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DMS Facility Services <br />Policy term 10-1-19 to 10-1-20 <br />GL Policy #TB2-691-458727-089 <br />Policy Number <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 />PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART <br />LIQUOR LIABILITY COVERAGE PART <br />COMMERCIAL. LIABILITY -- UMBRELLA COVERAGE FORM <br />Schedule <br />Person(s) I I Email Address or mailing address: I Number Days Notice: <br />Broker will provide list of <br />organizations and contacts at <br />least 10 days prior to the <br />advanced notification date <br />A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or <br />organizations shown to the Schedule above. We writ 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 nuke 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 0105 11 U 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 />REVIEWED & APPROVED <br />By Risk MANAGEMENT DivisiON <br />'�10 ina <br />FRANCINE R. VILLAREAL <br />