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POLICY NUMBER: 6BRPG0000004934600 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 />6BRP '0000004934600 <br />04121!1 t <br />Nationwide Mutual Insurance Company <br />NAMED INSURED <br />AUTHORIZED REPRESENTATIVE <br />Maria R. Vigil <br />K&K Insurance Group. Inc_ <br />i DBA: Ria Vigil Group Fit <br />COVERAGE PARTS AFFECTED <br />1 COMMERCIAL GENERAL LIABILITY COVERAGE <br />i <br />1 CHANGES <br />E <br />( Forms SRPG8016 and SRPG8018 is added to the policy <br />i <br />i <br />Ref: CP# 552. <br />The above amendments result in a change of premium as follows: <br />X� No Change To be Adjusted at Audit u Additional Premium L—A Return Prerniom <br />Authorized Representative Signature <br />IL 12 01 11 e5 Copyright, Insurance Services Office, Inc_. 1993 Page 1 of 1 <br />Copyrighz, ISO Commercial Rfsk Services, Inc.. 1983 <br />