMP@HORTICA-INSURANCE.COM
                                                           BLVD

Phone:     800-566-5458 Ext.
                                                                                                               Contact Name:




Last Updated: Wednesday, June 1, 2011                                             Page 240 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 4




 SBWC #     Name                            FEIN            Address                                                            Email


13259       FRANK WINSTON CRUM INSURANCE INC               100 SOUTH MISSOURI               CLEARWATER            FL 33756     BRIGITTEB@FWCRUMINSURANCE.COM
                                                           AVENUE



Phone:      -- Ext.

BROADSPIRE CLAIMS                           36-3917295     CALL BOX 30539                   TAMPA                 FL 33630     KRISTIN.CANNELL@CHOOSEBROADSPIRE.COM



Phone:      800-258-1811 Ext.
                                                                                                               Contact Name:   KRISTIN CANNELL

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 241 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13164       FRANKENMUTH MUTUAL INS.                        ONE MUTUAL AVENUE                FRANKENMUTH           MI 48787     JOHN.BENSON@FMINS.COM




Phone:      800-234-4433 Ext. 2914

ANSUR AMERICA INSURANCE COMPANY             38-3467437     ONE MUTUAL AVENUE                FRANKENMUTH           MI 48787     SUZANNE.COWAN@FMINS.COM



Phone:      800-234-1133 Ext.
                                                                                                               Contact Name:   SUZANNE COWAN
FRANKENMUTH MUTUAL INSURANCE                38-0555290     ONE MUTUAL AVE.                  FRANKENMUTH           MI 48787     SUZANNE.COWAN@FMINS.COM
COMPANY

Phone:      800-234-1122 Ext.
                                                                                                               Contact Name:   SUZANNE COWAN

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 242 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13264       GATEWAY INSURANCE COMPANY                      1401 S. BRENTWOOD BLVD           ST LOUIS              MO 63144     LWARD@GICAUTO.COM




Phone:      -- Ext.

GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:      770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 243 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10213       GENERAL ACCIDENT INSURANCE CO                  ONE BEACON STREET                BOSTON                MA 02108




Phone:      617-725-6000 Ext.

MONTGOMERY INSURANCE                        -              3555 KOGER BLVD.                 DULUTH                GA 30096



Phone:      800-762-5573 Ext.
                                                                                                               Contact Name:   DENISE GIVENS

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 244 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10058       GENERAL CASUALTY CO OF WISCONSIN               ONE GENERAL DRIVE                SUN PRAIRIE           WI 55359     SHEILA.MCGRAW@GENERALCASUALTY.COM




Phone:      800-362-5448 Ext.

GENERAL CASUALTY COMPANY OF                 39-0301590     P O BOX 450409                   ATLANTA               GA 31145     SHARON.STARKS@US.QBE.COM
WISCONSIN

Phone:      770-493-1931 Ext.
                                                                                                               Contact Name:   SHARON STARKS

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 245 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10073       GENERAL INSURANCE COMPANY OF                   1001 FOURTH AVENUE               SEATTLE               WA 98154     CORPORATESECRETARY@LIBERTYMUTUAL.COM
            AMERICA

                                                           SAFECO PLAZA
Phone:      206-675-3609 Ext.

SAFECO                                      91-0742148     2055 SUGARLOAF CIRCLE            DULUTH                GA 30097     MARPOO@SAFECO.COM


                                                           SAFECO PLAZA
Phone:      678-417-3654 Ext.
                                                                                                               Contact Name:   MARLENA POOL

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 246 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10075       GEORGIA CASUALTY & SURETY                      PO BOX 618                       COLUMBIA              MO 65205     FSHORE@COLINSGRP.COM




Phone:      573-474-6193 Ext. 1085

GEORGIA CASUALTY & SURETY                   58-0537066     4370 PEACHTREE ROAD NE           ATLANTA               GA 30319     FSHORE@COLINSGRP.COM



Phone:      800-877-3579 Ext.
                                                                                                               Contact Name:   FRANK SHORE
GEORGIA CASUALTY & SURETY                   58-0537066     2102 WHITE GATE DR               COLUMBIA              MO 65205     FSHORE@COLINSGRP.COM


                                                           PO BOX 618
Phone:      573-474-6193 Ext.
                                                                                                               Contact Name:   FRANK SHORE

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 247 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10277       GRANGE MUTUAL CASUALTY CO                      650 SOUTH FRONT ST.              COLUMBUS              OH 43206     COLEMANL@GRANGEINSURANCE.COM




Phone:      800-422-0550 Ext.

GRANGE MUTUAL CASUALTY                      31-4192970     27755 DIEHL ROAD                 WARRENVILLE           IL   60555   WIZAJ@GRANGEINSURANCE.COM


                                                           SUITE 200
Phone:      800-935-5300 Ext. 254
                                                                                                               Contact Name:   SUSAN FRANTZEN
GRANGE MUTUAL CASUALTY COMPANY              31-4192970     P O BOX 182306                   COLUMBUS              OH 43216     LVANCAMP@IMICO.COM



Phone:      800-348-1741 Ext. 8407
                                                                                                               Contact Name:   LISA VAN CAMP

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 248 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10079       GRANITE STATE INSURANCE CO                     175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM



                                                           18TH FLOOR
Phone:      212-458-7043 Ext.

ALTERNATIVE SERVICE CONCEPTS DBA            43-1954328     3135 AVALON RIDGE PLACE          NORCROSS              GA 30071     SUE.LORANCE@ASCRISK.COM
ASC LLC

                                                           SUITE 650
Phone:      678-447-0200 Ext. 302
                                                                                                               Contact Name:   SUE LORANCE
CHARTIS CLAIMS                              13-2925174     P O BOX 1821                     ALPHARETTA            GA 30023     ALGAWCFR@AIG.COM



Phone:      800-448-9707 Ext.
                                                                                                               Contact Name:   ANNA COLBURN

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 249 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12006       GRAPHIC ARTS MUT INS CO                        180 GENESEE STREET               NEW HARTFORD          NY 13413     WORKERSCOMPMAIL@UTICANATIONAL.COM




Phone:      800-274-1914 Ext.

GRAPHIC ARTS MUTUAL INSURANCE CO            13-5274760     1040 CROWN POINT                 ATLANTA               GA 30338     WORKERSCOMPMAIL@UTICANATIONAL.COM
                                                           PARKWAY

                                                           SUITE 450
Phone:      800-477-1914 Ext.
                                                                                                               Contact Name:   STEVE SOBOLIK

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 250 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12062       GRAY INSURANCE COMPANY (THE)                   3601 NORTH 1-10 SERVICE          METAIRIE              LA 70002     MTAYLOR@GRAYINSCO.COM
                                                           ROAD WEST



Phone:      504-888-7790 Ext.

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:      800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
CRAWFORD & COMPANY                          58-0506554     1001 SUMMIT BLVD                 ATLANTA               GA 30319     ATLANTA.GA@US.CRAWCO.COM



Phone:      -- Ext.
                                                                                                               Contact Name:   STUART TUCKER

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 251 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12007      GREAT AMERICAN ALLIANCE INS.                    49 EAST FOURTH STREET            CINCINNATI            OH 45202     TPEDOTO@GAIC.COM



                                                           4400 SOUTH
Phone:     513-287-8166 Ext.

GREAT AMERICAN ALLIANCE                     31-0501234     P O BOX 5432                     CINCINNATI            OH 45202     BSMITH@STRATEGICCOMP.COM



Phone:     877-589-6846 Ext.
                                                                                                               Contact Name:   BRENDA SMITH
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 60000                    ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM



Phone:     770-901-3121 Ext.
                                                                                                               Contact Name:   MARY D'AGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKEVIEW                     NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-493-5802 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:     800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN


Last Updated: Wednesday, June 1, 2011                                             Page 252 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12007       GREAT AMERICAN ALLIANCE INS.                   49 EAST FOURTH STREET            CINCINNATI            OH 45202     TPEDOTO@GAIC.COM



                                                           4400 SOUTH
Phone:      513-287-8166 Ext.

STRATEGIC COMP SERVICES                     72-1331800     P O BOX 1445                     ALPHARETTA            GA 30099     BSMITH@STRATEGICCOMP.COM



Phone:      770-225-3538 Ext. 360
                                                                                                               Contact Name:   BRENDA SMITH

Total # of Active Claim Offices: 6




Last Updated: Wednesday, June 1, 2011                                             Page 253 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12075      GREAT AMERICAN ASSURANCE COMP                   49 EAST FOURTH STREET            CINCINNATI            OH 45202     TPEDOTO@GAIC.COM




Phone:     513-287-8166 Ext.

GREAT AMERICAN ALLIANCE                     31-0501234     P O BOX 5432                     CINCINNATI            OH 45202     BSMITH@STRATEGICCOMP.COM



Phone:     877-589-6846 Ext.
                                                                                                               Contact Name:   BRENDA SMITH
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 60000                    ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM



Phone:     770-901-3121 Ext.
                                                                                                               Contact Name:   MARY D'AGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKEVIEW                     NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-493-5802 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:     800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN


Last Updated: Wednesday, June 1, 2011                                             Page 254 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12075       GREAT AMERICAN ASSURANCE COMP                  49 EAST FOURTH STREET            CINCINNATI            OH 45202     TPEDOTO@GAIC.COM




Phone:      513-287-8166 Ext.

STRATEGIC COMP SERVICES                     72-1331800     P O BOX 1445                     ALPHARETTA            GA 30099     BSMITH@STRATEGICCOMP.COM



Phone:      770-225-3538 Ext. 360
                                                                                                               Contact Name:   BRENDA SMITH

Total # of Active Claim Offices: 6




Last Updated: Wednesday, June 1, 2011                                             Page 255 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10080      GREAT AMERICAN INS CO                           49 EAST FOURTH STREET            CINCINNATI            OH 45202     TPEDOTO@GAIC.COM



                                                           SUITE 400 SOUTH
Phone:     513-287-8166 Ext.

CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR              MAITLAND              FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

Phone:     866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN
CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR              MAITLAND              FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

Phone:     866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN
GREAT AMERICAN ALLIANCE                     31-0501234     P O BOX 5432                     CINCINNATI            OH 45202     BSMITH@STRATEGICCOMP.COM



Phone:     877-589-6846 Ext.
                                                                                                               Contact Name:   BRENDA SMITH
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 60000                    ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM



Phone:     770-901-3121 Ext.
                                                                                                               Contact Name:   MARY D'AGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKEVIEW                     NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-493-5802 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS


Last Updated: Wednesday, June 1, 2011                                             Page 256 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10080       GREAT AMERICAN INS CO                          49 EAST FOURTH STREET            CINCINNATI            OH 45202     TPEDOTO@GAIC.COM



                                                           SUITE 400 SOUTH
Phone:      513-287-8166 Ext.

SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:      678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:      800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN
STRATEGIC COMP SERVICES                     72-1331800     P O BOX 1445                     ALPHARETTA            GA 30099     BSMITH@STRATEGICCOMP.COM



Phone:      770-225-3538 Ext. 360
                                                                                                               Contact Name:   BRENDA SMITH

Total # of Active Claim Offices: 8




Last Updated: Wednesday, June 1, 2011                                             Page 257 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10192       GREAT AMERICAN INS CO OF NY                    49 EAST FOURTH STREET            CINCINNATI            OH 45202



                                                           #400 SO
Phone:      513-287-8166 Ext.

GREAT AMERICAN ALLIANCE                     31-0501234     P O BOX 5432                     CINCINNATI            OH 45202     BSMITH@STRATEGICCOMP.COM



Phone:      877-589-6846 Ext.
                                                                                                               Contact Name:   BRENDA SMITH
STRATEGIC COMP SERVICES                     72-1331800     P O BOX 1445                     ALPHARETTA            GA 30099     BSMITH@STRATEGICCOMP.COM



Phone:      770-225-3538 Ext. 360
                                                                                                               Contact Name:   BRENDA SMITH

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 258 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13216       GREAT DIVIDE INSURANCE COMPANY                 7233 EAST BUTHERUS DR            SCOTTSDALE            AZ 85260     PLAMBERT@BERKLEYSUM.COM




Phone:      800-842-8972 Ext.

BERKLEY SPECIALTY UNDERWRITING              45-0397186     122 WEST CARPENTER               IRVING                TX 75039     JICLARK@BERKLEYSUM.COM
                                                           FREEWAY #300

Phone:      800-449-2024 Ext. 8952
                                                                                                               Contact Name:   JINNY CLARK

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 259 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12072      GREAT NORTHERN INSURANCE                        15 MOUNTAIN VIEW ROAD.           WARREN                NJ 07061     PREMIUMTAXGROUP@CHUBB.COM
           COMPANY



Phone:     908-903-3287 Ext.

CHUBB SERVICES CORPORATION                  22-3096895     3445 PEACHTREE ROAD NE           ATLANTA               GA 30326     KPILZ@CHUBB.COM


                                                           2 LIVE OAK CENTER #900
Phone:     404-266-4855 Ext.
                                                                                                               Contact Name:   KURT PILZ
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
GREAT NORTHERN INSURANCE                    41-0729473     2 LIVE OAK CENTER SUITE 900      ATLANTA               GA 30326     KPULZ@CHUBB.COM


                                                           3445 PEACHTREE ROAD
Phone:     404-266-4127 Ext.
                                                                                                               Contact Name:   KURT PILZ
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO


Last Updated: Wednesday, June 1, 2011                                             Page 260 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 5




Last Updated: Wednesday, June 1, 2011                                             Page 261 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10298       GREAT WEST CASUALTY COMPANY                    1100 WEST 29TH ST                SOUTH SIOUX CITY      NE 68776     WCCLAIMS@GWCCNET.COM




Phone:      800-228-8602 Ext.

GREAT WEST CASUALTY COPANY                  47-6024508     P O BOX 277                      SOUTH SIOUX CITY      NE 68776     WCCLAIMS@GWCCNET.COM



Phone:      800-228-8602 Ext. 7208
                                                                                                               Contact Name:   DALE SEGUIN
GREAT WEST CASUALTY HD                      47-6024508     THIS IS NOT A CLAIMS             SOUTH SIOUX CITY      NE 68776
                                                           OFFICE

                                                           EDI USE ONLY
Phone:      -- Ext.
                                                                                                               Contact Name:   MARVIN JOHNSON
HD GREAT WEST CASUALTY CO                   47-6024508     THIS IS NOT A CLAIMS             SOUTH SIOUX CITY      NE 68776     M.JOHNSON1@GWCCNET.COM
                                                           OFFICE

                                                           EDI USE ONLY
Phone:      -- Ext.
                                                                                                               Contact Name:   MARVIN JOHNSON

Total # of Active Claim Offices: 3




Last Updated: Wednesday, June 1, 2011                                             Page 262 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10082       GREATER NEW YORK MUTUAL INS. CO                200 MADISON AVE.                 NEW YORK              NY 10016     PMCGOVERN@GNY.COM




Phone:      212-683-9700 Ext.

INDEPENDENT ADJUSTERS INC.                  58-1075455     2130 TUCKER INDUSTRIAL RD        TUCKER                GA 30084     CLAIMS@IAICLAIMS.COM



Phone:      800-838-9853 Ext.
                                                                                                               Contact Name:   GEORGE SAPP

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 263 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12078      GREENWICH INSURANCE COMPANY                     505 EAGLEVIEW BLVD               EXTON                 PA 19341     ANTHONY.EVANS@XLGROUP.COM




Phone:     800-327-1414 Ext.

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
CAMBRIDGE INTEGRATED                        23-2731565     1775 THE EXCHANGE                ATLANTA               GA 30339     DAVID.HAYS@CAMBRIDGE-NA.COM


                                                           SUITE 360
Phone:     800-862-4252 Ext.
                                                                                                               Contact Name:   DAVID HAYES
CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD           POMPANO BEACH         FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:     877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD
ECS CLAIM ADMINISTRATORS                    -              3525 PIEDMONT RD #300            ATLANTA               GA 30305


                                                           BUILDING 7, STE 300
Phone:     404-504-6290 Ext.
                                                                                                               Contact Name:   MATTHEW FORD
GAB ROBINS NORTH AMERICA INC                13-2747054     1 METROPLEX DRIVE                BIRMINGHAM            AL 35209     ATLANTAR@GABROBINS.COM


                                                           SUITE 200
Phone:     800-587-3773 Ext.
                                                                                                               Contact Name:   MICHAEL LASKEY


Last Updated: Wednesday, June 1, 2011                                             Page 264 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12078      GREENWICH INSURANCE COMPANY                     505 EAGLEVIEW BLVD               EXTON                 PA 19341     ANTHONY.EVANS@XLGROUP.COM




Phone:     800-327-1414 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER            ATLANTA               GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKEVIEW                     NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-493-5802 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO


Last Updated: Wednesday, June 1, 2011                                             Page 265 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12078       GREENWICH INSURANCE COMPANY                    505 EAGLEVIEW BLVD               EXTON                 PA 19341     ANTHONY.EVANS@XLGROUP.COM




Phone:      800-327-1414 Ext.

SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:      800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN

Total # of Active Claim Offices: 11




Last Updated: Wednesday, June 1, 2011                                             Page 266 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12046       GUARANTEE INSURANCE CO                         401 EAST LAS OLAS BLVD           FT LAUDERDALE         FL 33301     KDAVIS@GUARANTEEINS.COM



                                                           SUITE 1540
Phone:      800-948-2651 Ext. 5229

GUARANTEE INSURANCE                         22-2222789     1000 PRIMERA BLVD                LAKE MARY             FL 32746     ALEPORE@GUARANTEEINS.COM


                                                           SUITE 3130
Phone:      800-948-2651 Ext. 1306
                                                                                                               Contact Name:   ALI LEPORE
GUARANTEE INSURANCE                         22-2222789     401 EAST LAS OLAS BLVD           FORT LAUDERDALE       FL 33301     ALEPORE@GUARANTEEINS.COM


                                                           SUITE 1540
Phone:      654-703-8038 Ext.
                                                                                                               Contact Name:   ALI LEPORE
GUARANTEE INSURANCE                         22-2222789     THIS IS NOT A CLAIMS             LAKE MARY             FL 33301     ALEPORE@GUARANTEEINS.COM
                                                           OFFICE

                                                           EDI USE ONLY
Phone:      954-703-8038 Ext.
                                                                                                               Contact Name:   ALI LEPORE

Total # of Active Claim Offices: 3




Last Updated: Wednesday, June 1, 2011                                             Page 267 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10246       GUIDEONE MUTUAL INSURANCE                      1111 ASHWORTH ROAD               WEST DES MOINES       IA 50265
            COMPANY



Phone:      877-448-4331 Ext. 5140

GUIDEONE MUTUAL INSURANCE CO                42-0645088     2305 W PARK PLACE                STONE MOUNTAIN        GA 30087     KTORAIN@GUIDEONE.COM


                                                           STE A
Phone:      800-659-1232 Ext. 6337
                                                                                                               Contact Name:   KIM TORAIN

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 268 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10086       HANOVER INSURANCE CO                           440LINCOLN STREET                WORCESTER             MA 01653     DAWMURPHY@HANOVER.COM




Phone:      508-855-5893 Ext.

HANOVER INSURANCE COMPANY                   13-5129825     440 LINCOLN STREET               WORCESTER             MA 01653     EBESHAI@HANOVER.COM



Phone:      800-628-0250 Ext.
                                                                                                               Contact Name:   ELIZABETH BESHAI

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 269 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13020       HARBOR SPECIALTY INS                           7 TIMES SQUARE                   NEW YORK              NY 10036     JSVOBODA@CLARENDON-INS.COM



                                                           36 & 37 FLOOR
Phone:      800-797-2526 Ext.

ADJUSTMENT SERVICES INC.                    58-1623664     P O BOX 81306                    ATLANTA               GA 30366     SHARON@ADJUSTMENTSERVICES.COM



Phone:      800-772-8427 Ext.
                                                                                                               Contact Name:   SHARON STRUBE FERRER
BUILDERS INSURANCE GROUP                    58-2453325     P O BOX 723099                   ATLANTA               GA 30339     CLAIMSFORM@BLDRS.COM



Phone:      800-883-9305 Ext.
                                                                                                               Contact Name:   LINDA MCMURRAY
NORTH AMERICAN RISK SERVICES INC            13-3901415     P O BOX 166002                   ALTAMONTE             FL 32716     MAILROOM@NARIK.COM
                                                                                            SPRINGS

Phone:      800-315-6090 Ext.
                                                                                                               Contact Name:   MELANIE STANISIC

Total # of Active Claim Offices: 3




Last Updated: Wednesday, June 1, 2011                                             Page 270 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12051       HARCO NATIONAL INSURANCE                       2850 WEST GOLF RD.               ROLLING MEADOW        IL 60008     KCOOK@IAT-HARCO.COM
            COMPANY



Phone:      800-448-4642 Ext.

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:      800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 271 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13057       HARLEYSVILLE ATLANTIC INSURANCE                355 MAPLE AVENUE                 HARLEYSVILLE          PA 19438     LHANSON@HARLEYSVILLEGROUP.COM




Phone:      888-549-9876 Ext. 1217

HARLEYSVILLE ATLANTIC INS                   23-0902325     P O BOX 244                      HARLEYSVILLE          PA 19438     LHANSON@HARLEYSVILLEGROUP.COM



Phone:      888-549-9876 Ext. 1217
                                                                                                               Contact Name:   LINDA HANSON

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 272 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13285       HARLEYSVILLE INSURANCE COMPANY                 355 MAPLE AVENUE                 HARLEYSVILLE          PA 19438     LHANSON@HARLEYSVILLEGROUP.COM




Phone:      -- Ext.

HARLEYSVILLE GROUP                          -              P O BOX 244                      HARLEYSVILLE          PA 19438     DHURT@HARLEYSVILLEGROUP.COM



Phone:      888-549-9826 Ext. 5003
                                                                                                               Contact Name:   DAN HURT

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 273 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12018       HARLEYSVILLE MUTUAL INSURANCE                  355 MAPLE AVENUE                 HARLEYSVILLE          PA 19438     LHANSON@HARLEYSVILLEGROUP.COM




Phone:      800-523-6344 Ext.

HARLEYSVILLE ATLANTIC INS                   23-0902325     P O BOX 244                      HARLEYSVILLE          PA 19438     LHANSON@HARLEYSVILLEGROUP.COM



Phone:      888-549-9876 Ext. 1217
                                                                                                               Contact Name:   LINDA HANSON

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 274 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13284       HARLEYSVILLE PREFERRED INSURANCE               355 MAPLE AVENUE                 HARLEYSVILLE          PA 19438     DBOND@HARLEYSVILLEGROUP.COM
            COMPANY



Phone:      -- Ext.

HARLEYSVILLE GROUP                          -              P O BOX 244                      HARLEYSVILLE          PA 19438     DHURT@HARLEYSVILLEGROUP.COM



Phone:      888-549-9826 Ext. 5003
                                                                                                               Contact Name:   DAN HURT

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 275 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13283       HARLEYSVILLE WORCESTER                         355 MAPLE AVENUE                 HARLEYSVILLE          PA 19438     LHANSON@HARLEYSVILLEGROUP.COM
            INSURANCE COMPANY



Phone:      -- Ext.

HARLEYSVILLE GROUP                          -              P O BOX 244                      HARLEYSVILLE          PA 19438     DHURT@HARLEYSVILLEGROUP.COM



Phone:      888-549-9826 Ext. 5003
                                                                                                               Contact Name:   DAN HURT

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 276 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10089      HARTFORD ACCIDENT & INDEMNITY                   ONE HARTFORD PLAZA               HARTFORD              CT 06115     PAULA.SOBOLESKI@THEHARTFORD.COM




Phone:     860-547-7823 Ext.

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
ESIS INC                                    95-2008390     500 COLONIAL PARKWAY             ROSWELL               GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES
GALLAGHER BASSETT SERVICES INC              36-3365500     1301 INTERNATIONAL               SUNRISE               FL 33323     ANDREA_HUMPHRIES@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 230
Phone:     800-889-6764 Ext. 201
                                                                                                               Contact Name:   ANDREA HUMPHRIES
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER


Last Updated: Wednesday, June 1, 2011                                             Page 277 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10089      HARTFORD ACCIDENT & INDEMNITY                   ONE HARTFORD PLAZA               HARTFORD              CT 06115     PAULA.SOBOLESKI@THEHARTFORD.COM




Phone:     860-547-7823 Ext.

HARTFORD ACCIDENT & INDEMNITY CO            06-0383030     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD CASUALTY INS CO                    06-0294398     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD CASUALTY INS CO                    06-0294398     300 SOUTH STATE STREET           SYRACUSE              NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                                                                                               ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD FIRE INS CO                        06-0383750     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD FIRE INS CO                        06-0383750     300 SOUTH STATE STREET           SYRACUSE              NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                                                                                               ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA


Last Updated: Wednesday, June 1, 2011                                             Page 278 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10089      HARTFORD ACCIDENT & INDEMNITY                   ONE HARTFORD PLAZA               HARTFORD              CT 06115     PAULA.SOBOLESKI@THEHARTFORD.COM




Phone:     860-547-7823 Ext.

HARTFORD INS CO OF THE SE                   06-1013048     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD SE WC CLAIMS CENTER                -              200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     877-673-9222 Ext.
                                                                                                               Contact Name:   LARRY FRY
HARTFORD SOUTHEAST WORKERS'                 -              50 GLENLAKE PKWY                 ATLANTA               GA 30328     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
COMPENSATION CLAIMS CENTER                                                                                                     ORD.COM

Phone:     877-673-9222 Ext.
                                                                                                               Contact Name:   ROBERT MYRICK
HARTFORD UNDERWRITERS INS CO                06-1222527     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
PROPERTY & CASUALTY INS CO OF               06-1276326     300 SOUTH STATE STREET           SYRACAUSE             NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
HARTFORD                                                                                                                       ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA


Last Updated: Wednesday, June 1, 2011                                             Page 279 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10089      HARTFORD ACCIDENT & INDEMNITY                   ONE HARTFORD PLAZA               HARTFORD              CT 06115     PAULA.SOBOLESKI@THEHARTFORD.COM




Phone:     860-547-7823 Ext.

SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER            ATLANTA               GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN
SEDGWICK CMS                                36-2685608     5260 PARKWAY PLAZA BLVD          CHARLOTTE             NC 28217     MYRA.NORMAN@SEDGWICKCMS.COM


                                                           SUITE 190
Phone:     800-822-4469 Ext.
                                                                                                               Contact Name:   MYRA NORMAN
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                    NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKEVIEW                     NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-493-5802 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO


Last Updated: Wednesday, June 1, 2011                                             Page 280 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10089       HARTFORD ACCIDENT & INDEMNITY                  ONE HARTFORD PLAZA               HARTFORD              CT 06115     PAULA.SOBOLESKI@THEHARTFORD.COM




Phone:      860-547-7823 Ext.

SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:      800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN
TWIN CITY FIRE INS CO                       06-0732738     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:      407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA

Total # of Active Claim Offices: 22




Last Updated: Wednesday, June 1, 2011                                             Page 281 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10044      HARTFORD CASUALTY INSURANCE                     ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESK@THEHARTFORD.COM
           COMPANY



Phone:     860-547-7823 Ext.

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR              MAITLAND              FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

Phone:     866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN
COTTINGHAM AND BUTLER CLAIM                 20-5233506     P O BOX 28                       DUBUQUE               IA 52004     DUNMACHT@CBCSCLAIMS.COM
SERVICES

Phone:     877-241-6121 Ext.
                                                                                                               Contact Name:   DAN UNMACHT
ESIS INC                                    95-2008390     500 COLONIAL PARKWAY             ROSWELL               GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES


Last Updated: Wednesday, June 1, 2011                                             Page 282 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10044      HARTFORD CASUALTY INSURANCE                     ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESK@THEHARTFORD.COM
           COMPANY



Phone:     860-547-7823 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     1301 INTERNATIONAL               SUNRISE               FL 33323     ANDREA_HUMPHRIES@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 230
Phone:     800-889-6764 Ext. 201
                                                                                                               Contact Name:   ANDREA HUMPHRIES
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
HARTFORD ACCIDENT & INDEMNITY CO            06-0383030     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD CASUALTY INS CO                    06-0294398     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA


Last Updated: Wednesday, June 1, 2011                                             Page 283 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10044      HARTFORD CASUALTY INSURANCE                     ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESK@THEHARTFORD.COM
           COMPANY



Phone:     860-547-7823 Ext.

HARTFORD CASUALTY INS CO                    06-0294398     300 SOUTH STATE STREET           SYRACUSE              NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                                                                                               ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD FIRE INS CO                        06-0383750     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD FIRE INS CO                        06-0383750     300 SOUTH STATE STREET           SYRACUSE              NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                                                                                               ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD INS CO OF THE SE                   06-1013048     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD SE WC CLAIMS CENTER                -              200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     877-673-9222 Ext.
                                                                                                               Contact Name:   LARRY FRY


Last Updated: Wednesday, June 1, 2011                                             Page 284 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10044      HARTFORD CASUALTY INSURANCE                     ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESK@THEHARTFORD.COM
           COMPANY



Phone:     860-547-7823 Ext.

HARTFORD UNDERWRITERS INS CO                06-1222527     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
JOHNSTON & ASSOCIATES INC                   62-1426686     1885 GENERAL GEORGE              FRANKLIN              TN 37067     KM@JOHNSTONANDASSOC.COM
                                                           PATTON DRIVE

Phone:     800-304-5035 Ext.
                                                                                                               Contact Name:   KIM MCCOIN
PROPERTY & CASUALTY INS CO OF               06-1276326     300 SOUTH STATE STREET           SYRACAUSE             NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
HARTFORD                                                                                                                       ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER            ATLANTA               GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN
SEDGWICK CMS                                36-2685608     5260 PARKWAY PLAZA BLVD          CHARLOTTE             NC 28217     MYRA.NORMAN@SEDGWICKCMS.COM


                                                           SUITE 190
Phone:     800-822-4469 Ext.
                                                                                                               Contact Name:   MYRA NORMAN


Last Updated: Wednesday, June 1, 2011                                             Page 285 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10044      HARTFORD CASUALTY INSURANCE                     ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESK@THEHARTFORD.COM
           COMPANY



Phone:     860-547-7823 Ext.

SEDGWICK CMS                                36-2685608     1100 RIDGEWAY LOOP ROAD          MEMPHIS               TN 38120     APULLEN@SEDGWICKCMS.COM



Phone:     241-922-0638 Ext.
                                                                                                               Contact Name:   ANTHONY PULLEN
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                    NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     HARTFORD PLAZA                   HARTFORD              CT 06115     PAUL.HAYWARD@THEHARTFORD.COM


                                                           HO-3-19
Phone:     860-547-7936 Ext.
                                                                                                               Contact Name:   PAUL HAYWARD
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     BETH.RODEE@SRSCONNECT.COM


                                                           SUITE 350
Phone:     770-901-3124 Ext.
                                                                                                               Contact Name:   BETH RODEE
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKEVIEW                     NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-493-5802 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS


Last Updated: Wednesday, June 1, 2011                                             Page 286 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10044       HARTFORD CASUALTY INSURANCE                    ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESK@THEHARTFORD.COM
            COMPANY



Phone:      860-547-7823 Ext.

SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:      678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:      800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN
TWIN CITY FIRE INS CO                       06-0732738     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:      407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA

Total # of Active Claim Offices: 28




Last Updated: Wednesday, June 1, 2011                                             Page 287 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12045      HARTFORD FIRE INS CO                            ONE HARTFORD PLAZA               HARTFORD              CT 06115     PAULA.SOBOLESKI@THEHARTFORD.COM




Phone:     860-547-7823 Ext.

AVIZENT FKA FRANK GATES SERVICE             31-4359765     THIS IS NOT A CLAIMS             EDI USE ONLY          OH 43017     RKARIKAS@AVIZENTRISK.COM
                                                           OFFICE

Phone:     614-766-8747 Ext.
                                                                                                               Contact Name:   REBECCA KARIKAS
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA            BIRMINGHAM            AL 35209     DMCCLOSKEY@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 29106
                                                                                                               Contact Name:   DAVIDA MCCLOSKEY
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA            BIRMINGHAM            AL 35209     CMULLINS@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 20104
                                                                                                               Contact Name:   CHRISTINA MULLINS
BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR              MAITLAND              FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

Phone:     866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN


Last Updated: Wednesday, June 1, 2011                                             Page 288 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12045      HARTFORD FIRE INS CO                            ONE HARTFORD PLAZA               HARTFORD              CT 06115     PAULA.SOBOLESKI@THEHARTFORD.COM




Phone:     860-547-7823 Ext.

CREATIVE RISK SOLUTIONS                     20-0989430     P O BOX 9207                     WHITESBURG            GA 30185     NLYMAN@YOURCLAIMS.COM



Phone:     770-577-9657 Ext.
                                                                                                               Contact Name:   NANCY LYMAN
ESIS                                        95-2008390     500 COLONIAL CENTER              ROSWELL               GA 30076     MARK.IRWIN@ESIS.COM
                                                           PARKWAY

                                                           SUITE 200
Phone:     678-795-4500 Ext.
                                                                                                               Contact Name:   MARK G IRWIN
ESIS INC                                    95-2008390     500 COLONIAL PARKWAY             ROSWELL               GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
F A RICHARD (FARA)                          72-0837383     1625 WEST CAUSEWAY               MANDEVILLE            LA 70471     GEORGIA.NOTICES@FARA.COM
                                                           APPROACH

Phone:     985-624-6739 Ext.
                                                                                                               Contact Name:   CHAD RANFLE
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES


Last Updated: Wednesday, June 1, 2011                                             Page 289 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12045      HARTFORD FIRE INS CO                            ONE HARTFORD PLAZA               HARTFORD              CT 06115     PAULA.SOBOLESKI@THEHARTFORD.COM




Phone:     860-547-7823 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 21227                    TAMPA                 FL 33622     WILLIAM_KIMBROUGH@GBTPA.COM



Phone:     866-428-0283 Ext.
                                                                                                               Contact Name:   WILLIAM KIMBROUGH
GALLAGHER BASSETT SERVICES INC              36-3365500     1301 INTERNATIONAL               SUNRISE               FL 33323     ANDREA_HUMPHRIES@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 230
Phone:     800-889-6764 Ext. 201
                                                                                                               Contact Name:   ANDREA HUMPHRIES
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
HARTFORD ACCIDENT & INDEMNITY CO            06-0383030     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA


Last Updated: Wednesday, June 1, 2011                                             Page 290 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12045      HARTFORD FIRE INS CO                            ONE HARTFORD PLAZA               HARTFORD              CT 06115     PAULA.SOBOLESKI@THEHARTFORD.COM




Phone:     860-547-7823 Ext.

HARTFORD CASUALTY INS CO                    06-0294398     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD CASUALTY INS CO                    06-0294398     300 SOUTH STATE STREET           SYRACUSE              NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                                                                                               ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD FIRE INS CO                        06-0383750     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD FIRE INS CO                        06-0383750     300 SOUTH STATE STREET           SYRACUSE              NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                                                                                               ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD INS CO OF THE SE                   06-1013048     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA


Last Updated: Wednesday, June 1, 2011                                             Page 291 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12045      HARTFORD FIRE INS CO                            ONE HARTFORD PLAZA               HARTFORD              CT 06115     PAULA.SOBOLESKI@THEHARTFORD.COM




Phone:     860-547-7823 Ext.

HARTFORD SE WC CLAIMS CENTER                -              200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     877-673-9222 Ext.
                                                                                                               Contact Name:   LARRY FRY
HARTFORD SOUTHEAST WORKERS'                 -              50 GLENLAKE PKWY                 ATLANTA               GA 30328     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
COMPENSATION CLAIMS CENTER                                                                                                     ORD.COM

Phone:     877-673-9222 Ext.
                                                                                                               Contact Name:   ROBERT MYRICK
HARTFORD UNDERWRITERS INS CO                06-1222527     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
JOHNSTON & ASSOCIATES INC                   62-1426686     1885 GENERAL GEORGE              FRANKLIN              TN 37067     KM@JOHNSTONANDASSOC.COM
                                                           PATTON DRIVE

Phone:     800-304-5035 Ext.
                                                                                                               Contact Name:   KIM MCCOIN
PROPERTY & CASUALTY INS CO OF               06-1276326     300 SOUTH STATE STREET           SYRACAUSE             NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
HARTFORD                                                                                                                       ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA


Last Updated: Wednesday, June 1, 2011                                             Page 292 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12045      HARTFORD FIRE INS CO                            ONE HARTFORD PLAZA               HARTFORD              CT 06115     PAULA.SOBOLESKI@THEHARTFORD.COM




Phone:     860-547-7823 Ext.

RISK ENTERPRISE MANAGEMENT                  13-3832689     1140 HAMMOND DR                  ATLANTA               GA 30328     JANET.GREER@REMLTD.COM
LIMITED

                                                           SUITE J-2075
Phone:     800-347-4494 Ext.
                                                                                                               Contact Name:   JANET GREER
SEDGWICK CMS                                36-2685608     2000 CENTER POINT DRIVE          COLUMBIA              SC 29210     JCONNOR@SEDGWICKCMS.COM


                                                           SUITE 2350
Phone:     800-426-2885 Ext.
                                                                                                               Contact Name:   JIM CONNOR
SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER            ATLANTA               GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN
SEDGWICK CMS                                36-2685608     5260 PARKWAY PLAZA BLVD          CHARLOTTE             NC 28217     MYRA.NORMAN@SEDGWICKCMS.COM


                                                           SUITE 190
Phone:     800-822-4469 Ext.
                                                                                                               Contact Name:   MYRA NORMAN
SEDGWICK CMS                                36-2685608     1100 RIDGEWAY LOOP ROAD          MEMPHIS               TN 38120     APULLEN@SEDGWICKCMS.COM



Phone:     241-922-0638 Ext.
                                                                                                               Contact Name:   ANTHONY PULLEN


Last Updated: Wednesday, June 1, 2011                                             Page 293 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12045      HARTFORD FIRE INS CO                            ONE HARTFORD PLAZA               HARTFORD              CT 06115     PAULA.SOBOLESKI@THEHARTFORD.COM




Phone:     860-547-7823 Ext.

SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                    NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 958424                   LAKE MARY             FL 32795     MARI.NOONAN@SRSCONNECT.COM



Phone:     877-300-6187 Ext. 1012
                                                                                                               Contact Name:   MARI NOONAN
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:     800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN
TWIN CITY FIRE INS CO                       06-0732738     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA


Last Updated: Wednesday, June 1, 2011                                             Page 294 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 35




Last Updated: Wednesday, June 1, 2011                                             Page 295 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12037      HARTFORD INSURANCE CO OF THE                    ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESKI@THEHARTFORD.COM
           SOUTHEAST



Phone:     860-547-7823 Ext.

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
ESIS INC                                    95-2008390     500 COLONIAL PARKWAY             ROSWELL               GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     1301 INTERNATIONAL               SUNRISE               FL 33323     ANDREA_HUMPHRIES@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 230
Phone:     800-889-6764 Ext. 201
                                                                                                               Contact Name:   ANDREA HUMPHRIES


Last Updated: Wednesday, June 1, 2011                                             Page 296 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12037      HARTFORD INSURANCE CO OF THE                    ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESKI@THEHARTFORD.COM
           SOUTHEAST



Phone:     860-547-7823 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
HARTFORD ACCIDENT & INDEMNITY CO            06-0383030     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD CASUALTY INS CO                    06-0294398     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD CASUALTY INS CO                    06-0294398     300 SOUTH STATE STREET           SYRACUSE              NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                                                                                               ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD FIRE INS CO                        06-0383750     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA


Last Updated: Wednesday, June 1, 2011                                             Page 297 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12037      HARTFORD INSURANCE CO OF THE                    ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESKI@THEHARTFORD.COM
           SOUTHEAST



Phone:     860-547-7823 Ext.

HARTFORD FIRE INS CO                        06-0383750     300 SOUTH STATE STREET           SYRACUSE              NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                                                                                               ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD INS CO OF THE SE                   06-1013048     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD SE WC CLAIMS CENTER                -              200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     877-673-9222 Ext.
                                                                                                               Contact Name:   LARRY FRY
HARTFORD UNDERWRITERS INS CO                06-1222527     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
PROPERTY & CASUALTY INS CO OF               06-1276326     300 SOUTH STATE STREET           SYRACAUSE             NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
HARTFORD                                                                                                                       ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA


Last Updated: Wednesday, June 1, 2011                                             Page 298 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12037      HARTFORD INSURANCE CO OF THE                    ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESKI@THEHARTFORD.COM
           SOUTHEAST



Phone:     860-547-7823 Ext.

SEDGWICK CMS                                36-2685608     2000 CENTER POINT DRIVE          COLUMBIA              SC 29210     JCONNOR@SEDGWICKCMS.COM


                                                           SUITE 2350
Phone:     800-426-2885 Ext.
                                                                                                               Contact Name:   JIM CONNOR
SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER            ATLANTA               GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN
SEDGWICK CMS                                36-2685608     5260 PARKWAY PLAZA BLVD          CHARLOTTE             NC 28217     MYRA.NORMAN@SEDGWICKCMS.COM


                                                           SUITE 190
Phone:     800-822-4469 Ext.
                                                                                                               Contact Name:   MYRA NORMAN
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                    NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO


Last Updated: Wednesday, June 1, 2011                                             Page 299 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12037       HARTFORD INSURANCE CO OF THE                   ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESKI@THEHARTFORD.COM
            SOUTHEAST



Phone:      860-547-7823 Ext.

SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:      800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN
TWIN CITY FIRE INS CO                       06-0732738     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:      407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA

Total # of Active Claim Offices: 22




Last Updated: Wednesday, June 1, 2011                                             Page 300 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12092      HARTFORD INSURANCE COMPANY OF                   ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESKI@THEHARTFORD.COM
           MIDWEST



Phone:     860-547-7823 Ext.

AVIZENT FKA FRANK GATES SERVICE             31-4359765     THIS IS NOT A CLAIMS             EDI USE ONLY          OH 43017     RKARIKAS@AVIZENTRISK.COM
                                                           OFFICE

Phone:     614-766-8747 Ext.
                                                                                                               Contact Name:   REBECCA KARIKAS
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA            BIRMINGHAM            AL 35209     DMCCLOSKEY@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 29106
                                                                                                               Contact Name:   DAVIDA MCCLOSKEY
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA            BIRMINGHAM            AL 35209     CMULLINS@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 20104
                                                                                                               Contact Name:   CHRISTINA MULLINS
BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
COTTINGHAM & BUTLER CLAIM                   20-5233506     P O BOX 28                       DUBUQUE               IA 52004     DUNMACHT@CBCSCLAIMS.COM
SERVICES

Phone:     877-241-6121 Ext.
                                                                                                               Contact Name:   DAN UNMACHT


Last Updated: Wednesday, June 1, 2011                                             Page 301 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12092      HARTFORD INSURANCE COMPANY OF                   ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESKI@THEHARTFORD.COM
           MIDWEST



Phone:     860-547-7823 Ext.

COTTINGHAM AND BUTLER CLAIM                 20-5233506     P O BOX 28                       DUBUQUE               IA 52004     DUNMACHT@CBCSCLAIMS.COM
SERVICES

Phone:     877-241-6121 Ext.
                                                                                                               Contact Name:   DAN UNMACHT
CREATIVE RISK SOLUTIONS                     20-0989430     P O BOX 9207                     WHITESBURG            GA 30185     NLYMAN@YOURCLAIMS.COM



Phone:     770-577-9657 Ext.
                                                                                                               Contact Name:   NANCY LYMAN
ESIS INC                                    95-2008390     500 COLONIAL PARKWAY             ROSWELL               GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
F A RICHARD (FARA)                          72-0837383     1625 WEST CAUSEWAY               MANDEVILLE            LA 70471     GEORGIA.NOTICES@FARA.COM
                                                           APPROACH

Phone:     985-624-6739 Ext.
                                                                                                               Contact Name:   CHAD RANFLE
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES


Last Updated: Wednesday, June 1, 2011                                             Page 302 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12092      HARTFORD INSURANCE COMPANY OF                   ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESKI@THEHARTFORD.COM
           MIDWEST



Phone:     860-547-7823 Ext.

GAB ROBINS NORTH AMERICA INC                13-2747054     9 CAMPUS DIRVE                   PARSIPPANY            NJ 07054     ATLANTAR@GABROBINS.COM


                                                           SUITE 7
Phone:     800-422-4436 Ext.
                                                                                                               Contact Name:   DEWEY BARNES
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     1301 INTERNATIONAL               SUNRISE               FL 33323     ANDREA_HUMPHRIES@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 230
Phone:     800-889-6764 Ext. 201
                                                                                                               Contact Name:   ANDREA HUMPHRIES
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
HARTFORD ACCIDENT & INDEMNITY CO            06-0383030     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA


Last Updated: Wednesday, June 1, 2011                                             Page 303 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12092      HARTFORD INSURANCE COMPANY OF                   ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESKI@THEHARTFORD.COM
           MIDWEST



Phone:     860-547-7823 Ext.

HARTFORD CASUALTY INS CO                    06-0294398     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD CASUALTY INS CO                    06-0294398     300 SOUTH STATE STREET           SYRACUSE              NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                                                                                               ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD FIRE INS CO                        06-0383750     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD FIRE INS CO                        06-0383750     300 SOUTH STATE STREET           SYRACUSE              NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                                                                                               ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD INC CO MIDWEST                     06-1008026     300 SOUTH STATE STREET           SYRACRUSE             NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                                                                                               ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA


Last Updated: Wednesday, June 1, 2011                                             Page 304 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12092      HARTFORD INSURANCE COMPANY OF                   ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESKI@THEHARTFORD.COM
           MIDWEST



Phone:     860-547-7823 Ext.

HARTFORD INS CO MIDWEST                     06-1008026     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD INS CO OF THE SE                   06-1013048     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD SE WC CLAIMS CENTER                -              200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     877-673-9222 Ext.
                                                                                                               Contact Name:   LARRY FRY
HARTFORD SOUTHEAST WORKERS'                 -              50 GLENLAKE PKWY                 ATLANTA               GA 30328     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
COMPENSATION CLAIMS CENTER                                                                                                     ORD.COM

Phone:     877-673-9222 Ext.
                                                                                                               Contact Name:   ROBERT MYRICK
HARTFORD UNDERWRITERS INS CO                06-1222527     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA


Last Updated: Wednesday, June 1, 2011                                             Page 305 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12092      HARTFORD INSURANCE COMPANY OF                   ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESKI@THEHARTFORD.COM
           MIDWEST



Phone:     860-547-7823 Ext.

PROPERTY & CASUALTY INS CO OF               06-1276326     300 SOUTH STATE STREET           SYRACAUSE             NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
HARTFORD                                                                                                                       ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER            ATLANTA               GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN
SEDGWICK CMS                                36-2685608     5260 PARKWAY PLAZA BLVD          CHARLOTTE             NC 28217     MYRA.NORMAN@SEDGWICKCMS.COM


                                                           SUITE 190
Phone:     800-822-4469 Ext.
                                                                                                               Contact Name:   MYRA NORMAN
SEDGWICK CMS                                36-2685608     1100 RIDGEWAY LOOP ROAD          MEMPHIS               TN 38120     APULLEN@SEDGWICKCMS.COM



Phone:     241-922-0638 Ext.
                                                                                                               Contact Name:   ANTHONY PULLEN
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                    NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS


Last Updated: Wednesday, June 1, 2011                                             Page 306 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12092       HARTFORD INSURANCE COMPANY OF                  ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESKI@THEHARTFORD.COM
            MIDWEST



Phone:      860-547-7823 Ext.

SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:      678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:      800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN
TWIN CITY FIRE INS CO                       06-0732738     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:      407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA

Total # of Active Claim Offices: 33




Last Updated: Wednesday, June 1, 2011                                             Page 307 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10123      HARTFORD UNDERWRITERS INS                       ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESKI@THEHARTFORD.COM




Phone:     860-547-8403 Ext.

AVIZENT FKA FRANK GATES SERVICE             31-4359765     THIS IS NOT A CLAIMS             EDI USE ONLY          OH 43017     RKARIKAS@AVIZENTRISK.COM
                                                           OFFICE

Phone:     614-766-8747 Ext.
                                                                                                               Contact Name:   REBECCA KARIKAS
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA            BIRMINGHAM            AL 35209     DMCCLOSKEY@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 29106
                                                                                                               Contact Name:   DAVIDA MCCLOSKEY
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA            BIRMINGHAM            AL 35209     CMULLINS@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 20104
                                                                                                               Contact Name:   CHRISTINA MULLINS
BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
COTTINGHAM & BUTLER CLAIM                   20-5233506     P O BOX 28                       DUBUQUE               IA 52004     DUNMACHT@CBCSCLAIMS.COM
SERVICES

Phone:     877-241-6121 Ext.
                                                                                                               Contact Name:   DAN UNMACHT


Last Updated: Wednesday, June 1, 2011                                             Page 308 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10123      HARTFORD UNDERWRITERS INS                       ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESKI@THEHARTFORD.COM




Phone:     860-547-8403 Ext.

COTTINGHAM AND BUTLER CLAIM                 20-5233506     P O BOX 28                       DUBUQUE               IA 52004     DUNMACHT@CBCSCLAIMS.COM
SERVICES

Phone:     877-241-6121 Ext.
                                                                                                               Contact Name:   DAN UNMACHT
ESIS INC                                    95-2008390     500 COLONIAL PARKWAY             ROSWELL               GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
F A RICHARD (FARA)                          72-0837383     1625 WEST CAUSEWAY               MANDEVILLE            LA 70471     GEORGIA.NOTICES@FARA.COM
                                                           APPROACH

Phone:     985-624-6739 Ext.
                                                                                                               Contact Name:   CHAD RANFLE
F A RICHARD (FARA)                          72-0837383     7000 EXECUTIVE CENTER            BRENTWOOD             TN 37027     GEORGIA.NOTICES@FARA.COM
                                                           DRIVE

                                                           SUITE 320
Phone:     800-675-2771 Ext. 225
                                                                                                               Contact Name:   KAREN PORTER
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES


Last Updated: Wednesday, June 1, 2011                                             Page 309 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10123      HARTFORD UNDERWRITERS INS                       ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESKI@THEHARTFORD.COM




Phone:     860-547-8403 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     1301 INTERNATIONAL               SUNRISE               FL 33323     ANDREA_HUMPHRIES@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 230
Phone:     800-889-6764 Ext. 201
                                                                                                               Contact Name:   ANDREA HUMPHRIES
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
HARTFORD ACCIDENT & INDEMNITY CO            06-0383030     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD CASUALTY INS CO                    06-0294398     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA


Last Updated: Wednesday, June 1, 2011                                             Page 310 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10123      HARTFORD UNDERWRITERS INS                       ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESKI@THEHARTFORD.COM




Phone:     860-547-8403 Ext.

HARTFORD CASUALTY INS CO                    06-0294398     300 SOUTH STATE STREET           SYRACUSE              NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                                                                                               ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD FIRE INS CO                        06-0383750     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD FIRE INS CO                        06-0383750     300 SOUTH STATE STREET           SYRACUSE              NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                                                                                               ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD INS CO OF THE SE                   06-1013048     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
HARTFORD SE WC CLAIMS CENTER                -              200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     877-673-9222 Ext.
                                                                                                               Contact Name:   LARRY FRY


Last Updated: Wednesday, June 1, 2011                                             Page 311 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10123      HARTFORD UNDERWRITERS INS                       ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESKI@THEHARTFORD.COM




Phone:     860-547-8403 Ext.

HARTFORD SOUTHEAST WORKERS'                 -              50 GLENLAKE PKWY                 ATLANTA               GA 30328     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
COMPENSATION CLAIMS CENTER                                                                                                     ORD.COM

Phone:     877-673-9222 Ext.
                                                                                                               Contact Name:   ROBERT MYRICK
HARTFORD UNDERWRITERS INS CO                06-1222527     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
PROPERTY & CASUALTY INS CO OF               06-1276326     300 SOUTH STATE STREET           SYRACAUSE             NY 13202     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
HARTFORD                                                                                                                       ORD.COM

Phone:     407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA
SEDGWICK CMS                                36-2685608     2000 CENTER POINT DRIVE          COLUMBIA              SC 29210     JCONNOR@SEDGWICKCMS.COM


                                                           SUITE 2350
Phone:     800-426-2885 Ext.
                                                                                                               Contact Name:   JIM CONNOR
SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER            ATLANTA               GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN


Last Updated: Wednesday, June 1, 2011                                             Page 312 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10123      HARTFORD UNDERWRITERS INS                       ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESKI@THEHARTFORD.COM




Phone:     860-547-8403 Ext.

SEDGWICK CMS                                36-2685608     5260 PARKWAY PLAZA BLVD          CHARLOTTE             NC 28217     MYRA.NORMAN@SEDGWICKCMS.COM


                                                           SUITE 190
Phone:     800-822-4469 Ext.
                                                                                                               Contact Name:   MYRA NORMAN
SEDGWICK CMS                                36-2685608     1100 RIDGEWAY LOOP ROAD          MEMPHIS               TN 38120     APULLEN@SEDGWICKCMS.COM



Phone:     241-922-0638 Ext.
                                                                                                               Contact Name:   ANTHONY PULLEN
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 60000                    ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM



Phone:     770-901-3121 Ext.
                                                                                                               Contact Name:   MARY D'AGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                    NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     BETH.RODEE@SRSCONNECT.COM


                                                           SUITE 350
Phone:     770-901-3124 Ext.
                                                                                                               Contact Name:   BETH RODEE


Last Updated: Wednesday, June 1, 2011                                             Page 313 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10123      HARTFORD UNDERWRITERS INS                       ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESKI@THEHARTFORD.COM




Phone:     860-547-8403 Ext.

SPECIALTY RISK SERVICES                     20-0730592     ONE LAKEVIEW                     NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-493-5802 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:     800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN
TRAVELERS INDEMNITY CO OF CT                06-0336212     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           SUITE 100
Phone:     800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
TRAVELERS INDEMNITY COMPANY                 06-0566050     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           SUITE 100
Phone:     800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON


Last Updated: Wednesday, June 1, 2011                                             Page 314 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10123       HARTFORD UNDERWRITERS INS                      ONE HARTFORD PLAZA               HARTFORD              CT 06155     PAULA.SOBOLESKI@THEHARTFORD.COM




Phone:      860-547-8403 Ext.

TRAVELERS INDEMNITY COMPANY                 06-0566050     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           SUITE 100
Phone:      800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
TRAVELERS INDEMNITY COMPANY                 06-0566050     10401 HIGHLAND MANOR             TAMPA                 FL 33610     DBRYSON@TRAVELERS.COM
                                                           DRIVE

                                                           BUILDING V SUITE 200
Phone:      888-329-6259 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON
TWIN CITY FIRE INS CO                       06-0732738     200 COLONIAL CENTER              LAKE MARY             FL 32746     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
                                                           PARKWAY                                                             ORD.COM

                                                           SUITE 500
Phone:      407-562-3632 Ext.
                                                                                                               Contact Name:   KIM MALISA

Total # of Active Claim Offices: 38




Last Updated: Wednesday, June 1, 2011                                             Page 315 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


40012       HEALTHCARE MUTUAL CAPTIVE                      1775 SPECTRUM DR. #100           LAWRENCEVILLE         GA 30043     CEDWARDS@GAADMINSVCS.COM




Phone:      800-421-0710 Ext.

GEORGIA ADMINISTRATIVE SERVICES             58-2196973     1775 SPECTRUM DRIVE              LAWRENCEVILLE         GA 30043     CEDWARDS@GEORGIA-ADMIN.COM


                                                           SUITE 100
Phone:      800-421-0710 Ext.
                                                                                                               Contact Name:   CARLA EDWARDS

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 316 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12071      INDEMNITY INSURANCE COMPANY OF                  436 WALNUT STREET                PHILADELPHIA          PA 19105     MARILEE.BRABSON@ACEGROUP.COM
           NORTH AMERICA



Phone:     215-640-4565 Ext.

BROADSPIRE INC                              36-3917295     P O BOX 926240                   NORCROSS              GA 30010     ATLANTA@CHOOSEBROADSPIRE.COM



Phone:     678-969-7337 Ext.
                                                                                                               Contact Name:   LORRAINE SHRINER
CAMBRIDGE INTEGRATED SERVICE                23-2731565     809 GLEN EAGLES COURT            TOWSON                MD 21286     BRIAN.WALSH@US.XCHANGING.COM
GROUP INC

                                                           SUITE 210
Phone:     419-847-6323 Ext.
                                                                                                               Contact Name:   BRIAN WALSH
CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD           POMPANO BEACH         FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:     877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD
CAMBRIDGE INTEGRATED SERVICES               23-2731565     6300 CENTER HILL ROAD            CINCINNATI            OH 45224     NICOLE.DEWITT@US.XCHANGING.COM
GROUP INC

Phone:     800-235-1134 Ext. 5
                                                                                                               Contact Name:   NICOLE DEWITT
CONSTITUTION STATE SERVICES                 06-1501229     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           STE 100
Phone:     770-352-2978 Ext.
                                                                                                               Contact Name:   KEVIN NELSON


Last Updated: Wednesday, June 1, 2011                                             Page 317 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12071      INDEMNITY INSURANCE COMPANY OF                  436 WALNUT STREET                PHILADELPHIA          PA 19105     MARILEE.BRABSON@ACEGROUP.COM
           NORTH AMERICA



Phone:     215-640-4565 Ext.

CONSTITUTION STATE SERVICES                 06-1501229     10401 HIGHLAND MANOR DR          TAMPA                 FL 33612     GEORGIAWCBOARD@TRAVELERS.COM


                                                           STE 200
Phone:     770-934-3414 Ext.
                                                                                                               Contact Name:   JOSEPH CIBULSKI
ESIS INC                                    95-2008390     500 COLONIAL PARKWAY             ROSWELL               GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES
GALLAGHER BASSETT SERVICES                  36-3365500     P O BOX 279310                   MIRAMAR               FL 33027     KRISTY_SANDS@GBTPA.COM



Phone:     800-473-9009 Ext.
                                                                                                               Contact Name:   KRISTY SANDS
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 292109                   NASHVILLE             TN 37229     GALE_LESIEUR@GBTPA.COM



Phone:     800-288-9843 Ext. 201
                                                                                                               Contact Name:   GALE LESIEUR


Last Updated: Wednesday, June 1, 2011                                             Page 318 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12071      INDEMNITY INSURANCE COMPANY OF                  436 WALNUT STREET                PHILADELPHIA          PA 19105     MARILEE.BRABSON@ACEGROUP.COM
           NORTH AMERICA



Phone:     215-640-4565 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     2600 MCCORMICK DR #110           CLEARWATER            FL 33758     CANDICE_BUCHANAN@GBTPA.COM


                                                           ONE PRESTIGE PLACE
Phone:     800-226-8002 Ext.
                                                                                                               Contact Name:   CANDICE BUCHANAN
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 21227                    TAMPA                 FL 33622     WILLIAM_KIMBROUGH@GBTPA.COM



Phone:     866-428-0283 Ext.
                                                                                                               Contact Name:   WILLIAM KIMBROUGH
GALLAGHER BASSETT SERVICES INC              36-3365500     601 VESTAVIA PARKWAY             BIRMINGHAM            AL 35266     CHRIS_ROCK@GBTPA.COM


                                                           SUITE 251
Phone:     800-762-3486 Ext.
                                                                                                               Contact Name:   CHRIS ROCK
GALLAGHER BASSETT SERVICES INC              36-3365500     1301 INTERNATIONAL               SUNRISE               FL 33323     ANDREA_HUMPHRIES@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 230
Phone:     800-889-6764 Ext. 201
                                                                                                               Contact Name:   ANDREA HUMPHRIES


Last Updated: Wednesday, June 1, 2011                                             Page 319 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12071      INDEMNITY INSURANCE COMPANY OF                  436 WALNUT STREET                PHILADELPHIA          PA 19105     MARILEE.BRABSON@ACEGROUP.COM
           NORTH AMERICA



Phone:     215-640-4565 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
GALLAGHER BASSETT SERVICES INC              36-3365500     1096 ASSEMBLY DRIVE              FT MILL               SC 29716     JULIE_MCCOY-LINCOLN@GBTPA.COM


                                                           SUITE 210
Phone:     866-814-1740 Ext. 201
                                                                                                               Contact Name:   JULIE MCCOY-LINCOLN
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 4840                     CLEARWATER            FL 33758     KIM_BUCHANAN@GBTPA.COM



Phone:     800-226-8002 Ext.
                                                                                                               Contact Name:   KIM BUCHANAN
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 31204                    TAMPA                 FL 33618     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   CHARLES HUNNELL
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 31204                    TAMPA                 FL 33631     HEATHER.STANFORD@LIBERTYMUTUAL.COM
LLC

Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   HEATHER STANFORD


Last Updated: Wednesday, June 1, 2011                                             Page 320 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12071      INDEMNITY INSURANCE COMPANY OF                  436 WALNUT STREET                PHILADELPHIA          PA 19105     MARILEE.BRABSON@ACEGROUP.COM
           NORTH AMERICA



Phone:     215-640-4565 Ext.

RISK ENTERPRISE MANAGEMENT                  13-3832689     1140 HAMMOND DR                  ATLANTA               GA 30328     JANET.GREER@REMLTD.COM
LIMITED

                                                           SUITE J-2075
Phone:     800-347-4494 Ext.
                                                                                                               Contact Name:   JANET GREER
RISK ENTERPRISE MANAGEMENT                  13-3832689     565 MARRIOTT DRIVE               NASHVILLE             TN 37214     JANICE.GUIDRY@REMLTD.COM
LIMITED

                                                           SUITE 725
Phone:     800-871-6670 Ext.
                                                                                                               Contact Name:   JANICE GUIDRY
SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER            ATLANTA               GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN
SEDGWICK CMS                                36-2685608     255 PRIMERA BLVD                 LAKE MARY             FL 32746     GASTATEBOARDINBOX@SEDGWICKCMS.COM


                                                           SUITE 400
Phone:     800-548-1373 Ext.
                                                                                                               Contact Name:   GEORGE CINTRON
SEDGWICK CMS                                36-2685608     5260 PARKWAY PLAZA BLVD          CHARLOTTE             NC 28217     MYRA.NORMAN@SEDGWICKCMS.COM


                                                           SUITE 190
Phone:     800-822-4469 Ext.
                                                                                                               Contact Name:   MYRA NORMAN


Last Updated: Wednesday, June 1, 2011                                             Page 321 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12071      INDEMNITY INSURANCE COMPANY OF                  436 WALNUT STREET                PHILADELPHIA          PA 19105     MARILEE.BRABSON@ACEGROUP.COM
           NORTH AMERICA



Phone:     215-640-4565 Ext.

SEDGWICK CMS                                36-2685608     1100 RIDGEWAY LOOP ROAD          MEMPHIS               TN 38120     APULLEN@SEDGWICKCMS.COM



Phone:     241-922-0638 Ext.
                                                                                                               Contact Name:   ANTHONY PULLEN
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 60000                    ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM



Phone:     770-901-3121 Ext.
                                                                                                               Contact Name:   MARY D'AGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKEVIEW                     NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-493-5802 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:     800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN


Last Updated: Wednesday, June 1, 2011                                             Page 322 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12071       INDEMNITY INSURANCE COMPANY OF                 436 WALNUT STREET                PHILADELPHIA          PA 19105     MARILEE.BRABSON@ACEGROUP.COM
            NORTH AMERICA



Phone:      215-640-4565 Ext.

UNDERWRITERS SAFETY & CLAIMS                61-0489172     5105 PAULSEN ST                  SAVANNAH              GA 31401     ANNF@USCKY.COM


                                                           SUITE 241
Phone:      912-355-8929 Ext. 224
                                                                                                               Contact Name:   ANN FINNIGAN
UNDERWRITERS SAFETY & CLAIMS INC            61-0489172     5105 PAULSEN STREET              SAVANNAH              GA 31405     ANNF@USCKY.COM



Phone:      912-355-8989 Ext.
                                                                                                               Contact Name:   ANN FINNEGAN
YORK CLAIMS SERVICE INC                     13-1963636     99 CHERRY HILL ROAD              PARSIPPANY            NJ 07054     STEPHANIE.MARSHALL@YORKRSG.COMM



Phone:      877-927-2255 Ext.
                                                                                                               Contact Name:   STEPHANIE MARSHALL

Total # of Active Claim Offices: 33




Last Updated: Wednesday, June 1, 2011                                             Page 323 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10093      INSURANCE COMPANY OF NORTH                      436 WALNUT STREET                PHILADELPHIA          PA 19106     MARILEE.BRABSON@ACEGROUP.COM
           AMERICA

                                                           WB04G
Phone:     215-640-4565 Ext.

ESIS INC                                    95-2008390     500 COLONIAL PARKWAY             ROSWELL               GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES
RISK ENTERPRISE MANAGEMENT                  13-3832689     1140 HAMMOND DR                  ATLANTA               GA 30328     JANET.GREER@REMLTD.COM
LIMITED

                                                           SUITE J-2075
Phone:     800-347-4494 Ext.
                                                                                                               Contact Name:   JANET GREER
RISK ENTERPRISE MANAGEMENT                  13-3832689     565 MARRIOTT DRIVE               NASHVILLE             TN 37214     JANICE.GUIDRY@REMLTD.COM
LIMITED

                                                           SUITE 725
Phone:     800-871-6670 Ext.
                                                                                                               Contact Name:   JANICE GUIDRY
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                    NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS


Last Updated: Wednesday, June 1, 2011                                             Page 324 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10093       INSURANCE COMPANY OF NORTH                     436 WALNUT STREET                PHILADELPHIA          PA 19106     MARILEE.BRABSON@ACEGROUP.COM
            AMERICA

                                                           WB04G
Phone:      215-640-4565 Ext.

SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:      678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:      800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN

Total # of Active Claim Offices: 7




Last Updated: Wednesday, June 1, 2011                                             Page 325 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10094      INSURANCE COMPANY OF STATE OF PA                175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM



                                                           18TH FLOOR
Phone:     -- Ext.

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
CAMBRIDGE INTEGRATED SERVICE                23-2731565     809 GLEN EAGLES COURT            TOWSON                MD 21286     BRIAN.WALSH@US.XCHANGING.COM
GROUP INC

                                                           SUITE 210
Phone:     419-847-6323 Ext.
                                                                                                               Contact Name:   BRIAN WALSH
CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD           POMPANO BEACH         FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:     877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD
CAMBRIDGE INTEGRATED SERVICES               23-2731565     6300 CENTER HILL ROAD            CINCINNATI            OH 45224     NICOLE.DEWITT@US.XCHANGING.COM
GROUP INC

Phone:     800-235-1134 Ext. 5
                                                                                                               Contact Name:   NICOLE DEWITT
CAMBRIDGE INTEGRATED SERVICES               23-2731565     6300 CENTER HILL ROAD            CINCINNATI            OH 45224     NICOLE.DEWITT@US.EXCHANGING.COM
GROUP INC

Phone:     800-235-1134 Ext. 5
                                                                                                               Contact Name:   NICOLE DEWITT


Last Updated: Wednesday, June 1, 2011                                             Page 326 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10094      INSURANCE COMPANY OF STATE OF PA                175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM



                                                           18TH FLOOR
Phone:     -- Ext.

CHARTIS CLAIMS                              13-2925174     P O BOX 1821                     ALPHARETTA            GA 30023     ALGAWCFR@AIG.COM



Phone:     800-448-9707 Ext.
                                                                                                               Contact Name:   ANNA COLBURN
CLAIMETRICS                                 20-1604010     PO BOX 22478                     OKLAHOMA CITY         OK 73123     LAUREN.TOPPINS@CLAIMETRICS.COM



Phone:     405-728-5544 Ext. 2326
                                                                                                               Contact Name:   LAUREN TOPPINS
CONSTITUTION STATE SERVICES                 06-1501229     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           STE 100
Phone:     770-352-2978 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
CONSTITUTION STATE SERVICES                 06-1501229     10401 HIGHLAND MANOR DR          TAMPA                 FL 33612     GEORGIAWCBOARD@TRAVELERS.COM


                                                           STE 200
Phone:     770-934-3414 Ext.
                                                                                                               Contact Name:   JOSEPH CIBULSKI
CONSTITUTION STATE SERVICES                 06-1501229     1000 FIANA WAY                   FT SMITH              AR 72919     MJWHITE@TRAVELERS.COM



Phone:     800-842-5612 Ext.
                                                                                                               Contact Name:   MELISSA WHITE


Last Updated: Wednesday, June 1, 2011                                             Page 327 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10094      INSURANCE COMPANY OF STATE OF PA                175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM



                                                           18TH FLOOR
Phone:     -- Ext.

ESIS INC                                    95-2008390     500 COLONIAL PARKWAY             ROSWELL               GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     1301 INTERNATIONAL               SUNRISE               FL 33323     ANDREA_HUMPHRIES@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 230
Phone:     800-889-6764 Ext. 201
                                                                                                               Contact Name:   ANDREA HUMPHRIES
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER


Last Updated: Wednesday, June 1, 2011                                             Page 328 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10094      INSURANCE COMPANY OF STATE OF PA                175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM



                                                           18TH FLOOR
Phone:     -- Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 4840                     CLEARWATER            FL 33758     KIM_BUCHANAN@GBTPA.COM



Phone:     800-226-8002 Ext.
                                                                                                               Contact Name:   KIM BUCHANAN
NOVAPRO RISK SOLUTIONS LP                   36-4550659     SIX CONCOURSE PARKWAY            ATLANTA               GA 30328     TKATER@NOVAPRORISK.COM


                                                           SUITE 1550
Phone:     678-731-9091 Ext. 252
                                                                                                               Contact Name:   TAMMIE KATER
RISK ENTERPRISE MANAGEMENT                  13-3832689     1140 HAMMOND DR                  ATLANTA               GA 30328     JANET.GREER@REMLTD.COM
LIMITED

                                                           SUITE J-2075
Phone:     800-347-4494 Ext.
                                                                                                               Contact Name:   JANET GREER
SEDGWICK CLAIMS MANAGEMENT                  71-0738006     THIS IS NOT A CLAIMS             BENTONVILLE           AR 72756     TINA.HUDNALL@CMIW.COM
                                                           OFFICE

                                                           EDI USE ONLY
Phone:     479-621-2900 Ext. 1279
                                                                                                               Contact Name:   TINA HUDNALL
SEDGWICK CMS                                36-2685608     3700 CRESTWOOD PARKWAY           DULUTH                GA 30096     ATLANTA.GA@SEDGWICKCMS.COM


                                                           SUITE 600
Phone:     678-628-1318 Ext.
                                                                                                               Contact Name:   RONETTA WILSON


Last Updated: Wednesday, June 1, 2011                                             Page 329 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10094      INSURANCE COMPANY OF STATE OF PA                175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM



                                                           18TH FLOOR
Phone:     -- Ext.

SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER            ATLANTA               GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN
SEDGWICK CMS                                36-2685608     1100 RIDGEWAY LOOP ROAD          MEMPHIS               TN 38120     APULLEN@SEDGWICKCMS.COM



Phone:     241-922-0638 Ext.
                                                                                                               Contact Name:   ANTHONY PULLEN
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 14151                    LEXINGTON             KY 40512     DANIELLE.MINNIEHAN@SRSCONNECT.COM



Phone:     800-541-0139 Ext. 35832
                                                                                                               Contact Name:   DANIELLE MINNIEHAN
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKEVIEW                     NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-493-5802 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO


Last Updated: Wednesday, June 1, 2011                                             Page 330 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10094       INSURANCE COMPANY OF STATE OF PA               175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM



                                                           18TH FLOOR
Phone:      -- Ext.

SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:      800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN
TRAVELERS INDEMNITY COMPANY                 06-0566050     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           SUITE 100
Phone:      800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON

Total # of Active Claim Offices: 27




Last Updated: Wednesday, June 1, 2011                                             Page 331 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13089       INSURANCE COMPANY OF THE WEST                  11455 EL CAMINO REAL             SAN DIEGO             CA 92130     JDODKIN@ICWGROUP.COM




Phone:      800-877-1111 Ext.

NOVAPRO RISK                                36-4550659     101 E KENNEDY BLVD               TAMPA                 FL 33602     KROGERS@NOVAPRORISK.COM


                                                           SUITE 870
Phone:      800-426-5990 Ext.
                                                                                                               Contact Name:   KAREN ROGERS

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 332 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13155       KEY RISK INSURANCE CO                          7900 MCCLOUD ROAD                GREENSBORO            NC 27409     TELBERT@KEYRISK.COM



                                                           SUITE 300
Phone:      800-366-1511 Ext.

KEY RISK MANAGEMENT SERVICES                56-1800954     P O BOX 49129                    GREENSBORO            NC 27419     GHENEHAN@KEYRISK.COM



Phone:      336-668-9050 Ext. 7539
                                                                                                               Contact Name:   GEORGE HENEHAN

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 333 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13267       KODIAK INSURANCE COMPANY                       820 BEAR TAVERN ROAD              WEST TRENTON         NJ 08628     CPOPP@HERMITAGEINS.COM




Phone:      -- Ext.

AMTRUST NORTH AMERICA                       34-1965476     11330 LAKEFIELD DRIVE             JOHNS CREEK          GA 30097     50STATENOTICES@AMTRUSTGROUP.COM


                                                           BUILDING II SUITE 100
Phone:      678-258-8000 Ext.
                                                                                                               Contact Name:   PHIL PUCKETT

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                              Page 334 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13182      LIBERTY INSURANCE CORPORATION                   175 BERKELEY ST.                 BOSTON                MA 02116     CORPORATESECRETARY@LIBERTYMUTUAL.COM




Phone:     617-654-4831 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 31204                    TAMPA                 FL 33618     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   CHARLES HUNNELL
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 49000                    CHARLOTTE             NC 28277     CMC550CHARLOTTE2@LIBERTYMUTUAL.COM



Phone:     800-532-7706 Ext.
                                                                                                               Contact Name:   ANGELA EVANS
LIBERTY INSURANCE CORPORATION               03-0316876     P O BOX 31204                    TAMPA                 FL 33631     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   DAVID KLOSSNER
LIBERTY INSURANCE CORPORATION               03-0316876     P O BOX 49000                    CHARLOTTE             NC 28277     CMC550CHARLOTTE2@LIBERTYMUTUAL.COM



Phone:     800-532-7706 Ext.
                                                                                                               Contact Name:   ANGELA EVANS


Last Updated: Wednesday, June 1, 2011                                             Page 335 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13182       LIBERTY INSURANCE CORPORATION                  175 BERKELEY ST.                 BOSTON                MA 02116     CORPORATESECRETARY@LIBERTYMUTUAL.COM




Phone:      617-654-4831 Ext.

LIBERTY MUTUAL GROUP                        04-1543470     P O BOX 31204                    TAMPA                 FL 33631     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:      800-282-6218 Ext.
                                                                                                               Contact Name:   DAVID KLOSSNER

Total # of Active Claim Offices: 6




Last Updated: Wednesday, June 1, 2011                                             Page 336 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10097      LIBERTY MUTUAL FIRE INS CO                      175 BERKELEY STREET              BOSTON                MA 02116     CORPORATESECRETARY@LIBERTYMUTUAL.COM




Phone:     800-344-0197 Ext.

HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 31204                    TAMPA                 FL 33618     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   CHARLES HUNNELL
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 49000                    CHARLOTTE             NC 28277     CMC550CHARLOTTE2@LIBERTYMUTUAL.COM



Phone:     800-532-7706 Ext.
                                                                                                               Contact Name:   ANGELA EVANS
LIBERTY MUTUAL FIRE INSURANCE               04-1924000     P O BOX 31204                    TAMPA                 FL 33631     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   DAVID KLOSSNER
LIBERTY MUTUAL FIRE INSURANCE               04-1924000     P O BOX 49000                    CHARLOTTE             NC 28277     CMC550CHARLOTTE2@LIBERTYMUTUAL.COM



Phone:     800-532-7706 Ext.
                                                                                                               Contact Name:   ANGELA EVANS
LIBERTY MUTUAL GROUP                        04-1543470     P O BOX 31204                    TAMPA                 FL 33631     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   DAVID KLOSSNER


Last Updated: Wednesday, June 1, 2011                                             Page 337 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10097       LIBERTY MUTUAL FIRE INS CO                     175 BERKELEY STREET              BOSTON                MA 02116     CORPORATESECRETARY@LIBERTYMUTUAL.COM




Phone:      800-344-0197 Ext.

LM INSURANCE CORPORATION                    04-3058504     P O BOX 31204                    TAMPA                 FL 33631     CMC555TAMPA@LIBERTYMUTUAL.COM


                                                           3901 PREMIER NORTH DRV
Phone:      800-282-6218 Ext.
                                                                                                               Contact Name:   DAVID KLOSSNER

Total # of Active Claim Offices: 6




Last Updated: Wednesday, June 1, 2011                                             Page 338 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10098      LIBERTY MUTUAL INS CO                           175 BERKELEY STREET              BOSTON                MA 02117     CORPORATESECRETARY@LIBERTYMUTUAL.COM




Phone:     800-282-6218 Ext.

HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 31204                    TAMPA                 FL 33618     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   CHARLES HUNNELL
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 49000                    CHARLOTTE             NC 28277     CMC550CHARLOTTE2@LIBERTYMUTUAL.COM



Phone:     800-532-7706 Ext.
                                                                                                               Contact Name:   ANGELA EVANS
LIBERTY INSURANCE CORPORATION               03-0316876     P O BOX 31204                    TAMPA                 FL 33631     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   DAVID KLOSSNER
LIBERTY MUTUAL GROUP                        04-1543470     P O BOX 31204                    TAMPA                 FL 33631     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   DAVID KLOSSNER
LIBERTY MUTUAL GROUP                        04-1543470     P O BOX 49000                    CHARLOTTE             NC 28277     CMC550CHARLOTTE2@LIBERTYMUTUAL.COM



Phone:     800-532-7706 Ext.
                                                                                                               Contact Name:   ANGELA EVANS


Last Updated: Wednesday, June 1, 2011                                             Page 339 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10098       LIBERTY MUTUAL INS CO                          175 BERKELEY STREET              BOSTON                MA 02117     CORPORATESECRETARY@LIBERTYMUTUAL.COM




Phone:      800-282-6218 Ext.

LIBERTY MUTUAL INS CO                       04-1543470     P O BOX 31204                    TAMPA                 FL 33631     RAYMOND.EVANS@LIBERTYMUTUAL.COM



Phone:      813-264-6588 Ext.
                                                                                                               Contact Name:   RAY EVANS
LM INSURANCE CORPORATION                    04-3058504     P O BOX 31204                    TAMPA                 FL 33631     CMC555TAMPA@LIBERTYMUTUAL.COM


                                                           3901 PREMIER NORTH DRV
Phone:      800-282-6218 Ext.
                                                                                                               Contact Name:   DAVID KLOSSNER

Total # of Active Claim Offices: 7




Last Updated: Wednesday, June 1, 2011                                             Page 340 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13220       LION INSURANCE COMPANY                         2739 US HIGHWAY 19 NORTH         HOLIDAY               FL 34691     GBEAN@LIONINSURANCECOMPANY.COM



                                                           SUITE 600
Phone:      727-938-5562 Ext. 6060

PACKARD CLAIMS ADMINISTRATION               03-0567602     2739 US HIGHWAY 19 NORTH         HOLIDAY               FL 34691     DOCUMENTS@PACKARDCLAIMS.COM
INC.

                                                           SUITE 500
Phone:      727-682-1072 Ext. 5552
                                                                                                               Contact Name:   Karen Betz

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 341 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13059      LM INSURANCE CO                                 175 BERKELEY STREET              BOSTON                MA 02116     CORPORATESECRETARY@LIBERTYMUTUAL.COM




Phone:     800-344-0197 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 31204                    TAMPA                 FL 33618     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   CHARLES HUNNELL
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 49000                    CHARLOTTE             NC 28277     CMC550CHARLOTTE2@LIBERTYMUTUAL.COM



Phone:     800-532-7706 Ext.
                                                                                                               Contact Name:   ANGELA EVANS
LIBERTY INSURANCE CORPORATION               03-0316876     P O BOX 31204                    TAMPA                 FL 33631     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   DAVID KLOSSNER


Last Updated: Wednesday, June 1, 2011                                             Page 342 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13059       LM INSURANCE CO                                175 BERKELEY STREET              BOSTON                MA 02116     CORPORATESECRETARY@LIBERTYMUTUAL.COM




Phone:      800-344-0197 Ext.

LIBERTY MUTUAL GROUP                        04-1543470     P O BOX 31204                    TAMPA                 FL 33631     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:      800-282-6218 Ext.
                                                                                                               Contact Name:   DAVID KLOSSNER
LM INSURANCE CORPORATION                    04-3058504     P O BOX 31204                    TAMPA                 FL 33631     CMC555TAMPA@LIBERTYMUTUAL.COM


                                                           3901 PREMIER NORTH DRV
Phone:      800-282-6218 Ext.
                                                                                                               Contact Name:   DAVID KLOSSNER
LM INSURANCE CORPORATION                    04-3058504     P O BOX 49000                    CHARLOTTE             NC 28277     CMC550CHARLOTTE2@LIBERTYMUTUAL.COM



Phone:      800-532-7706 Ext.
                                                                                                               Contact Name:   STEVEN SHORE

Total # of Active Claim Offices: 8




Last Updated: Wednesday, June 1, 2011                                             Page 343 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12005       LUMBERMENS UNDERWRITING                        1905 NW CORPORATE BLVD           BOCA RATON            FL 33431     GA@INS-LUA.COM
            ALLIANCE



Phone:      866-794-0360 Ext. 460

LUMBERMENS UNDERWRITING                     43-0799570     1905 NW CORPORATE BLVD           BOCA RATON            FL 33431     LYNNCLAIMS@INS-LUA.COM
ALLIANCE CLAIMS

Phone:      800-327-0515 Ext. 227
                                                                                                               Contact Name:   JANET SUTHERLAND

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 344 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10140       MAG MUTUAL INSURANCE COMPANY                   3525 PIEDMONT ROAD               ATLANTA               GA 30305     BPITTS@MAGMUTUAL.COM



                                                           BLDG 8-600
Phone:      800-282-4882 Ext.

ALTERNATIVE SERVICE CONCEPTS DBA            43-1954328     3135 AVALON RIDGE PLACE          NORCROSS              GA 30071     SUE.LORANCE@ASCRISK.COM
ASC LLC

                                                           SUITE 650
Phone:      678-447-0200 Ext. 302
                                                                                                               Contact Name:   SUE LORANCE
ALTERNATIVE SERVICE CONCEPTS DBA            43-1954328     3135 AVALON RIDGE PLACE          NORCROSS              GA 30071     SUE.LORANCE@ASCRISK.COM
ASC LLC

                                                           SUITE 650
Phone:      678-447-0200 Ext. 302
                                                                                                               Contact Name:   SUE LORANCE

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 345 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13139       MANUFACTURERS ALLIANCE                         380 SENTRY PARKWAY               BLUE BELL             PA 19422     STEPHEN_GARTNER@PMAGROUP.COM
            INSURANCE COMPANY



Phone:      800-222-2749 Ext.

MANUFACTURERS ALLIANCE                      23-2086596     500 NORTHPARK TOWN               ATLANTA               GA 30328     ADOLPHUS_DRAIN@PMAGROUP.COM
INSURANCE COMPANY                                          CENTER

                                                           1100 ABERNATHY RD NE #650
Phone:      888-888-8136 Ext.
                                                                                                               Contact Name:   ADOLPHUS DRAIN
PENNSYLVANIA MANUFACTURERS                  23-1642962     1100 ABERNATHY ROAD NE           ATLANTA               GA 30328     ADOLPHUS_DRAIN@PMAGROUP.COM
INDEMNITY

                                                           SUITE 650 500 NORTH PARK TOWN CENTER
Phone:      888-888-8136 Ext.
                                                                                                               Contact Name:   ADOLPHUS DRAIN
PMA INS GROUP                               23-1642962     1100 ABERNATHY ROAD NE           ATLANTA               GA 30328     ADOLPHUS_DRAIN@PMAGROUP.COM


                                                           SUITE 650 500 NORTH PARK TOWN CENTER
Phone:      770-677-3423 Ext.
                                                                                                               Contact Name:   ADOLPHUS DRAIN

Total # of Active Claim Offices: 3




Last Updated: Wednesday, June 1, 2011                                             Page 346 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10103      MARYLAND CASUALTY COMPANY                       1400 AMERICAN LANE               SCHAUMBURG            IL 60196     TIM.GRAHAM@ZURICHNA.COM




Phone:     800-340-8602 Ext. 8613

MARYLAND CASUALTY COMPANY                   52-0403120     3003 SUMMIT BLVD                 ATLANTA               GA 30319     CHRIS.CALLOWAY@ZURICHNA.COM


                                                           SUITE 1800
Phone:     404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY
MARYLAND CASUALTY COMPANY                   52-0403120     1900 SUMMIT TOWER BLVD           ORLANDO               FL 32810     CHRIS.CALLOWAY@ZURICHNA.COM


                                                           SUITE 600
Phone:     404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY
ZURICH NORTH AMERICA                        36-3839542     P.O. BOX 2769                    SCHAUMBERG            IL   60666   USZ_GA_WC_CLAIM_NOTICES@ZURICHNA.COM



Phone:     404-851-3208 Ext.
                                                                                                               Contact Name:   SHELLY HAYES
ZURICH SERVICES CORP                        36-3839542     3003 SUMMIT BLVD                 ATLANTA               GA 30319     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM


                                                           STE 1800
Phone:     404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY
ZURICH SERVICES CORPORATION                 36-3839542     1001 SUMMIT BLVD                 ATLANTA               GA 30319     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM


                                                           SUITE 800
Phone:     404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY


Last Updated: Wednesday, June 1, 2011                                             Page 347 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 5




 SBWC #     Name                            FEIN            Address                                                            Email


10258       MASSACHUSETTS BAY INS CO                       440 LINCOLN STREET               WORCESTER             MA 01653     DAWMURPHY@HANOVER.COM




Phone:      508-855-5893 Ext.

HANOVER INSURANCE COMPANY                   13-5129825     440 LINCOLN STREET               WORCESTER             MA 01653     EBESHAI@HANOVER.COM



Phone:      800-628-0250 Ext.
                                                                                                               Contact Name:   ELIZABETH BESHAI

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 348 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13215       MEMIC INDEMNITY COMPANY                        PO BOX 11409                     PORTLAND              ME 04104     KSCHWARTZ@MEMIC.COM




Phone:      -- Ext.

CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR              MAITLAND              FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

Phone:      866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN
MEMIC INDEMNITY COMPANY                     02-0515329     1750 ELM STREET                  MANCHESTER            NH 03104     MHARMON@MEMIC.COM


                                                           STE 500
Phone:      800-660-1306 Ext. 612
                                                                                                               Contact Name:   MATTHEW HARMON

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 349 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13148      MERIDIAN SECURITY INSURANCE CO                  2955 N MERIDIAN ST               INDIANAPOLIS          IN 46208     MIKE.HOLMES@STATEAUTO.COM




Phone:     800-777-7324 Ext.

CORVEL CORP                                 95-3382819     4820 LAKE BROOK DRIVE            GLEN ALLEN            VA 23058     MARCIA_MORGAN@CORVEL.COM


                                                           SUITE 150
Phone:     800-906-4461 Ext.
                                                                                                               Contact Name:   MARCIA MORGAN
CORVEL CORPORATION                          95-3382819     4820 LAKE BROOK DRIVE #150       GLEN ALLEN            VA 23058     MARCIA_MORGAN@CORVEL.COM



Phone:     -- Ext.
                                                                                                               Contact Name:   MARCIA MORGAN
MERIDIAN SECURITY INSURANCE                 35-1135866     P O BOX 7183                     INDIANAPOLIS          IN 46206     GLORIA-JEANNE.WILSON@STATEAUTO.COM



Phone:     800-777-7324 Ext.
                                                                                                               Contact Name:   GLORIA JEANNE WILSON
STATE AUTOMOBILE CLAIMS                     31-4316080     2955 N MERIDIAN STREET           INDIANAPOLIS          IN 46206     GLORIA-JEANNE.WILSON@STATEAUTO.COM



Phone:     800-777-7324 Ext.
                                                                                                               Contact Name:   GLORIA JEANNE WILSON




Last Updated: Wednesday, June 1, 2011                                             Page 350 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 4




Last Updated: Wednesday, June 1, 2011                                             Page 351 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10172       METLIFE INSURANCE OF CONNECTICUT               1300 HALL BOULEVARD              BLOOMFIELD            CT 06002     KDAVIS@TRAVELERS.COM
            FKA TRAVELERS INSURANCE CO



Phone:      860-656-3000 Ext.

TRAVELERS COMPANIES INC                     -              P O BOX 3570                     BRANDON               FL 33509     DBRYSON@TRAVELERS.COM



Phone:      800-238-6214 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON
TRAVELERS INDEMNITY COMPANY                 06-0566050     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           SUITE 100
Phone:      800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
TRAVELERS INDEMNITY COMPANY                 -              3097 SATELLITE BLVD              DULUTH                GA 30096     GEORGIAWCBOARD@TRAVELERS.COM



Phone:      800-241-6225 Ext.
                                                                                                               Contact Name:   TARI-LEE GATES

Total # of Active Claim Offices: 3




Last Updated: Wednesday, June 1, 2011                                             Page 352 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13274       MICHIGAN COMMERCIAL INSURANCE                  1044 EASTBURY DRIVE              LANSING               MI 48917     ESCHOBERT@MCIM.COM
            MUTUAL



Phone:      -- Ext.

CRAWFORD & COMPANY                          58-0506554     1001 SUMMIT BLVD                 ATLANTA               GA 30319     ATLANTA.GA@US.CRAWCO.COM



Phone:      -- Ext.
                                                                                                               Contact Name:   STUART TUCKER
MICHIGAN COMMERCIAL INSURANCE               38-3497412     4161 CLARK ROAD                  SARASOTA              FL 34233     WRODRIGUEZ@MCIM.COM
MUTUAL

Phone:      800-262-4743 Ext.
                                                                                                               Contact Name:   WANDA RODRIGUEZ
MICHIGAN COMMERCIAL INSURANCE               38-3497412     1044 EASTBURY DRIVE              LANSING               MI 48917     WRODRIGUEZ@MCIM.COM
MUTUAL

Phone:      800-262-4743 Ext.
                                                                                                               Contact Name:   WANDA RODRIGUEZ

Total # of Active Claim Offices: 3




Last Updated: Wednesday, June 1, 2011                                             Page 353 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10222       MIDDLESEX INSURANCE COMPANY                    PO BOX 8032                      STEVENS POINT         WI 54481     TOM.HERZOG@SENTRY.COM




Phone:      800-739-3344 Ext.

SENTRY INSURANCE A MUTUAL                   39-0333950     P O BOX 26263                    RICHMOND              VA 23260     WCCLAIMSEAST@SENTRY.COM
COMPANY

Phone:      800-338-2487 Ext. 4616
                                                                                                               Contact Name:   TIM O'BRIEN
SENTRY SELECT INSURANCE COMPANY             39-0333950     P O BOX 8032                     STEVENS POINT         WI 54481     WCCLAIMSEAST@SENTRY.COM



Phone:      800-739-3344 Ext. 9063
                                                                                                               Contact Name:   DONNA KLASING

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 354 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13292       MIDWEST BUILDERS CASUALTY                      1100 WALNUT STREET               KANSAS CITY           MO 64106     JCROWLEY@MWBC.COM
            MUTUAL COMPANY

                                                           SUITE 3010
Phone:      -- Ext.

CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD           POMPANO BEACH         FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:      877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 355 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10104      MIDWEST EMPLOYERS CASUALTY                      14755 NORTH OUTER FORTY          CHESTERFIELD          MO 63017     LALOISI@MWECC.COM
                                                           DR.

                                                           SUITE 300
Phone:     877-975-2667 Ext.

AVIZENT FKA FRANK GATES SERVICE             31-4359765     THIS IS NOT A CLAIMS             EDI USE ONLY          OH 43017     RKARIKAS@AVIZENTRISK.COM
                                                           OFFICE

Phone:     614-766-8747 Ext.
                                                                                                               Contact Name:   REBECCA KARIKAS
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA            BIRMINGHAM            AL 35209     DMCCLOSKEY@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 29106
                                                                                                               Contact Name:   DAVIDA MCCLOSKEY
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA            BIRMINGHAM            AL 35209     CMULLINS@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 20104
                                                                                                               Contact Name:   CHRISTINA MULLINS
BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI


Last Updated: Wednesday, June 1, 2011                                             Page 356 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10104       MIDWEST EMPLOYERS CASUALTY                     14755 NORTH OUTER FORTY          CHESTERFIELD          MO 63017     LALOISI@MWECC.COM
                                                           DR.

                                                           SUITE 300
Phone:      877-975-2667 Ext.

HERITAGE CONSULTANTS                        59-2305659     209 PALMETTO STREET              AUBRUNDALE            FL 33823     GGIST@FLORIDATPA.COM



Phone:      800-282-2460 Ext.
                                                                                                               Contact Name:   CATHY GIST
KEY RISK MANAGEMENT SERVICES                56-1800954     P O BOX 49129                    GREENSBORO            NC 27419     GHENEHAN@KEYRISK.COM



Phone:      336-668-9050 Ext. 7539
                                                                                                               Contact Name:   GEORGE HENEHAN

Total # of Active Claim Offices: 7




Last Updated: Wednesday, June 1, 2011                                             Page 357 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13208       MIDWESTERN INDEMNITY COMPANY                   6281 TRI RIDGE BLVD              LOVELAND              OH 45140     CORPORATESECRETARY@LIBERTYMUTUA.COM




Phone:      800-436-9600 Ext.

MONTGOMERY INSURANCE CLAIM                  52-0424870     P O BOX 49130                    CHARLOTTE             NC 28277     CHRISTINE.JONES@MONTGOMERY-INS.COM
CENTER

Phone:      800-334-0078 Ext. 214
                                                                                                               Contact Name:   CHRISTINE JONES

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 358 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13054       MITSUI SUMITOMO INS. CO. OF AM                 15 INDEPENDENCE BLVD             WARREN                NJ 07059     BCURTIS@MSIGUSA.COM




Phone:      800-388-1802 Ext. 8906

MITSUI SUMITO MARINE MGT                    13-3429270     14 PIEDMONT CNT #415             ATLANTA               GA 30305     PEASTERWOOD@MSIGUSA.COM


                                                           3535 PIEDMONT ROAD
Phone:      877-365-2299 Ext.
                                                                                                               Contact Name:   PAT EASTERWOOD
MITSUI SUMITOMO MARINE                      22-3818012     312 ELM STREET                   CINCINNATI            OH 45202
MANAGEMENT (USA) INC

                                                           SUITE 1250
Phone:      -- Ext.
                                                                                                               Contact Name:   WORKERS COMPENSATION MANAGER

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 359 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13233       MITSUI SUMITOMO INSURANCE USA INC              15 INDEPENDENCE BLVD             WARREN                NJ 07059     BCURTIS@MSIGUSA.COM




Phone:      -- Ext.

MITSUI SUMITO MARINE MGT                    13-3429270     14 PIEDMONT CNT #415             ATLANTA               GA 30305     PEASTERWOOD@MSIGUSA.COM


                                                           3535 PIEDMONT ROAD
Phone:      877-365-2299 Ext.
                                                                                                               Contact Name:   PAT EASTERWOOD

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 360 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13219       MONROE GUARANTY INSURANCE COMP                 6300 UNIVERSITY PARKWAY          SARASOTA              FL 34240     COMPLIANCEDEPT@FCCI-GROUP.COM




Phone:      -- Ext.

FCCI SERVICES                               59-1968027     P O BOX 58004                    SARASOTA              FL 34232     FCCICLAIMSEDI@FCCI-GROUP.COM



Phone:      800-226-3243 Ext. 5729
                                                                                                               Contact Name:   TINA YENNA
FCCI SERVICES INC                           59-1968027     6300 UNIVERSITY                  SARASOTA              FL 34240     FCCICLAIMSEDI@FCCI-GROUP.COM



Phone:      800-226-3243 Ext. 5729
                                                                                                               Contact Name:   TINA YENNA

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 361 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12081       NATIONAL AMERICAN INSURANCE                    1010 MANVEL AVENUE               CHANDLER              OK 74834
            COMPANY



Phone:      800-332-2210 Ext.

NATIONAL AMERICAN INS CO                    47-0247300     1010 MANVEL AVENUE               CHANDLER              OK 74834     LMCGREGOR@NAICO.COM



Phone:      800-332-2210 Ext.
                                                                                                               Contact Name:   RAY HERRING

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 362 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10115      NATIONAL FIRE INS COMPANY OF                    3333 S WABASH AVENUE             CHICAGO               IL 60604     GASTATEICNUMBERS@CNA.COM
           HARTFORD

                                                           28 SOUTH
Phone:     312-822-3874 Ext.

CNA CLAIMS PLUS                             16-1633560     2435 COMMERCE AVENUE             DULUTH                GA 30096     GASTATEICNUMBERS@CNA.COM


                                                           BDG 2200 SATELLITE PLACE
Phone:     800-283-2318 Ext. 3574
                                                                                                               Contact Name:   TAMARA WILLIAMS
CONTINENTAL CASUALTY COMPANY                36-2114545     333 SOUTH WABASH                 CHICAGO               IL   60604   GASTATEICNUMBERS@CNA.COM


                                                           38S
Phone:     312-822-2331 Ext.
                                                                                                               Contact Name:   COLETTE TURNER
COTTINGHAM & BUTLER CLAIM                   20-5233506     P O BOX 28                       DUBUQUE               IA 52004     DUNMACHT@CBCSCLAIMS.COM
SERVICES

Phone:     877-241-6121 Ext.
                                                                                                               Contact Name:   DAN UNMACHT
COTTINGHAM AND BUTLER CLAIM                 20-5233506     P O BOX 28                       DUBUQUE               IA 52004     DUNMACHT@CBCSCLAIMS.COM
SERVICES

Phone:     877-241-6121 Ext.
                                                                                                               Contact Name:   DAN UNMACHT
SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER            ATLANTA               GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN


Last Updated: Wednesday, June 1, 2011                                             Page 363 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 5




 SBWC #     Name                            FEIN            Address                                                            Email


12088       NATIONAL INDEMNITY COMPANY                     3024 HARNEY ST                   OMAHA                 NE 68131     LRRU@NATIONALINDEMNITY.COM




Phone:      800-356-5750 Ext.

CYPRESS INSURANCE                           95-6042929     1725 WINDWARD                    ALPHARETTA            GA 30005     CBARNES@BHHC.COM
                                                           CONCOURSE

                                                           SUITE 200
Phone:      877-212-3816 Ext. 230
                                                                                                               Contact Name:   COURTNEY BARNES

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 364 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13184       NATIONAL INTERSTATE INSURANCE                  3250 INTERSTATE DR.              RICHFIELD             OH 44286     KATHY.JUHASZ@NATL.COM
            COMPANY



Phone:      800-929-1500 Ext.

COLLINS & COMPANY                           62-0882150     P O BOX 6429                     DALTON                GA 30722     AGRIME@COLLINSANDCO.COM



Phone:      706-277-1253 Ext.
                                                                                                               Contact Name:   ANGELA GRIME
COLLINS & COMPANY                           62-0882150     555 RIVER ST                     CHATTANOOGA           TN 37405     SBIBLE@COLLINSANDCO.COM



Phone:      423-265-0541 Ext.
                                                                                                               Contact Name:   SUE BIBLE
COLLINS AND COMPANY                         62-0882150     P O BOX 723783                   ATLANTA               GA 31139     ATLANTA@COLLINSANDCO.COM



Phone:      770-434-9222 Ext.
                                                                                                               Contact Name:   CHRIS CANE

Total # of Active Claim Offices: 3




Last Updated: Wednesday, June 1, 2011                                             Page 365 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13047       NATIONAL LIABILITY & FIRE                      3024 HARNEY STREET               OMAHA                 NE 68131     STRPTGA@NATIONALINDEMNITY.COM
            INSURANCE COMPANY



Phone:      402-536-3000 Ext.

ASSOCIATED INSURANCE                        63-1103582     P O BOX 230848                   MONTGOMERY            AL 36123     CDAIL@ACAWORKCOMP.COM
ADMINISTRATORS

Phone:      800-388-6268 Ext.
                                                                                                               Contact Name:   CINDY DAIL

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 366 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10117       NATIONAL SURETY CORPORATION                    777 SAN MARIN DRIVE              NOVATO                CA 94998     LMUNSON@FFIC.COM




Phone:      800-227-1700 Ext.

FIREMAN'S FUND CLAIMS CENTER                58-1373156     P O BOX 740174                   ATLANTA               GA 30374     KLOCKE@FFIC.COM



Phone:      678-393-4550 Ext.
                                                                                                               Contact Name:   KEN LOCKE
FIREMAN'S FUND INSURANCE CO                 94-1610280     11475 GREAT OAKS WAY             ALPHARETTA            GA 30022     JUDY.OWEN@AFFIC.COM


                                                           ROYAL CTR 3 STE 200
Phone:      678-393-4584 Ext.
                                                                                                               Contact Name:   JUDY OWEN

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 367 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13061       NATIONAL TRUST INSURANCE                       6300 UNIVERSITY PARKWAY          SARASOTA              FL 34240     COMPLIANCEDEPT@FCCI-GROUP.COM
            COMPANY



Phone:      800-226-3224 Ext.

FCCI SERVICES                               59-1968027     P O BOX 58004                    SARASOTA              FL 34232     FCCICLAIMSEDI@FCCI-GROUP.COM



Phone:      800-226-3243 Ext. 5729
                                                                                                               Contact Name:   TINA YENNA
FCCI SERVICES INC                           59-1968027     6300 UNIVERSITY                  SARASOTA              FL 34240     FCCICLAIMSEDI@FCCI-GROUP.COM



Phone:      800-226-3243 Ext. 5729
                                                                                                               Contact Name:   TINA YENNA

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 368 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10118      NATIONAL UNION FIRE INSURANCE                   175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM
           COMPANY OF PITTSBURGH PA

                                                           18TH FLOOR
Phone:     212-458-7043 Ext.

ALTERNATIVE SERVICE CONCEPTS DBA            43-1954328     3135 AVALON RIDGE PLACE          NORCROSS              GA 30071     SUE.LORANCE@ASCRISK.COM
ASC LLC

                                                           SUITE 650
Phone:     678-447-0200 Ext. 302
                                                                                                               Contact Name:   SUE LORANCE
ALTERNATIVE SERVICE CONCEPTS LLC            43-1954328     3135 AVALON RIDGE PLACE          NORCROSS              GA 30071     SUE.LORANCE@ASCRISK.COM
DBA ASC

                                                           SUITE 650
Phone:     678-447-0200 Ext. 302
                                                                                                               Contact Name:   SUE LORANCE
AVIZENT FKA FRANK GATES SERVICE             31-4359765     THIS IS NOT A CLAIMS             EDI USE ONLY          OH 43017     RKARIKAS@AVIZENTRISK.COM
                                                           OFFICE

Phone:     614-766-8747 Ext.
                                                                                                               Contact Name:   REBECCA KARIKAS
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA            BIRMINGHAM            AL 35209     DMCCLOSKEY@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 29106
                                                                                                               Contact Name:   DAVIDA MCCLOSKEY
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA            BIRMINGHAM            AL 35209     CMULLINS@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 20104
                                                                                                               Contact Name:   CHRISTINA MULLINS


Last Updated: Wednesday, June 1, 2011                                             Page 369 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10118      NATIONAL UNION FIRE INSURANCE                   175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM
           COMPANY OF PITTSBURGH PA

                                                           18TH FLOOR
Phone:     212-458-7043 Ext.

CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD           POMPANO BEACH         FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:     877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD
CAMBRIDGE INTEGRATED SERVICES               23-2731565     6300 CENTER HILL ROAD            CINCINNATI            OH 45224     NICOLE.DEWITT@US.XCHANGING.COM
GROUP INC

Phone:     800-235-1134 Ext. 5
                                                                                                               Contact Name:   NICOLE DEWITT
CHARTIS CLAIMS                              13-2925174     P O BOX 1821                     ALPHARETTA            GA 30023     ALGAWCFR@AIG.COM



Phone:     800-448-9707 Ext.
                                                                                                               Contact Name:   ANNA COLBURN
ESIS INC                                    95-2008390     500 COLONIAL PARKWAY             ROSWELL               GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
F A RICHARD (FARA)                          72-0837383     1625 WEST CAUSEWAY               MANDEVILLE            LA 70471     GEORGIA.NOTICES@FARA.COM
                                                           APPROACH

Phone:     985-624-6739 Ext.
                                                                                                               Contact Name:   CHAD RANFLE


Last Updated: Wednesday, June 1, 2011                                             Page 370 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10118      NATIONAL UNION FIRE INSURANCE                   175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM
           COMPANY OF PITTSBURGH PA

                                                           18TH FLOOR
Phone:     212-458-7043 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
SEDGWICK CLAIMS MANAGEMENT                  71-0738006     THIS IS NOT A CLAIMS             BENTONVILLE           AR 72756     TINA.HUDNALL@CMIW.COM
                                                           OFFICE

                                                           EDI USE ONLY
Phone:     479-621-2900 Ext. 1279
                                                                                                               Contact Name:   TINA HUDNALL
SEDGWICK CMS                                36-2685608     3700 CRESTWOOD PARKWAY           DULUTH                GA 30096     ATLANTA.GA@SEDGWICKCMS.COM


                                                           SUITE 600
Phone:     678-628-1318 Ext.
                                                                                                               Contact Name:   RONETTA WILSON
SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER            ATLANTA               GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKEVIEW                     NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-493-5802 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS


Last Updated: Wednesday, June 1, 2011                                             Page 371 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10118       NATIONAL UNION FIRE INSURANCE                  175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM
            COMPANY OF PITTSBURGH PA

                                                           18TH FLOOR
Phone:      212-458-7043 Ext.

SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:      678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:      800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN

Total # of Active Claim Offices: 17




Last Updated: Wednesday, June 1, 2011                                             Page 372 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13143       NATIONWIDE AGRIBUSINESS                        1100 LOCUST ST.                  DES MOINES            IA 50391     NEWCLAIM@NATIONWIDE.COM



                                                           DEPT 3030
Phone:      515-508-4921 Ext.

NATIONWIDE AGRIBUSINESS                     42-1015537     1100 LOCUST ST.                  DES MOINES            IA 50391     NEWCLAIM@NATIONWIDE.COM


                                                           DEPT 3010
Phone:      800-532-1436 Ext. 4344
                                                                                                               Contact Name:   STEVE LARSEN

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 373 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12021       NATIONWIDE MUTUAL FIRE INS CO                  ONE NATIONWIDE PLAZA             COLUMBUS              OH 43215     KINGJ4@NATIONWIDE.COM




Phone:      614-249-0702 Ext.

NATIONWIDE INSURANCE                        31-4177100     P O BOX 147061                   GAINESVILLE           FL 32614     FERRANT@NATIONWIDE.COM



Phone:      800-985-7078 Ext.
                                                                                                               Contact Name:   TOM FERRANTE

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 374 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10119       NATIONWIDE MUTUAL INS CO                       ONE NATIONWIDE PLAZA             COLUMBUS              OH 43215     KINGJ4@NATIONWIDE.COM



                                                           3-13-401
Phone:      614-249-0702 Ext.

NATIONWIDE INSURANCE                        31-4177100     P O BOX 147061                   GAINESVILLE           FL 32614     FERRANT@NATIONWIDE.COM



Phone:      800-985-7078 Ext.
                                                                                                               Contact Name:   TOM FERRANTE

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 375 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13015       NATIONWIDE PROPERTY AND                        ONE NATIONWIDE PLAZA             COLUMBUS              OH 43215     KINGJ4@NATIONWIDE.COM
            CASUALTY INSURANCE CO                          3-13-401



Phone:      614-249-0702 Ext.

NATIONWIDE INSURANCE                        31-4177100     P O BOX 147061                   GAINESVILLE           FL 32614     FERRANT@NATIONWIDE.COM



Phone:      800-985-7078 Ext.
                                                                                                               Contact Name:   TOM FERRANTE

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 376 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13045       NETHERLANDS INS CO                             62 MAPLE AVENUE                  KEENE                 NH 03431     CORPORATESECRETARY@LIBERTYMUTUAL.COM




Phone:      800-826-6189 Ext.

MONTGOMERY INSURANCE CLAIM                  52-0424870     P O BOX 49130                    CHARLOTTE             NC 28277     CHRISTINE.JONES@MONTGOMERY-INS.COM
CENTER

Phone:      800-334-0078 Ext. 214
                                                                                                               Contact Name:   CHRISTINE JONES

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 377 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10122      NEW HAMPSHIRE INSURANCE CO                      175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM



                                                           18TH FLOOR
Phone:     -- Ext.

ALTERNATIVE SERVICE CONCEPTS DBA            43-1954328     3135 AVALON RIDGE PLACE          NORCROSS              GA 30071     SUE.LORANCE@ASCRISK.COM
ASC LLC

                                                           SUITE 650
Phone:     678-447-0200 Ext. 302
                                                                                                               Contact Name:   SUE LORANCE
ALTERNATIVE SERVICE CONCEPTS LLC            43-1954328     3135 AVALON RIDGE PLACE          NORCROSS              GA 30071     SUE.LORANCE@ASCRISK.COM
DBA ASC

                                                           SUITE 650
Phone:     678-447-0200 Ext. 302
                                                                                                               Contact Name:   SUE LORANCE
AVIZENT FKA FRANK GATES SERVICE             31-4359765     THIS IS NOT A CLAIMS             EDI USE ONLY          OH 43017     RKARIKAS@AVIZENTRISK.COM
                                                           OFFICE

Phone:     614-766-8747 Ext.
                                                                                                               Contact Name:   REBECCA KARIKAS
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA            BIRMINGHAM            AL 35209     DMCCLOSKEY@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 29106
                                                                                                               Contact Name:   DAVIDA MCCLOSKEY
AVIZENT fka FRANK GATES SERVICE CO          31-4359765     #1 INDEPENDENCE PLAZA            BIRMINGHAM            AL 35209     CMULLINS@AVIZENTRISK.COM



Phone:     800-277-7500 Ext. 20104
                                                                                                               Contact Name:   CHRISTINA MULLINS


Last Updated: Wednesday, June 1, 2011                                             Page 378 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10122      NEW HAMPSHIRE INSURANCE CO                      175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM



                                                           18TH FLOOR
Phone:     -- Ext.

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
CAMBRIDGE INTEGRATED SERVICE                23-2731565     809 GLEN EAGLES COURT            TOWSON                MD 21286     BRIAN.WALSH@US.XCHANGING.COM
GROUP INC

                                                           SUITE 210
Phone:     419-847-6323 Ext.
                                                                                                               Contact Name:   BRIAN WALSH
CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD           POMPANO BEACH         FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:     877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD
CAMBRIDGE INTEGRATED SERVICES               23-2731565     6300 CENTER HILL ROAD            CINCINNATI            OH 45224     NICOLE.DEWITT@US.XCHANGING.COM
GROUP INC

Phone:     800-235-1134 Ext. 5
                                                                                                               Contact Name:   NICOLE DEWITT
CAMBRIDGE INTEGRATED SERVICES               23-2731565     6300 CENTER HILL ROAD            CINCINNATI            OH 45224     NICOLE.DEWITT@US.EXCHANGING.COM
GROUP INC

Phone:     800-235-1134 Ext. 5
                                                                                                               Contact Name:   NICOLE DEWITT


Last Updated: Wednesday, June 1, 2011                                             Page 379 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10122      NEW HAMPSHIRE INSURANCE CO                      175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM



                                                           18TH FLOOR
Phone:     -- Ext.

CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR              MAITLAND              FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

Phone:     866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN
CHARTIS CLAIMS                              13-2925174     P O BOX 1821                     ALPHARETTA            GA 30023     ALGAWCFR@AIG.COM



Phone:     800-448-9707 Ext.
                                                                                                               Contact Name:   ANNA COLBURN
CONSTITUTION STATE SERVICES                 06-1501229     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           STE 100
Phone:     770-352-2978 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
CONSTITUTION STATE SERVICES                 06-1501229     10401 HIGHLAND MANOR DR          TAMPA                 FL 33612     GEORGIAWCBOARD@TRAVELERS.COM


                                                           STE 200
Phone:     770-934-3414 Ext.
                                                                                                               Contact Name:   JOSEPH CIBULSKI
CONSTITUTION STATE SERVICES                 06-1501229     1000 FIANA WAY                   FT SMITH              AR 72919     MJWHITE@TRAVELERS.COM



Phone:     800-842-5612 Ext.
                                                                                                               Contact Name:   MELISSA WHITE


Last Updated: Wednesday, June 1, 2011                                             Page 380 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10122      NEW HAMPSHIRE INSURANCE CO                      175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM



                                                           18TH FLOOR
Phone:     -- Ext.

COTTINGHAM & BUTLER CLAIM                   20-5233506     P O BOX 28                       DUBUQUE               IA 52004     DUNMACHT@CBCSCLAIMS.COM
SERVICES

Phone:     877-241-6121 Ext.
                                                                                                               Contact Name:   DAN UNMACHT
ESIS INC                                    95-2008390     500 COLONIAL PARKWAY             ROSWELL               GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
F A RICHARD (FARA)                          72-0837383     1625 WEST CAUSEWAY               MANDEVILLE            LA 70471     GEORGIA.NOTICES@FARA.COM
                                                           APPROACH

Phone:     985-624-6739 Ext.
                                                                                                               Contact Name:   CHAD RANFLE
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES
GALLAGHER BASSETT SERVICES                  36-3365500     P O BOX 279310                   MIRAMAR               FL 33027     KRISTY_SANDS@GBTPA.COM



Phone:     800-473-9009 Ext.
                                                                                                               Contact Name:   KRISTY SANDS


Last Updated: Wednesday, June 1, 2011                                             Page 381 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10122      NEW HAMPSHIRE INSURANCE CO                      175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM



                                                           18TH FLOOR
Phone:     -- Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 21227                    TAMPA                 FL 33622     WILLIAM_KIMBROUGH@GBTPA.COM



Phone:     866-428-0283 Ext.
                                                                                                               Contact Name:   WILLIAM KIMBROUGH
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 785071                   ORLANDO               FL 32878     KEITH_LEAHY@GBTPA.COM



Phone:     800-843-8999 Ext.
                                                                                                               Contact Name:   KEITH LEAHY
GALLAGHER BASSETT SERVICES INC              36-3365500     1301 INTERNATIONAL               SUNRISE               FL 33323     ANDREA_HUMPHRIES@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 230
Phone:     800-889-6764 Ext. 201
                                                                                                               Contact Name:   ANDREA HUMPHRIES
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER


Last Updated: Wednesday, June 1, 2011                                             Page 382 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10122      NEW HAMPSHIRE INSURANCE CO                      175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM



                                                           18TH FLOOR
Phone:     -- Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 4840                     CLEARWATER            FL 33758     KIM_BUCHANAN@GBTPA.COM



Phone:     800-226-8002 Ext.
                                                                                                               Contact Name:   KIM BUCHANAN
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 31204                    TAMPA                 FL 33618     CMC555TAMPA@LIBERTYMUTUAL.COM



Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   CHARLES HUNNELL
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 49000                    CHARLOTTE             NC 28277     CMC550CHARLOTTE2@LIBERTYMUTUAL.COM



Phone:     800-532-7706 Ext.
                                                                                                               Contact Name:   ANGELA EVANS
HELMSMAN MANAGEMENT SERVICES                04-2791584     P O BOX 31204                    TAMPA                 FL 33631     HEATHER.STANFORD@LIBERTYMUTUAL.COM
LLC

Phone:     800-282-6218 Ext.
                                                                                                               Contact Name:   HEATHER STANFORD
RISK ENTERPRISE MANAGEMENT                  13-3832689     1140 HAMMOND DR                  ATLANTA               GA 30328     JANET.GREER@REMLTD.COM
LIMITED

                                                           SUITE J-2075
Phone:     800-347-4494 Ext.
                                                                                                               Contact Name:   JANET GREER


Last Updated: Wednesday, June 1, 2011                                             Page 383 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10122      NEW HAMPSHIRE INSURANCE CO                      175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM



                                                           18TH FLOOR
Phone:     -- Ext.

RISK ENTERPRISE MANAGEMENT                  13-3832689     565 MARRIOTT DRIVE               NASHVILLE             TN 37214     JANICE.GUIDRY@REMLTD.COM
LIMITED

                                                           SUITE 725
Phone:     800-871-6670 Ext.
                                                                                                               Contact Name:   JANICE GUIDRY
SEDGWICK CMS                                36-2685608     3700 CRESTWOOD PARKWAY           DULUTH                GA 30096     ATLANTA.GA@SEDGWICKCMS.COM


                                                           SUITE 600
Phone:     678-628-1318 Ext.
                                                                                                               Contact Name:   RONETTA WILSON
SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER            ATLANTA               GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN
SEDGWICK CMS                                36-2685608     1100 RIDGEWAY LOOP ROAD          MEMPHIS               TN 38120     APULLEN@SEDGWICKCMS.COM



Phone:     241-922-0638 Ext.
                                                                                                               Contact Name:   ANTHONY PULLEN
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                    NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS


Last Updated: Wednesday, June 1, 2011                                             Page 384 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10122       NEW HAMPSHIRE INSURANCE CO                     175 WATER STREET                 NEW YORK              NY 10038     ALGAWCFR@AIG.COM



                                                           18TH FLOOR
Phone:      -- Ext.

SPECIALTY RISK SERVICES                     20-0730592     P O BOX 14151                    LEXINGTON             KY 40512     DANIELLE.MINNIEHAN@SRSCONNECT.COM



Phone:      800-541-0139 Ext. 35832
                                                                                                               Contact Name:   DANIELLE MINNIEHAN
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:      678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:      800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN

Total # of Active Claim Offices: 38




Last Updated: Wednesday, June 1, 2011                                             Page 385 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13294       NEW YORK MARINE & GENERAL                      919 3RD AVENUE                   NEW YORK              NY 10022     CMCAULEY@PROSIGHTSPECIALTY.COM
            INSURANCE COMPANY

                                                           10TH FLOOR
Phone:      -- Ext.

SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER            ATLANTA               GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:      800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 386 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12040       NIPPONKOA INS CO LTD (US BRANCH)               ONE TOWER SQUARE                 HARTFORD              CT 06183




Phone:      860-954-5660 Ext.

NIPPONKOA INSURANCE COMPANY                 98-0032627     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
LIMITED (U S BRANCH)                                       CONCOURSE

                                                           SUITE 100
Phone:      800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
NIPPONKOA INSURANCE COMPANY                 98-0032627     10401 HIGHLAND MANOR             TAMPA                 FL 33610     DBRYSON@TRAVELERS.COM
LIMITED (U S BRANCH)                                       DRIVE

                                                           BUILDING V SUITE 200
Phone:      888-329-6259 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 387 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13101       NLC MUTUAL INSURANCE COMPANY                   1301 PENNSYLVANIA                WASHINGTON            DC 20004     MMCCORD@NLCMUTUAL.COM
                                                           AVENUE NW

                                                           #550
Phone:      202-626-3110 Ext.

NLC Mutual Insurance Company                52-1479893     1301 PENNSYLVANIA AVE            WASHINGTON            DC 20004     GERGEN@NLCMUTUAL.COM


                                                           SUITE 550
Phone:      202-626-3162 Ext.
                                                                                                               Contact Name:   ANN GERGEN

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 388 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13169      NORGUARD INSURANCE COMPANY                      P O BOX A-H                      WILKES-BARRE          PA 18703     ESOLA@GUARD.COM




Phone:     800-673-2465 Ext.

AMGUARD                                     23-2240321     P O Box 1368                     WILKES-BARRE          PA 18703     CLAIMS3@GUARD.COM



Phone:     800-673-2465 Ext. 8110
                                                                                                               Contact Name:   BELINDA DIAMOND
GUARD INSURANCE GROUP                       23-2240322     P O BOX A - H                    WILKES-BARRE          PA 18703     CLAIMS3@GUARD.COM



Phone:     800-673-2465 Ext. 8110
                                                                                                               Contact Name:   BELINDA DIAMOND
GUARD INSURANCE GROUP                       -              P O Box 1368                     WILKES-BARRE          PA 18703     CLAIMS3@GUARD.COM



Phone:     678-581-0589 Ext.
                                                                                                               Contact Name:   KEVIN FOLEY
GUARD INSURANCE GROUP                       23-2240322     102 WEST PENNSYLVANIA            TOWSON                MD 21204     CLAIMS3@GUARD.COM
                                                           AVE

                                                           SUITE 206
Phone:     800-673-2465 Ext. 8302
                                                                                                               Contact Name:   LENWOOD HALL




Last Updated: Wednesday, June 1, 2011                                             Page 389 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 4




 SBWC #     Name                            FEIN            Address                                                            Email


13001       NORTH AMERICAN SPECIALTY                       650 ELM STREET                   MANCHESTER            NH 03101     MARILYN_WRIGHT@SWISSRE.COM
            INSURANCE



Phone:      913-676-3015 Ext.

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:      800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
GALLAGHER BASSETT SERVICES INC              36-3365500     1096 ASSEMBLY DRIVE              FT MILL               SC 29716     JULIE_MCCOY-LINCOLN@GBTPA.COM


                                                           SUITE 210
Phone:      866-814-1740 Ext. 201
                                                                                                               Contact Name:   JULIE MCCOY-LINCOLN

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 390 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10125       NORTH RIVER INSURANCE COMPANY                  305 MADISON AVENUE               MORRISTOWN            NJ 07962     GEORGE_ROBERTS@CFINS.COM




Phone:      800-690-5520 Ext.

UNITED STATES FIRE INSURANCE                13-5459190     1064 GREENWOOD BLVD              LAKE MARY             FL 32795     DENVER_CHEEK@CFINS.COM
COMPANY

                                                           SUITE 300
Phone:      800-423-3060 Ext. 6301
                                                                                                               Contact Name:   DENVER L CHEEK

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 391 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12026       NORTHBROOK INDEMNITY INSURANCE                 2775 SANDERS ROAD                NORTHBROOK            IL 60062
            CO



Phone:      847-402-5000 Ext.

TRAVELERS INDEMNITY COMPANY                 06-0566050     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           SUITE 100
Phone:      800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 392 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10126       NORTHERN ASSURANCE COMPANY OF                  ONE BEACON LANE                  CANTON                MA 02081     SHOLLAND@ONEBEACON.COM
            AMERICA



Phone:      973-630-6601 Ext.

ONEBEACON INSURANCE                         23-1502700     P O BOX 9155                     CANTON                MA 02021     DDAVENPORT@ONEBEACON.COM



Phone:      800-203-9600 Ext. 9706
                                                                                                               Contact Name:   DENISE DAVENPORT

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 393 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10209      NORTHERN INSURANCE COMPANY OF                   1400 AMERICAN LANE               SCHAMBURG             IL 60196     TIM.GRAHAM@ZURICHNA.COM
           NEW YORK



Phone:     800-340-8602 Ext. 8613

NORTHERN INSURANCE COMPANY OF               13-5283360     3003 SUMMIT BLVD                 ATLANTA               GA 30319     CHRIS.CALLOWAY@ZURICHNA.COM
NEW YORK

                                                           SUITE 800
Phone:     404-851-3601 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY
NORTHERN INSURANCE COMPANY OF               13-5283360     1900 SUMMIT TOWER BLVD           ORLANDO               FL 32810     CHRIS.CALLOWAY@ZURICHNA.COM
NEW YORK

                                                           SUITE 600
Phone:     404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY
ZURICH NORTH AMERICA                        36-3839542     P.O. BOX 2769                    SCHAUMBERG            IL   60666   USZ_GA_WC_CLAIM_NOTICES@ZURICHNA.COM



Phone:     404-851-3208 Ext.
                                                                                                               Contact Name:   SHELLY HAYES
ZURICH SERVICES CORPORATION                 36-3839542     1001 SUMMIT BLVD                 ATLANTA               GA 30319     USZ.GA.WC.CLAIM.NOTICES@ZURICHNA.COM


                                                           SUITE 800
Phone:     404-851-3207 Ext.
                                                                                                               Contact Name:   CHRIS CALLOWAY




Last Updated: Wednesday, June 1, 2011                                             Page 394 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 4




Last Updated: Wednesday, June 1, 2011                                             Page 395 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13288      NOVA CASUALTY COMPANY                           726 EXCHANGE STREET              BUFFALO               NY 14210     MSTARSKI@AIXGROUP.COM



                                                           STE 1020
Phone:     -- Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
PMA MANAGEMENT CORPORATION                  23-2652239     1100 ABERNATHY ROAD NE           ATLANTA               GA 30328     ADOLPHUS_DRAIN@PMAGROUP.COM


                                                           SUITE 650 500 NORTH PARK TOWN CENTER
Phone:     888-888-8136 Ext.
                                                                                                               Contact Name:   ADOLPHUS DRAIN
YORK CLAIMS SERVICE INC                     13-1963636     99 CHERRY HILL ROAD              PARSIPPANY            NJ 07054     STEPHANIE.MARSHALL@YORKRSG.COMM



Phone:     877-927-2255 Ext.
                                                                                                               Contact Name:   STEPHANIE MARSHALL
YORK CLAIMS SERVICE INC                     13-1963636     1117 PERIMETER CENTER            ATLANTA               GA 30338     GEORGE.NAJIM@YORKCLAIMS.COM
                                                           WEST

                                                           STE W403
Phone:     678-225-2284 Ext.
                                                                                                               Contact Name:   GEORGE NAJIM




Last Updated: Wednesday, June 1, 2011                                             Page 396 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 4




 SBWC #     Name                            FEIN            Address                                                            Email


10212       OHIO CASUALTY INS CO                           9450 SEWARD ROAD                 FAIRFIELD             OH 45014     CORPORATESECRETARY@LIBERTYMUTUAL.COM




Phone:      800-843-6446 Ext.

MONTGOMERY INSURANCE CLAIM                  52-0424870     P O BOX 49130                    CHARLOTTE             NC 28277     CHRISTINE.JONES@MONTGOMERY-INS.COM
CENTER

Phone:      800-334-0078 Ext. 214
                                                                                                               Contact Name:   CHRISTINE JONES

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 397 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12093       OHIO FARMERS INSURANCE CO                      ONE PARK CIRCLE                  WESTFIELD             OH 44251     DONBRATTON@WESTFIELDGRP.COM
                                                                                            CENTER



Phone:      800-243-0210 Ext.

WESTFIELD INSURANCE GROUP                   34-6516838     3505 KROGER BLVD                 DULUTH                GA 30096     MARKKWIATKOWSKI@WESTFIELDGRP.COM


                                                           SUITE 275
Phone:      800-685-4604 Ext. 222
                                                                                                               Contact Name:   MARK KWIATKOWSKI

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 398 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13147       OHIO SECURITY INSURANCE CO                     9450 SEWARD ROAD                 FAIRFIELD             OH 45014     CORPORATESECRETARY@LIBERTYMUTUAL.COM




Phone:      800-843-6446 Ext.

MONTGOMERY INSURANCE CLAIM                  52-0424870     P O BOX 49130                    CHARLOTTE             NC 28277     CHRISTINE.JONES@MONTGOMERY-INS.COM
CENTER

Phone:      800-334-0078 Ext. 214
                                                                                                               Contact Name:   CHRISTINE JONES

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 399 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13032       OLD DOMINION INS CO                            4601 TOUCHTON ROAD               JACKSONVILLE          FL 32245     FOXB@MSAGROUP.COM
                                                           EAST

                                                           SUITE 3400
Phone:      904-380-7223 Ext.

OLD DOMINION INSURANCE COMPANY              59-2070420     P O BOX 4828                     SYRACUSE              NY 13212     KILLGOREK@MSAGROUP.COM



Phone:      315-434-1450 Ext.
                                                                                                               Contact Name:   KATHY KILLGORE

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 400 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


12058      OLD REPUBLIC GENERAL INSURANCE                  PO BOX 789                       GREENSBURG            PA 15601     E.STROKA@ORINSCO.COM
           CORPORATION



Phone:     724-838-5423 Ext.

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
GALLAGHER BASSETT SERVICES                  36-3365500     P O BOX 279310                   MIRAMAR               FL 33027     KRISTY_SANDS@GBTPA.COM



Phone:     800-473-9009 Ext.
                                                                                                               Contact Name:   KRISTY SANDS
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 292109                   NASHVILLE             TN 37229     GALE_LESIEUR@GBTPA.COM



Phone:     800-288-9843 Ext. 201
                                                                                                               Contact Name:   GALE LESIEUR
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI




Last Updated: Wednesday, June 1, 2011                                             Page 401 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 4




Last Updated: Wednesday, June 1, 2011                                             Page 402 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10129      OLD REPUBLIC INSURANCE COMPANY                  P O BOX 789                      GREENSBURG            PA 15601     J.ROBINSON@ORINSCO.COM




Phone:     724-834-5000 Ext. 5423

BERKLEY RISK ADMINISTRATORS                 22-2235730     3655 NORTH POINT                 ALPHARETTA            GA 30005     TGARRISON@BERKLEYRISK.COM
                                                           PARKWAY

                                                           SUITE 420
Phone:     800-247-2656 Ext.
                                                                                                               Contact Name:   TOM GARRISON
BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
CAMBRIDGE INTEGRATED SERVICE                23-2731565     809 GLEN EAGLES COURT            TOWSON                MD 21286     BRIAN.WALSH@US.XCHANGING.COM
GROUP INC

                                                           SUITE 210
Phone:     419-847-6323 Ext.
                                                                                                               Contact Name:   BRIAN WALSH
CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD           POMPANO BEACH         FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:     877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD
CAMBRIDGE INTEGRATED SERVICES               23-2731565     6300 CENTER HILL ROAD            CINCINNATI            OH 45224     NICOLE.DEWITT@US.XCHANGING.COM
GROUP INC

Phone:     800-235-1134 Ext. 5
                                                                                                               Contact Name:   NICOLE DEWITT


Last Updated: Wednesday, June 1, 2011                                             Page 403 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10129      OLD REPUBLIC INSURANCE COMPANY                  P O BOX 789                      GREENSBURG            PA 15601     J.ROBINSON@ORINSCO.COM




Phone:     724-834-5000 Ext. 5423

CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR              MAITLAND              FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

Phone:     866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN
CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR              MAITLAND              FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

Phone:     866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN
CANNON COCHRAN MANAGEMENT                   37-1057804     2600 LAKE LUCIEN DR              MAITLAND              FL 32751     SHEIMAN@CCMSI.COM
SERVICES INC (CCMSI)

                                                           SUITE 225
Phone:     866-291-0194 Ext.
                                                                                                               Contact Name:   SHERRY SUTTON-HEIMAN
CORVEL                                      42-1704550     2905 PREMIER PARKWAY             DULUTH                GA 30097     SHERRE_KAHRS@CORVEL.COM


                                                           STE 125
Phone:     678-942-7300 Ext.
                                                                                                               Contact Name:   SHERRE KAHRS
CUSTARD INSURANCE ADJUSTERS                 -              P O BOX 888385                   ATLANTA               GA 30356     MADKINS@CUSTARD.COM


                                                           ONE DUNWOODY
Phone:     770-551-2070 Ext.
                                                                                                               Contact Name:   MARSHA ADKINS


Last Updated: Wednesday, June 1, 2011                                             Page 404 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10129      OLD REPUBLIC INSURANCE COMPANY                  P O BOX 789                      GREENSBURG            PA 15601     J.ROBINSON@ORINSCO.COM




Phone:     724-834-5000 Ext. 5423

ESIS INC                                    95-2008390     500 COLONIAL PARKWAY             ROSWELL               GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES
GALLAGHER BASSETT SERVICES                  36-3365500     P O BOX 279310                   MIRAMAR               FL 33027     KRISTY_SANDS@GBTPA.COM



Phone:     800-473-9009 Ext.
                                                                                                               Contact Name:   KRISTY SANDS
GALLAGHER BASSETT SERVICES INC              36-3365500     P O BOX 292109                   NASHVILLE             TN 37229     GALE_LESIEUR@GBTPA.COM



Phone:     800-288-9843 Ext. 201
                                                                                                               Contact Name:   GALE LESIEUR
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI


Last Updated: Wednesday, June 1, 2011                                             Page 405 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10129      OLD REPUBLIC INSURANCE COMPANY                  P O BOX 789                      GREENSBURG            PA 15601     J.ROBINSON@ORINSCO.COM




Phone:     724-834-5000 Ext. 5423

GALLAGHER BASSETT SERVICES INC              36-3365500     601 VESTAVIA PARKWAY             BIRMINGHAM            AL 35266     CHRIS_ROCK@GBTPA.COM


                                                           SUITE 251
Phone:     800-762-3486 Ext.
                                                                                                               Contact Name:   CHRIS ROCK
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
HARTFORD SOUTHEAST WORKERS'                 -              50 GLENLAKE PKWY                 ATLANTA               GA 30328     SOUTHEASTCLAIMCENTER.WCEDM@THEHARTF
COMPENSATION CLAIMS CENTER                                                                                                     ORD.COM

Phone:     877-673-9222 Ext.
                                                                                                               Contact Name:   ROBERT MYRICK
RISK ENTERPRISE MANAGEMENT                  13-3832689     1140 HAMMOND DR                  ATLANTA               GA 30328     JANET.GREER@REMLTD.COM
LIMITED

                                                           SUITE J-2075
Phone:     800-347-4494 Ext.
                                                                                                               Contact Name:   JANET GREER
RISK ENTERPRISE MANAGEMENT                  13-3832689     565 MARRIOTT DRIVE               NASHVILLE             TN 37214     JANICE.GUIDRY@REMLTD.COM
LIMITED

                                                           SUITE 725
Phone:     800-871-6670 Ext.
                                                                                                               Contact Name:   JANICE GUIDRY


Last Updated: Wednesday, June 1, 2011                                             Page 406 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10129      OLD REPUBLIC INSURANCE COMPANY                  P O BOX 789                      GREENSBURG            PA 15601     J.ROBINSON@ORINSCO.COM




Phone:     724-834-5000 Ext. 5423

SEDGWICK CMS                                36-2685608     3700 CRESTWOOD PARKWAY           DULUTH                GA 30096     ATLANTA.GA@SEDGWICKCMS.COM


                                                           SUITE 600
Phone:     678-628-1318 Ext.
                                                                                                               Contact Name:   RONETTA WILSON
SEDGWICK CMS                                36-2685608     1117 PERIMETER CENTER            ATLANTA               GA 30338     ATLANTA.GA@SEDGWICKCMS.COM
                                                           WEST

                                                           SUITE E-500
Phone:     800-932-4464 Ext.
                                                                                                               Contact Name:   KOWALSKI BROWN
SEDGWICK CMS                                36-2685608     1100 RIDGEWAY LOOP ROAD          MEMPHIS               TN 38120     APULLEN@SEDGWICKCMS.COM



Phone:     241-922-0638 Ext.
                                                                                                               Contact Name:   ANTHONY PULLEN
SPECIALTY RISK SERVICES                     20-0730592     P O BOX 60000                    ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM



Phone:     770-901-3121 Ext.
                                                                                                               Contact Name:   MARY D'AGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                    NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS


Last Updated: Wednesday, June 1, 2011                                             Page 407 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10129       OLD REPUBLIC INSURANCE COMPANY                 P O BOX 789                      GREENSBURG            PA 15601     J.ROBINSON@ORINSCO.COM




Phone:      724-834-5000 Ext. 5423

SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:      678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO
SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:      800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN
UNDERWRITERS SAFETY & CLAIMS INC            61-0489172     5105 PAULSEN STREET              SAVANNAH              GA 31405     ANNF@USCKY.COM



Phone:      912-355-8989 Ext.
                                                                                                               Contact Name:   ANN FINNEGAN

Total # of Active Claim Offices: 28




Last Updated: Wednesday, June 1, 2011                                             Page 408 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13028       OLD REPUBLIC UNION INS                         307 NORTH MICHIGAN               CHICAGO               IL 60601     ORIACCOUNTING@OLDREPUBLIC.COM
                                                           AVENUE



Phone:      800-621-0365 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:      800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
OLD REPUBLIC UNION INSURANCE                36-3765116     307 N MICHIGAN AVE               CHICAGO               IL   60601



Phone:      800-621-0365 Ext.
                                                                                                               Contact Name:   SPENCER LEROY III

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 409 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13197       ONEBEACON AMERICAN INS CO                      ONE BEACON LANE                  CANTON                MA 02021     SHOLLAND@ONEBEACON.COM




Phone:      800-203-9600 Ext.

MONTGOMERY INSURANCE                        -              3555 KOGER BLVD.                 DULUTH                GA 30096



Phone:      800-762-5573 Ext.
                                                                                                               Contact Name:   DENISE GIVENS
ONEBEACON INSURANCE                         23-1502700     P O BOX 9155                     CANTON                MA 02021     DDAVENPORT@ONEBEACON.COM



Phone:      800-203-9600 Ext. 9706
                                                                                                               Contact Name:   DENISE DAVENPORT

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 410 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13199       ONEBEACON INSURANCE CO.                        ONE BEACON LANE                  CANTON                MA 02021     SHOLLAND@ONEBEACON.COM




Phone:      973-630-6601 Ext.

MONTGOMERY INSURANCE                        -              3555 KOGER BLVD.                 DULUTH                GA 30096



Phone:      800-762-5573 Ext.
                                                                                                               Contact Name:   DENISE GIVENS
ONEBEACON INSURANCE                         23-1502700     P O BOX 9155                     CANTON                MA 02021     DDAVENPORT@ONEBEACON.COM



Phone:      800-203-9600 Ext. 9706
                                                                                                               Contact Name:   DENISE DAVENPORT

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 411 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13131       ONEBEACON MIDWEST INS CO FKA                   ONE BEACON STREET                CANTON                MA 02021
            COMMERICAL UNION MIDWEST INS



Phone:      617-725-9322 Ext.

MONTGOMERY INSURANCE                        -              3555 KOGER BLVD.                 DULUTH                GA 30096



Phone:      800-762-5573 Ext.
                                                                                                               Contact Name:   DENISE GIVENS

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 412 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13196       ONEBEACON MIDWEST INS. CO.                     ONE BEACON STREET                CANTON                MA 02021     SHOLLAND@ONEBEACON.COM




Phone:      973-630-6601 Ext.

ONEBEACON INSURANCE                         23-1502700     P O BOX 9155                     CANTON                MA 02021     DDAVENPORT@ONEBEACON.COM



Phone:      800-203-9600 Ext. 9706
                                                                                                               Contact Name:   DENISE DAVENPORT

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 413 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13004       OWNERS INSURANCE COMPANY                       6101 ANACAPRI BLVD               LANSING               MI 48917     FISHER.BRUCE@AOINS.COM




Phone:      800-346-0346 Ext. 8794

AUTO OWNERS INSURANCE CO                    38-0315280     P O BOX 100044                   DULUTH                GA 30096     GEORGIAWORKCOMP.CLM@AOINS.COM


                                                           1705 EXECUTIVE DRIVE
Phone:      770-931-7766 Ext. 201
                                                                                                               Contact Name:   JAY LANNIN

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 414 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10130      PACIFIC EMPLOYERS INSURANCE                     436 WALNUT STREET                PHILADELPHIA          PA 19106     MARILEE.BRABSON@ACEGROUP.COM
           COMPANY

                                                           WB04G
Phone:     215-640-4565 Ext.

ALTERNATIVE SERVICE CONCEPTS LLC            43-1954328     P O BOX 15550                    LITTLE ROCK           AZ 72231     JAMES.CHANCELLOR@ASCRISK.COM



Phone:     800-669-0437 Ext. 108
                                                                                                               Contact Name:   JAMES CHANCELLOR
ESIS INC                                    95-2008390     500 COLONIAL PARKWAY             ROSWELL               GA 30076     GAFORMS@ESIS.COM


                                                           SUITE 200
Phone:     800-685-7361 Ext.
                                                                                                               Contact Name:   MARK IRWIN
GAB ROBINS NORTH AMERICA INC                13-2747054     3039 PREMIERE PARKWAY            DULUTH                GA 30097     ATLANTAR@GABROBINS.COM


                                                           SUITE 900
Phone:     770-813-0997 Ext. 230
                                                                                                               Contact Name:   DEWEY BARNES
SPECIALTY RISK SERVICES                     20-0730592     ONE LAKE VIEW                    NASHVILLE             TN 37214     TAMMY.WILLIAMS@SRSCONNECT.COM


                                                           25 CENTURY BLVD STE 505
Phone:     615-824-5095 Ext.
                                                                                                               Contact Name:   TAMMY WILLIAMS
SPECIALTY RISK SERVICES                     20-0730592     50 GLENLAKE PARKWAY              ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM


                                                           SUITE 330
Phone:     678-338-4171 Ext.
                                                                                                               Contact Name:   MARY DAGOSTINO


Last Updated: Wednesday, June 1, 2011                                             Page 415 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10130       PACIFIC EMPLOYERS INSURANCE                    436 WALNUT STREET                PHILADELPHIA          PA 19106     MARILEE.BRABSON@ACEGROUP.COM
            COMPANY

                                                           WB04G
Phone:      215-640-4565 Ext.

SPECIALTY RISK SERVICES                     20-0730592     605 CRESCENT EXECUTIVE           LAKE MARY             FL 32746     SCOTT.WESTMAN@SRSCONNECT.COM
                                                           COURT

                                                           BLDG 3 2ND FLOOR
Phone:      800-541-0139 Ext.
                                                                                                               Contact Name:   SCOTT WESTMAN

Total # of Active Claim Offices: 6




Last Updated: Wednesday, June 1, 2011                                             Page 416 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10132      PACIFIC INDEMNITY COMPANY                       15 MOUNTAIN VIEW ROAD            WARREN                NJ 07061     PREMIUMTAXGROUP@CHUBB.COM




Phone:     908-903-5156 Ext.

CHUBB SERVICES CORPORATION                  22-3096895     3445 PEACHTREE ROAD NE           ATLANTA               GA 30326     KPILZ@CHUBB.COM


                                                           2 LIVE OAK CENTER #900
Phone:     404-266-4855 Ext.
                                                                                                               Contact Name:   KURT PILZ
GALLAGHER BASSETT SERVICES INC              36-3365500     100 CRESCENT CENTRE              TUCKER                GA 30084     GB-ATLANTA_NORTH-MAIL@GBTPA.COM
                                                           PARKWAY

                                                           SUITE 600
Phone:     800-354-6494 Ext. 201
                                                                                                               Contact Name:   VICTORIA ROSETTI
GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
PACIFIC INDEMNITY                           95-1078160     3445 PEACHTREE RD                ATLANTA               GA 30326     KPILZ@CHUBB.COM


                                                           2 LIVE OAK CENTER #900
Phone:     404-266-4127 Ext.
                                                                                                               Contact Name:   KURT PILZ
PACIFIC INDEMNITY INSURANCE                 95-1078160     2 LIVE OAK CENTER SUITE 900      ATLANTA               GA 30326     KPILZ@CHUBB.COM


                                                           3445 PEACHTREE ROAD
Phone:     404-266-4127 Ext.
                                                                                                               Contact Name:   KURT PILZ


Last Updated: Wednesday, June 1, 2011                                             Page 417 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10132       PACIFIC INDEMNITY COMPANY                      15 MOUNTAIN VIEW ROAD            WARREN                NJ 07061     PREMIUMTAXGROUP@CHUBB.COM




Phone:      908-903-5156 Ext.

SPECIALTY RISK SERVICES                     20-0730592     P O BOX 60000                    ATLANTA               GA 30328     MARY.DAGOSTINO@SRSCONNECT.COM



Phone:      770-901-3121 Ext.
                                                                                                               Contact Name:   MARY D'AGOSTINO

Total # of Active Claim Offices: 6




Last Updated: Wednesday, June 1, 2011                                             Page 418 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10247       PATRIOT GENERAL INSURANCE                      P O BOX 8032                     STEVENS POINT         WI 54481     TOM.HERZOG@SENTRY.COM
            COMPANY



Phone:      800-739-3344 Ext. 6663

SENTRY INSURANCE A MUTUAL                   39-0333950     P O BOX 26263                    RICHMOND              VA 23260     WCCLAIMSEAST@SENTRY.COM
COMPANY

Phone:      800-338-2487 Ext. 4616
                                                                                                               Contact Name:   TIM O'BRIEN
SENTRY SELECT INSURANCE COMPANY             39-0333950     P O BOX 8032                     STEVENS POINT         WI 54481     WCCLAIMSEAST@SENTRY.COM



Phone:      800-739-3344 Ext. 9063
                                                                                                               Contact Name:   DONNA KLASING

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 419 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10029       PEERLESS INDEMNITY INSURANCE                   27201 BELLA VISTA                WARRENVILLE           IL 60555     CORPORATESECRETARY@LIBERTYMUTUAL.COM
            COMPANY                                        PARKWAY

                                                           SUITE 130
Phone:      800-826-6189 Ext.

MONTGOMERY INSURANCE CLAIM                  52-0424870     P O BOX 49130                    CHARLOTTE             NC 28277     CHRISTINE.JONES@MONTGOMERY-INS.COM
CENTER

Phone:      800-334-0078 Ext. 214
                                                                                                               Contact Name:   CHRISTINE JONES

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 420 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10134       PEERLESS INSURANCE CO                          62 MAPLE AVE                     KEENE                 NH 03431     CORPORATESECRETARY@LIBERTYMUTUAL.COM




Phone:      800-826-6189 Ext.

MONTGOMERY INSURANCE CLAIM                  52-0424870     P O BOX 49130                    CHARLOTTE             NC 28277     CHRISTINE.JONES@MONTGOMERY-INS.COM
CENTER

Phone:      800-334-0078 Ext. 214
                                                                                                               Contact Name:   CHRISTINE JONES

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 421 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10291       PENN MILLERS INSURANCE                         72 N FRANKLIN STREET             WILKES BARRE          PA 18773     MMARRA@PENNMILLERS.COM




Phone:      800-233-8347 Ext.

COLLINS AND COMPANY                         62-0882150     P O BOX 723783                   ATLANTA               GA 31139     ATLANTA@COLLINSANDCO.COM



Phone:      770-434-9222 Ext.
                                                                                                               Contact Name:   CHRIS CANE

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 422 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13280       PENN STAR INSURANCE                            THREE BALA PLAZA EAST            BALA CYNWYD           PA 19004     GSEGELKEN@UAI-GROUP.COM



                                                           SUITE 300
Phone:      -- Ext.

RISK ENTERPRISE MANAGEMENT                  13-3832689     1140 HAMMOND DR                  ATLANTA               GA 30328     JANET.GREER@REMLTD.COM
LIMITED

                                                           SUITE J-2075
Phone:      800-347-4494 Ext.
                                                                                                               Contact Name:   JANET GREER

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 423 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13198       PENNSYLVANIA GENERAL INS CO                    ONE BEACON STREET                CANTON                MA 02028     SHOLLAND@ONEBEACON.COM




Phone:      800-203-9600 Ext.

ONEBEACON INSURANCE                         23-1502700     P O BOX 9155                     CANTON                MA 02021     DDAVENPORT@ONEBEACON.COM



Phone:      800-203-9600 Ext. 9706
                                                                                                               Contact Name:   DENISE DAVENPORT

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 424 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12074       PENNSYLVANIA LUMBERMENS MUTUAL                 ONE COMMERCE SQUARE              PHILADELPHIA          PA 19103     HJAMISON@PLMINS.COM
            INSURANCE CO

                                                           2005 MARKET ST, STE 1200
Phone:      800-752-1895 Ext.

TENCO SERVICES                              62-0449213     8735 DUNWOODY PL                 ATLANTA               GA 30350     BSHARPE@TENCO.COM


                                                           SUITE 3
Phone:      800-621-1313 Ext.
                                                                                                               Contact Name:   BILL SHARPE

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 425 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


12009       PENNSYLVANIA MANUFACTURERS ASSN                380 SENTRY PARKWAY               BLUE BELL             PA 19422     STEPHEN_GARTNER@PMAGROUP.COM
            INS CO



Phone:      800-222-2749 Ext.

PENNSYLVANIA MANUFACTURERS                  23-1642962     1100 ABERNATHY ROAD NE           ATLANTA               GA 30328     ADOLPHUS_DRAIN@PMAGROUP.COM
INDEMNITY

                                                           SUITE 650 500 NORTH PARK TOWN CENTER
Phone:      888-888-8136 Ext.
                                                                                                               Contact Name:   ADOLPHUS DRAIN
PMA INS GROUP                               23-1642962     1100 ABERNATHY ROAD NE           ATLANTA               GA 30328     ADOLPHUS_DRAIN@PMAGROUP.COM


                                                           SUITE 650 500 NORTH PARK TOWN CENTER
Phone:      770-677-3423 Ext.
                                                                                                               Contact Name:   ADOLPHUS DRAIN

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 426 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13138       PENNSYLVANIA MANUFACTURERS                     380 SENTRY PARKWAY               BLUE BELL             PA 19422     STEPHEN_GARTNER@PMAGROUP.COM
            INDEMNITY CO



Phone:      800-222-2749 Ext.

PENNSYLVANIA MANUFACTURERS                  23-1642962     1100 ABERNATHY ROAD NE           ATLANTA               GA 30328     ADOLPHUS_DRAIN@PMAGROUP.COM
INDEMNITY

                                                           SUITE 650 500 NORTH PARK TOWN CENTER
Phone:      888-888-8136 Ext.
                                                                                                               Contact Name:   ADOLPHUS DRAIN
PMA INS GROUP                               23-1642962     1100 ABERNATHY ROAD NE           ATLANTA               GA 30328     ADOLPHUS_DRAIN@PMAGROUP.COM


                                                           SUITE 650 500 NORTH PARK TOWN CENTER
Phone:      770-677-3423 Ext.
                                                                                                               Contact Name:   ADOLPHUS DRAIN

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 427 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10136       PENNSYLVANIA NAT MUT CAS                       P. O. BOX 2361                   HARRISBURG            PA 17105     DAUSTIN@PNAT.COM




Phone:      800-388-4764 Ext.

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:      800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
PENNSYLVANIA NATIONAL MUTUAL                23-0961349     1703 E WENDOUR AVENUE            GREENSBORO            NC 27405
CASUALTY

Phone:      800-877-7366 Ext.
                                                                                                               Contact Name:   KATHY PEOPLES

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 428 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


10285       PETROLEUM CASUALTY COMPANY                     P O BOX 3342                     HOUSTON               TX 77253     BARBARA.L.HOOPER@EXXONMOBIL.COM




Phone:      800-323-4416 Ext.

EXXON MOBIL RISK MANAGEMENT INC.            76-0006056     3225 GALLOWS ROAD                FAIRFAX               VA 22037     MONICA.A.PARATONE@EXXONMOBILE.COM



Phone:      888-975-2667 Ext.
                                                                                                               Contact Name:   MONICA A PARATONE

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 429 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #     Name                            FEIN            Address                                                            Email


13257       PHARMACISTS MUTUAL INSURANCE CO                808 HIGHWAY 18 WEST              ALGONA                IA 50511     LISA.MOLSBERRY@PHMIC.COM



                                                           PO BOX 370
Phone:      800-247-5930 Ext.

RISK ENTERPRISE MANAGEMENT                  13-3832689     1140 HAMMOND DR                  ATLANTA               GA 30328     JANET.GREER@REMLTD.COM
LIMITED

                                                           SUITE J-2075
Phone:      800-347-4494 Ext.
                                                                                                               Contact Name:   JANET GREER
RISK ENTERPRISE MANAGEMENT                  13-3832689     565 MARRIOTT DRIVE               NASHVILLE             TN 37214     JANICE.GUIDRY@REMLTD.COM
LIMITED

                                                           SUITE 725
Phone:      800-871-6670 Ext.
                                                                                                               Contact Name:   JANICE GUIDRY

Total # of Active Claim Offices: 2




Last Updated: Wednesday, June 1, 2011                                             Page 430 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


10138      PHOENIX INSURANCE COMPANY                       ONE TOWER SQUARE                 HARTFORD              CT 06183     KDAVIS@TRAVELERS.COM




Phone:     860-954-5660 Ext.

GALLAGHER BASSETT SERVICES INC              36-3365500     2915 PREMIERE PARKWAY            DULUTH                GA 30097     GB-ATLANTA_NORTH-MAIL@GBTPA.COM


                                                           SUITE 350
Phone:     866-246-0259 Ext.
                                                                                                               Contact Name:   PATRICIA BARBER
PHOENIX INSURANCE COMPANY                   06-0303275     1000 WINDWARD                    ALPHARETTA            GA 30005     GEORGIAWCBOARD@TRAVELERS.COM
                                                           CONCOURSE

                                                           STE 100
Phone:     800-238-6214 Ext.
                                                                                                               Contact Name:   KEVIN NELSON
PHOENIX INSURANCE COMPANY                   06-0303275     BUILDING V SUITE 200             TAMPA                 FL 33610     DBRYSON@TRAVELERS.COM


                                                           10401 HIGHLAND MANOR DR
Phone:     888-487-3492 Ext.
                                                                                                               Contact Name:   DEBRA BRYSON
PHOENIX INSURANCE COMPANY                   06-0303275     11440 CARMEL COMMONS             CHARLOTTE             NC 28226     CMHARRIS1@TRAVELERS.COM
                                                           BLVD

Phone:     800-759-6194 Ext. 3298
                                                                                                               Contact Name:   CHRISTIE HARRIS




Last Updated: Wednesday, June 1, 2011                                             Page 431 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 4




 SBWC #     Name                            FEIN            Address                                                            Email


13251       PRAETORIAN INSURANCE CO                        88 PINE STREET                   NEW YORK              NY 10005     MBLAKE@PFGI.COM




Phone:      -- Ext.

ADJUSTMENT SERVICES INC.                    58-1623664     P O BOX 81306                    ATLANTA               GA 30366     SHARON@ADJUSTMENTSERVICES.COM



Phone:      800-772-8427 Ext.
                                                                                                               Contact Name:   SHARON STRUBE FERRER

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 432 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor


 SBWC #    Name                             FEIN            Address                                                            Email


13141      PREFERRED PROFESSIONAL INS CO                   11605 MIRACLE HILLS DRIVE        OMAHA                 NE 68154     COMPLIANCE@PPICINS.COM



                                                           SUITE 200
Phone:     800-441-7742 Ext.

BROADSPIRE SERVICES                         36-3917295     1001 SUMMIT BOULEVARD            ATLANTA               GA 30319     ATLANTA@CHOOSEBROADSPIRE.COM


                                                           9TH FLOOR
Phone:     800-450-0692 Ext.
                                                                                                               Contact Name:   KELLY BRYANT
CRAWFORD & COMPANY                          58-0506554     1001 SUMMIT BLVD                 ATLANTA               GA 30319     ATLANTA.GA@US.CRAWCO.COM



Phone:     -- Ext.
                                                                                                               Contact Name:   STUART TUCKER
F A RICHARD (FARA)                          72-0837383     1625 WEST CAUSEWAY               MANDEVILLE            LA 70471     GEORGIA.NOTICES@FARA.COM
                                                           APPROACH

Phone:     985-624-6739 Ext.
                                                                                                               Contact Name:   CHAD RANFLE
F A RICHARD (FARA)                          72-0837383     7000 EXECUTIVE CENTER            BRENTWOOD             TN 37027     GEORGIA.NOTICES@FARA.COM
                                                           DRIVE

                                                           SUITE 320
Phone:     800-675-2771 Ext. 225
                                                                                                               Contact Name:   KAREN PORTER




Last Updated: Wednesday, June 1, 2011                                             Page 433 of 613


The authorized use of this data is limited to informational and educational purposes only. The accuracy or reliability of the data is not guaranteed or warranted in any
way and the Georgia State Board of Workers' Compensation, its Agencies and Representatives disclaim liability of any kind whatsoever, including, without limitation,
liability for quality, performance, merchantability and fitness for a particular purpose arising out of the use, or inability to use the data.
                                                         Georgia State Board of Workers' Compensation
                                                                  Insurer and Claim Processor

Total # of Active Claim Offices: 4




 SBWC #     Name                            FEIN            Address                                                            Email


13226       PREMIER GROUP INSURANCE COMPANY                100 EAST VINE STREET             MURFREESBORO          TN 37130     DHESTER@PREMIERGROUPINS.COM




Phone:      866-414-7442 Ext. 203

CAMBRIDGE INTEGRATED SERVICES               23-2731565     1100 PARK CENTRAL BLVD           POMPANO BEACH         FL 33064     ARTGOULD@US.XCHANGING.COM
                                                           SOUTH

                                                           #1100
Phone:      877-295-0011 Ext.
                                                                                                               Contact Name:   ART GOULD

Total # of Active Claim Offices: 1




Last Updated: Wednesday, June 1, 2011                                             Page 434 of 613


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