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POLICY NUMBER: 6BRPG0000005895300 <br />INTERLINE <br />IL 12 0111 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 />6BRPG0000005895300 <br />04/16/16 <br />Nationwide Mutual Insurance Company <br />NAMED INSURED <br />AUTHORIZED REPRESENTATIVE <br />Kevin Christian Noonchester <br />K&K Insurance Group, Inc. <br />DBA: Noteworthy Puepets Inc. <br />COVERAGE PARTS AFFECTED <br />COMMERCIAL GENERAL LIABILITY COVERAGE <br />CHANGES <br />The Policy Changes Effective date above is amended to read: 6/10/2016 <br />Form SRPG8016, SRPG8018 is added to the policy. <br />Cert. #68 <br />Reviewed By: <br />�sL(p <br />Monique Rosales <br />SAPL/Youth Services <br />The above amendments result in a change of premium as follows: <br />ElNo Change 0 To be Adjusted at Audit ❑ Additional Premium E]Return Premium <br />14--4 /A� <br />Authorized Representative Signature <br />IL 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 1 <br />Copyright, ISO Commercial Risk Services, Inc., 1983 <br />