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Policy Number: AS2-631-510199-321 <br />COMMERCIAL AUTO <br />CA 04"1013 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />WAIVER OF TRANSFER OF RIGHTS OF RECOVERY <br />AGAINST OTHERS TO US (WAIVER OF SUBROGATION) <br />This endorsement modifies insurance provided under the following: <br />AUTO DEALERS COVERAGE FORM <br />BUSINESS AUTO COVERAGE FORM <br />MOTOR CARRIER COVERAGE FORM <br />With respectto coverage provided by this endorsement, the provisionsof the Coverage Form apply unless modified <br />by the endorsement. <br />SCHEDULE <br />Name(s) Of Person(s) Or Organization(s): <br />Any person or organization for whom you perform work under a written contract if the contract requires you to <br />obtain this agreement from us, but only if the contract is executed prior to the injury or damage occurring. <br />Premium: $ INCL <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />The Transfer Of Rights Of Recovery Against <br />Others To Us condition does not apply to the <br />person(s) or organization(s) shown in the Schedule, <br />but only to the extent that subrogation is waived prior <br />to the "accident' or the 'loss" under a contract with <br />that person or organization. <br />CA 04 44 10 13 © Insurance Services Office, Inc., 2011 <br />Rick ManagmatE Division <br />REVIEWED & NPRDVED BY. <br />i <br />-.----� RiskManagemenCAnalyst <br />