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LIM 99 04 03 14 © 2014 Liberty Mutual Insurance. All rights reserved. <br />Includes copyrighted material of Insurance Services Office, Inc., with its permission. <br />Page 1 of 1 <br />Policy Number TB2-661-067353-033 <br />Issued by Liberty Mutual Fire Insurance Co. <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />NOTICE OF CANCELLATION OR MATERIAL REDUCTION IN COVERAGE 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 />PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART <br />LIQUOR LIABILITY COVERAGE PART <br />COMMERCIAL LIABILITY – UMBRELLA COVERAGE FORM <br />Schedule <br />Name of Other Person(s) / <br />Organization(s): <br />Email Address or mailing address: Number Days Notice: <br />Per schedule on file with broker Per schedule on file with broker 30 days <br />A.If we cancel this policy for any reason other than nonpayment of premium, or make a material reduction in <br />coverage, we will notify the persons or organizations shown in the Schedule above. We will send notice to the <br />email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the <br />cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first <br />named insured. <br />B.This advance notification of a pending cancellation or material reduction of coverage is intended as a courtesy <br />only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate <br />cancellation of the policy. <br />All other terms and conditions of this policy remain unchanged. <br />Docusign Envelope ID: AE6D62F6-F8A3-4FE3-ABFB-CC69763A0B44