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POLICY NUMBER: 6078951371 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 />Named Insured: MARK THOMAS & COMPANY, INC. <br />Endorsement Effective Date: 09/15/2021 <br />SCHEDULE <br />Name(s) Of Person(s) Or Organization(s): <br />Any person or organization with whom you have agreed in writing <br />in a contract or agreement to waive any right of recovery <br />against such person or organization, but only if the contract <br />or agreement: <br />1. Is in effect or becomes effective during the term <br />of this policy; and <br />2. Was executed prior to loss <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 4410 13 Copyright, Insurance Services Office, Inc., 2011 <br />662376B7 I MhxKr 1 [ 21 22 Master m1 I Prabnjot Kau, 1 1/12/2022 6:54:25 AM PSV [ Page 7 of 11 <br />Rwe &AVPRw®ar. <br />iau �!rts:ox <br />RakkNna9e,mrtORiul Aitle <br />r ayc i v1 i <br />