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Policy Number AS2-631-510005-022 <br />Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />NOTICE OF CANCELLATION TO THIRD PARTIES <br />This endorsement modes 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) / <br />O anization s : Email Address or mailing address: Number Days Notice: <br />City of Santa Ana 20 Civic Center Plaza (M-30) <br />PO Box 1988 30 <br /> Santa Ana, CA 92702-1988 <br /> <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 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 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 />LIM 99 01 05 11 ® 2011 Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 <br />Includes copyrighted material of Insurance Services Office, Inc., with <br />its permission.