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Policy Number: TB2-681-004145-712 <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 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) / <br />Organization(s): <br />Email Address: <br />Per schedule on file with the Company <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 <br />Insured. <br />B. This advance email notification of a pending cancellation of coverage is intended as a courtesy only. Our <br />failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation <br />of the policy. <br />All other terms and conditions of this policy remain unchanged. <br />LIM 99 02 08 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. <br />