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DocuSign Envelope ID: FF596EF9-95C3-43F0-9E5B-F05288BBF843 <br /> SCHOOL POLICY FOR HEALTHCARE PROVIDER STUDENTS <br /> Agreement to Provide Notice of Cancellation <br /> In consideration of the premium paid, it is agreed that if the policy to which this endorsement is attached <br /> is cancelled before the expiration date, we will endeavor to mail notice to the person or entity named <br /> below. However, failure to mail such notice shall impose no obligation or liability of any kind upon the <br /> company, its agents or representatives. <br /> Person or Entity Name and Address: <br /> Northgate Associates <br /> PO Box 2476 <br /> Durham, NC 27715 <br /> This endorsement is a part of the policy and takes effect on the effective date of the policy, unless <br /> another effective date is shown below. All other provisions of the policy remain unchanged. <br /> Must Be Completed Complete Only When This Endorsement is Not Prepared with the Policy <br /> Or is Not to be Effective with the Polio <br /> ENDT. NO. POLICY NO. ISSUED TO ENDORSEMENT EFFECTIVE DATE <br /> 01 1 0127265153 Durham Technical Community College 10/01/2015 <br /> G-144M-A(1/2003) <br /> AMERICAN CASUALTY COMPANY OF READING, PA Page 1 of 1 <br />