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POLICY NUMBER: 68RP00000005515500 <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 <br />POLICY NUMBER <br />POLICY CHANGES EFFECTIVE <br />COMPANY <br />6BRPG0000005515500 <br />02/13/15 <br />Nationwide Mutual Insurance Company <br />NAMED INSURED <br />AUTHORIZED REPRESENTATIVE <br />Maria L Madrigal <br />K&K Insurance Group, Inc. <br />COVERAGE PARTS AFFECTED <br />ALL COVERAGE PARTS <br />CHANGES <br />The following form,SRPG8016, is added to the policy in regards to City of Santa Ana, its officers, agents, and employees. <br />CP# 4540 <br />A- "d <br />Authorized Representative Signature <br />\S <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 />