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Exhibit B <br />Statement of Work: Plan Design Change -Carryover <br />The purpose of this form is to collect all information necessary to update your Plan design to either remove or add the <br />carryover feature. <br />Instructions <br />1. Please complete the following form in its entirety. <br />2. Send the completed form to your Client Relations Executive <br />If you are not sure how to answer any of the below questions, please contact your Client Relations Executive. They will <br />coordinate a conference call with the appropriate parties. <br />Basic Client Information and Demographics <br />Please complete what you are able to. If you are uncertain of the below, you may leave the below items blank. This <br />simply allows us to check your existing plan documents for accuracy in these areas. <br />1. Company Name:City of Santa Ana <br />2. Tax ID:- <br />3. Company Phone Number: (714) 647-5299 <br />4. Company Fax Number: <br />5. Address:20 Civic Center Plaza #M-34, Santa Ana, CA 92701 <br />6. Entity Type: <br />❑C Corp <br />❑S Corp <br />❑ LLC <br />❑ LLP <br />©Other, Please explain: Government Agency <br />SOW: Carryover: Page 1 <br />C <br />�� <br />ljt-r��UE <br />0 Igoe Administrative Services 2021 <br />