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POLICY NUMBER: 6BRPG0000006933600 <br />INTERLINE <br />IL 12 01 1185 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, <br />POLICY CHANGES <br />Policy Change <br />Number 1 <br />POLICY NUMBER <br />POLICY CHANGES EFFECTIVE <br />COMPANY <br />SBRPG0000006933600 <br />01/01/20 <br />Nationwide Mutual Insurance Company <br />NAMED INSURED <br />AUTHORIZED REPRESENTATIVE <br />Khai Hoang <br />K&K Insurance Group, Inc. <br />COVERAGE PARTS AFFECTED <br />Common Policy Conditions <br />CHANGES <br />Form Number: SRPG8016 <br />Add Form Delete Form 71 Amend Form as Follows: <br />CP# 1564 <br />Authorized Representative Signature <br />AI <br />IL 12 01 1185 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 1 <br />Copyright, ISO Commercial Risk Services, Inc., 1983 <br />