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DMS Facility Services, LLC <br />Policy Term 10/l/2021-10/1/2022 <br />Commercial General Liability <br />Policy Number TB2-691-458727-081 <br />Issuedby LIBERTY NTUTUAL FIRE INSURANCE COMPANY <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, <br />NOTICE OF CANCELLATION TO THIRD PARTIES <br />This endorsement modifies insurance previdee 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 LIA.BI_ - f COVERAGE PART <br />PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART <br />LIQUOR LIABILITY COVERAGE PART <br />COMMERCIAL UABII_ITY — UMBRELLA COVERAGE FORM <br />Schedule <br />Name of Other Person(s)! <br />Or9anization(sl: <br />Email Address or mailing address: <br />Number Days Notice: <br />I <br />Brcker will provide list of <br />organizations and contacts at <br />30 <br />least 10 days prior to the <br />advanced notification date <br />j <br />A. If we cancel this policy fcr any reason othe, than nonpayment of premium, we will notify the persons or <br />organizations shown in the Schedule above. Vie will send notice to the email or ma ling address listed above <br />at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no <br />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 to <br />provide such advance notfication will not extend the policy cancellation date nor negate cancel ation of the <br />ool cy. <br />All oche.- terms and conditions of this policy remain unchanged. <br />LIM 99 01 05 11 Cd 2011 Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 <br />Includes copyrighted material of Insurance Services OfFce, Inc., with <br />its perm'ssion. <br />R ek muagonmi trim <br />REMEwED 6 APPROVED BY: <br />will, <br />laze Pe <br />Risle Management Ci eriral Aide <br />