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090 <br />United Care <br />Contact Information <br />Legal Name of Applicant: City of Santa Ana <br />(name as it will appear on billing) <br />Abbreviations Or Alternate Names For Company: <br />Address: 20 Civic Center Plaza. M-24 City: Santa Ana State: CA <br />Phone: 714 / 647_/5299 Website: www.santa-ana.org <br />Industry: Manufacturing -1 Finance/Insurance i Wholesale/Retail Trade' Construction Fi <br />Transportation :1 Service X Other government <br />States Where Employees are Located <br />Affiliated Companies, <br />HR Contact: Lori Schnaider Title: HR Operations Manager <br />(Please Print Name) <br />Email Address: —Ischnaider@santa-ana.org Phone: 714 / 647 / 6967 <br />Broker Information (If Applicable) <br />Broker Agency: Keenan Broker Agent: Megan Gardner <br />Payroll and Billing Information <br />Billing Contact: Lily Pham, Senior Analyst <br />(If different than HR Contact) (Print Name) <br />Phone 714 / 64715317 Email Address: _l hp am5(asanta-ana.org <br />Invoices: Email Invoices: X Mail Invoices: ❑ <br />(Title) <br />Effective Date (Date Benefit Takes Effect): 1/1/2023 Open Enrollment Period: 9/19/22—10/14/22 <br />Total Number of Employees: 1100 Number of Pay Periods: <br />Are Employee ID Numbers Required for Enrollment? NO ❑ YES X <br />Permission for UPC to Use Logo for Marketing Purposes? NO X YES ❑ <br />Make Checks Payable to: United Pet Care LLC <br />This application is subject to all terms and conditions of the Group Membership Agreement. <br />Authorized Representative (Please Print): <br />Signed By: <br />Company Name: City of Santa An <br />Date: <br />(602) 266-5303 ♦ 350 W. Washington St ♦ Tempe, AZ 85281 5/23/2022 <br />