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DEPAFiT:LNT OE LABOR AHD EMf'Wtru..vi ~ DIVISION OF LABOR .' 1313 SHERMAN STR6ET _ . DENVER, COLORADO SELF-INSURERS RESERVE TRUST ACRE~NT THIS CONTRACT A.4D ACR5EAtENT Mede and entered into in triplicate this...~Ih......... day of-...J,u,ly,,,,,,,,,,,,,,, A. D. 19.$x..., by and between..FFb~.~?F~G.cpRPDRPTION...... . .. . . .... . .. . .. . hereinafter referred to as party oC the Cirst port, and the Executive Director of the Department of Labor and Eaployment, hereinafter referred to as party of the second part, WITNESSETR: WfD:REAS, Said party of the first part is an employer subject to the terms and provisions oC the Workmen's Compensation Act of Colorado, and is insuring its liability under said act under end by virtue of the terms and provisions of certain permits for • self-insurance issued to said first party by said second party, and under the rules and reEulations from time to time prescribed by said second party. NON, THEREFORE, Said party of the first part in consideration o[ its existin; self-insurance permit and any renewals thereof hereafter granted, does hereby contract, covenant, and agree with said second party es follows, to-wit: That said first party during the continuance of its existing self-insurance permit, or any renewal thereof, will set up such reserves to the amount end in the manner end method as prescribed by said second party to insure and protect the payment of ' compensation and n11 other benefits provided for by said Horkmen's Compensation Aet of Colorado to any of the persons entitled thereto under end by virtue of the terms and provisions of said act, for all accidents resulting in injury or death and eominP within the terms and provisions of the said Workmen's Compensation Act, which may have occurred under any e:isting or any past self-insurance permit. • ?he party of the first part agrees to deposit such reserves ns it is required to set up under the rules and regulations of said second party in cash or in securities approved by said second party, all said reserves to be deposited ~in a_trust fund to be placed in..The.~p~Pl'AdA.NPL~An~.1.9.ink.at.4en~er ......................................... which shall act as Trustee hereunder and is herein termed "Trustee." All reserves so deposited shall constitute a trust fund for the express payment of compensation or other benefits for which said first party may become liable under said Horkmen's Compensation Act. Said trust furit~'~'shall De free and clear from all control of Lhe said party of the first part but shall De subject to withdre.+nl or other dispositieq by said party of the • second Dart without notice to the said party of the first part forrthe payment. of compensation or other benefits herein provided for and shall be subject to the sole control of the said party of the second part. In the event eecur~ties are deposited in lieu of cash, said~Trustee, upon the order of said second party, shall-have the ri;ht to and shall se12 said securities or any pert thereof et public or private sale without notice to said party of the fire! part, and shall goy and deliver such cash and any other cash or securities held by said Trustee to said party of the second part, upon the order and receipt of said party of the second port, sitned by ^ny two of the then siEners, which order and receipt shall be a full acquittance and discharEe to said ' Trustee of all liability or responsibility for the funds so paid over to said party of the second part. The Trustee shall not be in any Wanner responsible for the use or epplicaticn of such funds, by the party of the second part, nor for the fulfillment by the party of the second pert of its duties or obli=ationa under the contract. EXHIBIT 1 C3 pages) J