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POLICY NUMBER: 6BRPG0000007214200 <br />INTERLINE <br />IL12011185 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />POLICY CHANGES <br />Policy Change <br />Number 1 <br />POLICY NUMBER <br />POLICY CHANGES EFFECTIVE <br />COMPANY <br />6BRPG0000007214200 <br />01/07/20 <br />Nationwide Mutual Insurance Company <br />NAMED INSURED <br />AUTHORIZED REPRESENTATIVE <br />Salomon Rivera <br />K&K Insurance Group, Inc. <br />COVERAGE PARTS AFFECTED <br />Common Policy Conditions <br />CHANGES <br />Form Number: SRPG8016 <br />FX Add Form 7 Delete Form <br />Amend Form as Follows: <br />CP# 75 <br />Authorized Representative Signature <br />& APPROVED <br />1r,,FNIFNT DIVISION <br />2 2 2020 <br />IL 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983 $AMA HA M. <br />Copyright, ISO Commercial Risk Services, Inc., 1983 <br />