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EXHIBIT A: Adopting Employer/Plan Administrator Information <br /> <br /> <br />EMPLOYER INFORMATION: <br /> <br />Employer Name: City of Roseville <br />Address: 2660 Civic Center Dr <br />City, State and Zip: Roseville MN 55113 <br />Phone Number: 651-792-7034 <br />Federal EIN: 41-6007849 <br />If applicable, subsidiaries and/or affiliates participating in the Plan are: <br />Agent of Service of Legal Process: NFP 505 Waterford Park <br />Hwy 169 N, Suite 1100 <br />Plymouth MN 55441 <br /> <br /> <br /> <br />ADDITIONAL INFORMATION: <br />Effective Date means: January 1, 2020 <br /> <br />Section III.B.1. <br />Finance contact information: <br /> <br />Employer Name: City of Roseville <br />Address: 2660 Civic Center Dr <br />City, State and Zip: Roseville MN 55113 <br />Phone Number: 651-792-7034 <br /> <br />Section VII.B. Notices: <br /> <br />If to the Adopting Employer and Plan Administrator: <br /> <br />Employer Name: City of Roseville <br />Address: 2660 Civic Center Dr <br />City, State and Zip: Roseville MN 55113 <br />Phone Number: 651-792-7034 <br /> <br />If to MEDSURETY, LLC: <br /> 18001 Highway 7 Suite 204 <br /> Minnetonka, MN 55345 <br /> Phone: (952) 303-5700 <br /> <br />Note: Upon the occurrence of a change in any of the above address information, each party shall notify the other <br />party(ies) of such change within five (5) business days of the effective date of the change. <br /> <br /> <br /> <br /> <br />Continuation and/or Retiree Billing 12 <br />Administrative Agreement (public sector) <br /> <br />