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POLICY NUMBER: 6BRPG0000007214200 <br />INTERLINE <br />IL 12 01 11 85 <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 />6BRPG0000007214200 <br />02/10/20 <br />Nationwide Mutual Insurance Company <br />NAMED INSURED <br />AUTHORIZED REPRESENTATIVE <br />Raquel Gutierrez <br />K&K Insurance Group, Inc. <br />COVERAGE PARTS AFFECTED <br />Common Policy Conditions <br />CHANGES <br />Form Number: SRPG8016 <br />�X Add Form F-1 Delete Form Amend Form as Follows: <br />CP# 251 <br />�N <br />Authorized Representative Signature <br />REVIEWED & APPROVED <br />By Risk MANAGEMENT DIVISION <br />F �202O <br />ANCIIE ACEWdO <br />IL 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 1 <br />Copyright, ISO Commercial Risk Services, Inc., 1983 <br />