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1 +9330 3 00080 60 0069 <br />Policy Number T3326810041,45715 <br />Issued by IJBERTY MUTUAL, FIRE INSURANCE COMPANY <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />This endorsement modifies insurance provided under the following: <br />BUSINESS AUTO COVE-RAGE 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 />.. ............. - ------ L <br />Schedule <br />Name of Other Person(s) I Email Address or mailing address: Number Days Notice, <br />organization(s.): <br />Per Schedule on file with the Pr r Schedule on file with the Company 30 <br />Company <br />.. . .......... ............. . . .. - ------ <br />A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons of <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 />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 0x'011 Liberty Mutual Group of Companies. All rights reserved, Page I of 1 <br />Includes copyrighted material of Insurance Services Office, Inc., with <br />its permission. <br />cl, <br />