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0141M0036,5700004 <br />Policy Number TB2- 681 - 004145 -713 <br />Issued by LIBERTY h7UTUAL FIRE INSURANCE COO 4PANY <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 folloMng: <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 GENE RAL LIABILITY COVERAGE PART <br />EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />PRODUCTSICOMPLETEDOPERATIONS UABILITY COVERAGE PART <br />LIQUOR LIABILITY COVERAGE PART <br />COMMERCIAL LIABILITY— UMBRELLA COVERAGE FORM <br />j .. Schedule <br />E <br />Name of Other Person (s) I <br />Or anizatien s): <br />Email Address or mailing <br />address: <br />Number Days Notice: j <br />I <br />Par schedule an file with the company <br />30 <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 IQ the email or mailing address listed above <br />at least 10 days, or the number of days fisted above, If any, before the cancellation becomes aKeotivo. to 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 dale nor negate cancellation of the <br />policy. <br />All other terms and conditions of this policy remain unchanged. <br />LIM 99 01 0511 C 2011 Liberty Mutual Group of Companies. All rights reserved. Page t of 1 <br />includes copyrighted material of Insurance Services Office, Inc, with <br />Ks permission. <br />