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DMS Facility Services <br />Policy term 10-1-19 to 10-1-20 <br />Policy Number: Auto Policy #AS6-691-458727-079 <br />Issued By: The First Liberty Insurance Corp. <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />NOTICE OF CANCELLATION TO THIRD PARTIES <br />This endorsement modifies insurance provided under the following: <br />BUSINESS AUTO COVERAGE PART <br />MOTOR CARRIER COVERAGE PART <br />GARAGE COVERAGE PART <br />TRUCKERS COVERAGE PART <br />EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART <br />SELF -INSURED TRUCKER EXCESS LIABILITY COVERAGE PART <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART <br />LIQUOR LIABILITY COVERAGE PART <br />Schedule <br />Name of Other Person(s)/ <br />Organizatlon(s): <br />Email Address or mailing <br />address, <br />Number <br />Days <br />Notice. <br />Broker will provide list of <br />organizations and contacts at least <br />30 <br />10 days prior to the advanced <br />notification date <br />A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or <br />organizations shown in the Schedule above. We will send notice to the email or mailing address listed <br />above at least 10 days, or the number of days listed above, if any, before the cancellation becomes <br />effective. In no event does the notice to the third party exceed the notice to the first named insured. <br />B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure <br />to provide such advance notification will not extend the policy cancellation date nor negate cancellation of <br />the policy. <br />All other terms and conditions of this policy remain unchanged. <br />LIM 99 0105 11 V 2011, Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 <br />Includes copyrighted material of Insurance Services Office, Inc. <br />with its permission. <br />REVIEWED & APPROVED <br />By Risk MANAGEMENT DIVISION <br />/NIR4 7 19 <br />F AN INE 1q. VILLAREAL <br />