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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.m <br />Industry: Manufacturing Finance/Insurance Wholesale/Retail Trade - Construction <br />Transportation---! Service X Other government <br />States Where Employees are Located _California <br />Affiliated Companies, if any <br />HR Contact: Lori Schnaider Title: HR Operations Manager <br />(Please Print Name) <br />Email Address: _lchnaider@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 714264725317 Email Address: 1 ham5 santa-ana.or <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: _24. <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 Ana <br />Date: <br />(602) 266-5303 ♦ 350 W. Washington St ♦ Tempe, AZ 85281 5/23/2022 <br />