CM-2025-084 - 4/4/2025 OPTUM`"
Class Action Service Agreement
Walgreens
Class Action Settlement
I, Brooks Bennett, City Manager (signer name, please print), being duly
authorized by The City of Round Rock, Texas (company name) request that
Optum file a claim and take required actions to establish that claim in the
Walgreens class action settlement. It is agreed that a fee of 18% of any
settlement proceeds will be deducted prior to payment to company.
Please return a completed and signed copy of this form to
optumantitrust a(�optum.com by April 10, 2025.
Company Name: City of Round Rock, Texas
FEIN: 3114 °! -74(?�
Policy Number(s): cal/ deg I
Signature:
Y�.
Date:ern
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