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POLICY Nu4I BE R-ufiN55es-9Tun I,,LADA- 111091 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />DESIGNATED ENTITY - NOTICE OF <br />CANCELLATION PROVIDED BY US <br />Thu -,di memnas i All provided under Yue mllowvg. <br />ALL COVERAGE PARTS INCLUDED IN TO POI ICY <br />SCHEDULE <br />CANCELLATION. Nuroer of Cry, Nonce of C,,ceumlo,of Do s <br />PERSON OR <br />ORGANIZATION: AS Per Written Contract Or Agreement <br />ADDRESS: <br />PROVISIONS: <br />It Are oucel :his policy for any staWbnN ser -d ed <br />abo,e <br />We AT mail such notice, to file, adl <br />show, <br />other than nonpayment of <br />premium. and a <br />n the. <br />schedule Ao,e et eest :he cumber of <br />days <br />n�her o' days A shown -or c <br />colathn In ine <br />shwm <br />for cancellation i, Te schedule shove <br />before <br />scbeboh ,bay- ve will Fall notice <br />of cancellation to <br />file enectrvedate of cancel'alicn. <br />true person or organisation shown <br />L. true ached, '¢ <br />ILT6050311 A2DnTh, Te.eie.. r.ennM r.09nJA Fi Agn¢meorv�1ad p Page 1of1 <br />I^'�4'WIYi Ry. <br />