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PolloyNumber: A12-641-005097-050 <br />Issued By: Liberty Mutual Fire insurance Co. <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)1 <br />Organization(s): <br />Email Address or mailing <br />address: <br />Number <br />Days <br />Notice: <br />Per schedule of certificate holders <br />on file with the Company <br />Per schedule of certificate holders <br />on file with the Company <br />90 <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 emall 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 />S. 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 remaln unchanged. <br />LIM 99 01 0511 0 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 />IQ 6P <br />