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00 ML0087 00 11 10 Page 1 of 1 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />NOTICE OF CANCELLATION – CERTIFICATE HOLDERS <br />(SPECIFIED DAYS) <br />The person(s) or organization(s) listed or described in the Schedule below have requested that they <br />receive written notice of cancellation when this policy is cancelled by us. We will mail or deliver to the <br />Person(s) or Organization(s) listed or described in the Schedule a copy of the written notice of <br />cancellation that we sent to you. If possible, such copies of the notice will be mailed at least days, <br />except for cancellation for non-payment of premium which will be mailed 10 days, prior to the effective <br />date of the cancellation, to the address or addresses of certificate holders as provided by your broker or <br />agent. <br />Schedule <br />Person(s) or Organization(s) including mailing address: <br />(Blanket wording option) <br />All certificate holders where written notice of the cancellation of this policy is required by written <br />contract, permit or agreement with the Named Insured and whose names and addresses will be <br />provided by the broker or agent listed in the Declarations Page of this policy for the purposes of <br />complying with such request. <br />This notification of cancellation of the policy is intended as a courtesy only. Our failure to provide such <br />notification to the person(s) or organization(s) shown in the Schedule will not extend any policy <br />cancellation date nor impact or negate any cancellation of the policy. This endorsement does not entitle <br />the person(s) or organization(s) listed or described in the Schedule above to any benefit, rights or <br />protection under this policy. <br />Any provision of this endorsement that is in conflict with a statute or rule is hereby amended to conform to <br />that statute or rule. <br />All other terms and conditions of this policy remain unchanged. <br /> <br />Endorsement Number: <br />This endorsement is effective on the inception date of this Policy unless otherwise stated herein: <br />(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br />Policy Number: <br />Named Insured: <br />Endorsement Effective Date: <br />71PKG8985001 <br />7/1/2023 <br />O'Grady Paving, Inc. <br />30 <br />79731068 | OGRAPAV-C1 | 23-24 GL Auto WC XS | Sara Powell | 4/29/2024 12:14:36 PM (PDT) | Page 3 of 8 <br />DocuSign Envelope ID: 481D2ACD-7F64-46CA-9ACB-AF08839CFE54