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POLICY NUMBER: 6BRPG0000006940000 <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 2 <br />POLICY NUMBER <br />POLICY CHANGES EFFECTIVE <br />COMPANY <br />6BRPG0000006940000 <br />01/01/20 <br />Nationwide Mutual Insurance Company <br />NAMED INSURED <br />AUTHORIZED REPRESENTATIVE <br />Martin Torres <br />K&K Insurance Group, Inc. <br />COVERAGE PARTS AFFECTED <br />Common Policy Conditions <br />CHANGES <br />Form Number: SRPG8016 <br />�X Add Form Delete Form Amend Form as Follows: <br />The following form SRPG8016 has been added to the policy. <br />CP# 260 <br />Authorized Representative Signature <br />TD & APPRiJVFD <br />hbv nr`jrNlrrvl Divkioy <br />06 2020 <br />HA N1. [AMBERT <br />IL 12 0111 85 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 1 <br />Copyright, ISO Commercial Risk Services, Inc., 1983 <br />