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POLICY NUMBER: 6BRPG0000004192500 <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 />6BRPG0000004192500 <br />10/21/08 <br />Nationwide Mutual Insurance Company <br />NAMED INSURED <br />AUTHORIZED REPRESENTATIVE <br />K&K Insurance Group, Inc. <br />Jurgens, Jennifer <br />COVERAGE PARTS AFFECTED <br />ALL COVERAGE PARTS <br />CHANGES <br />It is hereby agreed that form SRPG876 added by Policy Change Number 1, is voided and replaced with the following <br />form of the same number. <br />Authorized Representative Signature <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 />