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POLICY NUMBER: 6BRPG0000005516500 <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 />6BRPG0000005515500 <br />05I31/15 <br />Nationwide Mutual Insurance Company <br />NAMED INSURED <br />AUTHORIZED REPRESENTATIVE <br />Carmen M. Whitmer <br />K&K Insurance Group, Inc. <br />COVERAGE PARTS AFFECTED <br />COMMERCIAL GENERAL LIABILITY COVERAGE <br />CHANGES <br />The following form, SRPG8018, is added to the policy in regards to The City of Santa Ana, Officers, Employees, Agents <br />& Representatives <br />CP# 5469 <br />Aa't/I "j <br />Authorized Representative Signature <br />Reviewed by <br />Carmen Acosta <br />PRCSA/Recreation <br />r14 o� � <br />IL 12 01 11 86 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 1 <br />Copyright, ISO Commercial Risk Services, Inc„ 1983 <br />