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Policy Number. WC-/-641-00509?-021 <br />Issued by: LIBERTY MUTUAL FIRE INSURANCE COMPANY Endorsement Effective Date: 01 /01 /2011 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />NOTICE OF CANCELLATION TO THIRD PARTIES <br />A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations <br />shown in the Schedule below. We will send notice to the email or mailing address listed below at least 10 days, or the <br />number of days listed below, if any, before the cancellation becomes effective. In no event does the notice to the third <br />party exceed the notice to the first named insured. <br />B. This advance email 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 policy. <br />SCHEDULE <br />Name of Other Person(s) / <br />Organ Izatlon(s) <br />Email Address or mailing address: <br />_ <br />Number Days Notice: <br />Per Schedule on file with the <br />company <br />-- -_._ ____ <br />-9-0_____.___ <br />Ali other terms and conditions of this policy remain unchanged. <br />WM g0 18 Og 10 2010 Liberty Mutual Group of Compatnes Page I of 1 <br />FA. e1) /U1 1'-,010 All Rights Reserved <br />