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. �. <br /> 1�EC11�NCE STl�N�1�t�1� <br />' Life Insurance Company <br /> Home Office: Chica o Illinois • Administrative Office: Philadel hi P 1 i <br /> g , p a, ennsy van a <br />' - POLICYHOLDER: City of Decatur Illinois POLICY NUMBER: GL 143071 <br /> . <br /> - EFFECTIVE DATE: November 1, 2007 <br /> ANNIVERSARY DATES: November 1, 2008 and each November 1 st thereafter. <br /> PREMIUM DUE DATES: The first premium is due on the Effective Date. Further premiums are due monthly, in <br /> advance, on the first day of each month. <br /> The Policy is delivered in Illinois and is governed by its laws. <br /> We agree to provide insurance to you in exchange for the payment of premium and a signed Application. The Policy <br /> provides benefits for loss of life from injury or sickness. It insures the eligible persons for the amount of insurance shown <br /> on the Schedule of Benefits. The insurance is subject to the terms and conditions of the Policy. <br /> The effective date of the Policy is shown above. Insurance starts and ends at 12:01 A.M., Local Time, at your main <br /> address. It stays in effect as long as premium is paid when due. The "TERMINATION OF THE POLICY" section of the <br /> GENERAL PROVISIONS explains when the insurance can be ended. <br /> The Policy is signed by the President and Secretary. <br /> -l�r�.vwv <br /> � <br /> Secretary President <br /> Countersigned , <br /> Licensed Resident Agent <br /> y'' GROUP LIFE INSURANCE <br /> ' NON-PARTICIPATING <br /> LRS-6422 Ed. 2/84 <br />