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Policy Number TB2-641-444950-037 <br /> Issued by <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) / Email Address or mailing address: Number Days Notice: <br /> Organization(s): <br /> Per Schedule on File with Broker 30 Days <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. We will 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 notice 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 01 05 11 ©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 />