Laserfiche WebLink
POLICY NUMBER: 6BRP00000005627000 <br />INTERLINE <br />IL 12 01 1185 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />1aQRWAMLJWe1;N <br />Policy Change <br />Number 1 <br />POLICY NUMBER —[�0610811Y4 <br />POLICY <br />POLICY CHANGES EFFECTIVE <br />COMPANY <br />6BRPG0000005527000 <br />Nationwide Mutual Insurance Company <br />NAMED INSURED <br />AUTHORIZED REPRESENTATIVE <br />LaVerne Davis <br />K&K Insurance Group, Inc. <br />COVERAGE PARTS AFFECTED <br />COMMERCIAL GENERAL LIABILITY COVERAGE <br />CHANGES <br />Forms CG2011, SRPG8016, SRPG8018 are added to the policy, <br />Ref: CP# 1203 <br />Effective: 06/08/14 to 06/08/15 <br />The above amendments result in a change of premium as follows: <br />1ENo Change r-1 To be Adjusted at Audit Additional Premium El Return Premium <br />Authorized Representative Sigiiat-tTria- <br />UP-ROV D S TO 'FOY"d <br />1, <br />LI <br />ORCK <br />A E, Attorney <br />IL 12 01 11 85 Copyright, Insurance Services Office, Inc.. 1983 Page I of 1 <br />Copyright, ISO Commercial Risk Services, Inc., 1983 <br />