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LIM 99 02 08 11 © 2011 Liberty Mutual Group of Companies. All rights reserved. <br />Includes copyrighted material of Insurance Services Office, Inc., with <br />its permission. <br />Page 1 of 1 <br />Policy Number: AS2-661-067353-023 <br />Issued by: Liberty Mutual Fire Insurance Co. <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 />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: <br />Per schedule on file with broker <br />A.If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or <br />organizations shown in the Schedule above by email as soon as practical after notifying the first Named Insured. <br />B.This advance email notification of a pending cancellation of coverage is intended as a courtesy only. Our failure <br />to 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 />Docusign Envelope ID: AE6D62F6-F8A3-4FE3-ABFB-CC69763A0B44