R2007-197 AUTHORIZING GROUP TERM LIFE INSURANCE COVERAGE

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. � PARTICIPATING UNIT APPLICATION RELIANCE STANDARD LIFE INSURANCE COMPANY HOME OFFICE: CHICAGO, ILLINOIS '' ADMINISTRATIVE OFFICE: PHILADELPHIA, PENNSYLVANIA ' Effective November 1, 2007, City of Decatur Illinois (herein referred to as the Participating Unit), agrees to be a participant in the RSL Group and Blanket Insurance Trust, and agrees to be bound by all the applicable terms and conditions of the Trust Agreement. The Participating Unit agrees to make insurance available to its Eligible Persons in accordance with the terms and conditions of the Master Policy numbered VL 600 issued to the RSL Group and Blanket Insurance Trust. 1. NAME OF SUBSIDIARIES, DIVISIONS OR AFFILIATES: None 2. PARTICIPATING UNIT NUMBER: VG 180670 3. PARTICIPATING UNIT ADDRESS: 1 GARY K ANDERSON PLAZA DECATUR, ILLINOIS 62523 4. PARTICIPATING UNIT ANNIVERSARY DATE: November 1 in each year 5. PREMIUM DUE DATE: November 1, and the 1st of each month thereafter 6. ELIGIBLE PERSONS: All Actively-at-Work, Full-time Management Employee of the Participating Unit, except any person employed on a temporary or seasonal basis, and their Dependents. Employees are not eligible and cannot enroll until their date of hire. "Actively-at-Work" means: a person actually performing on a Full-time basis each and every duty pertaining to his job in the place where and manner in which the job is normally performed. This includes approved time off such as vacation,jury duty and funeral leave, but does not include time off as a result of injury or illness. "Futl-time" means: working for the Participating Unit for a minimum of 30 hours during a person's regularly scheduled work week. "DependenY' means: (a) the employee's legal spouse; (b) the employee's unmarried child(ren), including any foster child, adopted child or stepchild who resides in the employee's home, who is age 14 days but under 20 years of age and who is financially dependent on the employee for support; and (c) the employee's unmarried child(ren), including any foster child, adopted child or stepchild, who is attending a college or other school on a full-time basis, and is financially dependent on the employee for support and under age 26. A person may not have coverage both as an employee and as a Dependent. Only one insured spouse may cover the eligible children as insured Dependents. The employee or spouse must be insured in order for children to be insured. Spouse Maximum Age: 75 On the date of application,the spouse must be under age 70. LRS-8348-01-0592 I IIIIIII IIIIII IIII I II I'II