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220703135 <br />B1225987.112 <br />POLICY NUMBER: COMMERCIAL AUTO <br />CA 04 44 10 13 <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 respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless <br />modified by the endorsement. <br />This endorsement changes the policy effective on the inception date of the policy unless another date is indicated <br />below. <br />Bmmjtpo!Nfdibojdbm-!Jod/ <br />Named Insured: <br />220203135 <br />Endorsement Effective Date: <br />SCHEDULE <br />Name(s) Of Person(s) Or Organization(s): <br />Boz!qfstpo!ps!pshboj{bujpo!up!xipn!ps!xijdi!zpv!bsf!sfrvjsfe!up!qspwjef!uijt!xbjwfs!pg!tvcsphbujpo!jo!b!xsjuufo!dpousbdu!ps!xsjuufo!bhsffnfou <br />fyfdvufe!qsjps!up!mptt-!fydfqu!xifsf!tvdi!dpousbdu!ps!bhsffnfou!jt!qspijcjufe!cz!mbx/ <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 />CzDzouijbNpsbbu:;31bn-Opw24-3135 <br />CA 04 44 10 13 © Insurance Services Office, Inc.,2011 Page 1of 1 <br />9374126:!}!BMMJTNFD!}!3135.36!HMJ-!DBV-!XDP-!VND!\\qsjnbsz^!}!Kfoojgfs!Cfsobm!}!220703135!8;5:;43!BN!)QTU*!}!Qbhf!8!pg!22 <br />Uijt!dfsujgjdbuf!dbodfmt!boe!tvqfstfeft!BMM!qsfwjpvtmz!jttvfe!dfsujgjdbuft/ <br /> <br />