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POLICY NUMBER:ISSUE DATE: <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />DESIGNATED PERSON OR ORGANIZATION – NOTICE OF <br />CANCELLATION PROVIDED BY US <br />This endorsement modifies insurance provided under the following: <br />ALL COVERAGE PARTS INCLUDED IN THIS POLICY <br />CANCELLATION: <br />SCHEDULE <br />Number of Days Notice: <br />PERSON OR <br />ORGANIZATION: <br />ADDRESS: <br />PROVISIONS <br />IL T4 05 05 19 © 2019 The Travelers Indemnity Company. All rights reserved.Page 1 of 1 <br />ANY PERSON OR ORGANIZATION TO WHOM YOU <br />HAVE AGREED IN A WRITTEN CONTRACT THAT <br />NOTICE OF CANCELLATION OF THIS POLICY <br />WILL BE GIVEN, BUT ONLY IF: <br />1. YOU SEND US A WRITTEN REQUEST TO <br />PROVIDE SUCH NOTICE, INCLUDING THE <br />NAME AND ADDRESS OF SUCH PERSON OR <br />ORGANIZATION, AFTER THE FIRST NAMED <br />INSURED RECEIVES NOTICE FROM US OF <br />THE CANCELLATION OF THIS POLICY; AND <br />2. WE RECEIVE SUCH WRITTEN REQUEST AT <br />LEAST 14 DAYS BEFORE THE BEGINNING OF <br />THE APPLICABLE NUMBER OF DAYS SHOWN <br />IN THIS SCHEDULE. <br />THE ADDRESS FOR THAT PERSON OR ORGANIZ- <br />ATION INCLUDED IN SUCH WRITTEN REQUEST <br />FROM YOU TO US. <br />If we cancel this policy for any legally permitted reason other than nonpayment of premium, and a number of days <br />is shown for Cancellation in the Schedule above, we will mail notice of cancellation to the person or organization <br />shown in such Schedule. We will mail such notice to the address shown in the Schedule above at least the <br />number of days shown for Cancellation in such Schedule before the effective date of cancellation. <br />CUP-9S633893-23-NF 04/01/2023 <br />30 <br />DocuSign Envelope ID: EF4B1761-E191-4214-9651-0FC3E17A972A