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POLICY NUMBER: 66RPGO00000493460C INTERLINE <br />IL 12 01 11 85 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />POLICY CHANGES <br />Policy Change <br />I POLICY NUMBER POLICY CHANGES EFFECTIVE COMPANY <br />6BRPGO000004934600 04/21/11 Nationwide Mutual Insurance Company <br />NAMED INSURED AUTHCRIZED REPRESENTATIVE I <br />Maria R. Vigil K&K Insurance Group. Inc_ <br />COV Ria GIMP Group Fit <br />COV <br />E ERAGE PARTS AFFECTED <br />COMMERCIAL GENERAL LIABILITY COVERAGE <br />CHANGES <br />-arms SRPG8016 and SRPG8018 is added to the policy <br />Ref: CP4 552. <br />The abcve amendments result in a change of premium as follows: <br />----I <br />X I No Change To be Adjusted at Audit ;. Additional Premium r 1 Return Premium <br />Authorized. Representative Signature <br />IL 12 01 E1 85 Copyright, Insurance Services Office, Inc., 1933 Page 1 of 1 <br />Copyright, ISO Commercial! Risk Services, Inc., 1983 <br />