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Policy Number: AS2-661-067353-023 <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 /> COMMERCIAL LIABILITY— UMBRELLA COVERAGE FORM <br /> Schedule <br /> Name of Other Person(s)/ Email Address: <br /> Organization(s): <br /> Per schedule on file with broker <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 by email as soon as practical after notifying the first Named Insured. <br /> B. This advance email 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 the <br /> policy. <br /> All other terms and conditions of this policy remain unchanged. <br /> \ Riak Management Division <br /> LIM 99 02 08 11 ©2011 Liberty Mutual Group of Companies.All rights reserve % REVIEWED&APPROVED BY: <br /> Includes copyrighted material of Insurance Services Office, Inc.: `, Fl Acztado <br /> Its permission. Risk Management Speciaiist <br />