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NI IL 01 50 09 11 <br />Endorsement Effective <br />Named Insured <br />Policy Number <br />Authorized Signature <br />Includes copyrighted material of Insurance Services Office, Inc used with its <br />permission. Copyright, Insurance Services Office, Inc. <br />Page 1 of 1 <br />NI IL 01 50 09 11 <br />National Interstate Insurance Company <br />CANCELLATION NOTICE <br />DESIGNATED CERTIFICATE HOLDERS <br />ENDORSEMENT <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />COMMERCIAL AUTO COVERAGE PART <br />The organization(s) or person(s) described or listed in the Schedule below have requested that they receive <br />written notice of cancellation when this policy is cancelled by us. We will mail to the organization(s) or <br />person(s) described or listed in the Schedule a copy of the written notice of cancellation. If possible, such <br />Our failure to provide such notification to the organization(s) or person(s) shown in the Schedule will not <br />extend any policy cancellation date nor impact or negate any cancellation of the policy. This endorsement <br />does not entitle the organization(s) or person(s) listed or described in the Schedule above to any benefit, rights <br />or protection under this policy. <br />Any provision of this endorsement that is in conflict with a statute or rule is hereby amended to conform to <br />that statute or rule. This endorsement is effective on the inception date of this Policy if the Endorsement <br />Effective is left blank. <br />All other terms and conditions of the policy remain unchanged. <br />copies of the notice will be mailed at least _____ days, except for cancellation for non-payment of premium <br />which will be mailed according to the policy provisions, prior to the effective date of the cancellation, to the <br />address or addresses of certificate holders as provided by your broker or agent. <br />Schedule <br />Organization(s) or Person(s) including mailing address <br />City of Pleasanton <br />400 Old Bernal <br />Pleasanton CA 94566 <br />YPP 5735260 0105/01/2025 <br />BLACK TIE TRANSPORTATION, LLC <br />30 <br />Docusign Envelope ID: 2C9A65BB-21B7-4E3B-A5B5-F713B3B31D24Docusign Envelope ID: 8D82D9D4-0EDC-4063-A4B1-305FA902188EDocusign Envelope ID: 0D1BA1AB-EE6C-4FC0-8B30-14755F8114EE