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B1ueCross BlueShield <br /> of Illinois <br /> ADMINISTRATIVE SERVICES AGREEMENT <br /> The Effective Date of this Agreement is January 1, 2017. <br /> For Employer Group Number(s): As specified on the most current ASO BPA(as defined below). <br /> Account Number: 22346 <br /> IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the date and year specified below. <br /> BLUE CROSS AND BLUE SHIELD OF ILLINOIS, CITY OF DECATUR <br /> a Division of Health Care Service Corporation, <br /> a Mutual Legal Reserve Company <br /> By: EDceuSigneedd by: <br /> � ,l• �t,IaVa <br /> BFOOC88A8397429... <br /> Title: Divisional Senior Vice President Title <br /> Date: Effective Date of Coverage noted above Gregg D. zientara city Treasurer & Director of Financ <br /> Date <br /> 7anuary 23, 2017 <br /> HCSC IL Gen ASA Med Non ERISA REG Rev.8.16 1 <br /> Proprietary and Confidential Information of Claim Administrator <br /> Not for use or disclosure outside Claim Administrator,Employer,their respective affiliated companies and third party <br /> representatives,except with written permission of Claim Administrator. <br /> A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, <br /> An Independent Licensee of the Blue Cross and Blue Shield Association <br />