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POLICY NUMBER: 72 APB 012913 <br />M-5144a (06/2007) <br />WAIVER OF TRANSFER OF RIGHTS OF <br />RECOVERY AGAINST OTHERS TO US <br />This endorsement modifies insurance provided under the following: <br />BUSINESS AUTO COVERAGE FORM <br />BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM <br />GARAGE COVERAGE FORM <br />MOTOR CARRIER COVERAGE FORM <br />TRUCKERS COVERAGE FORM <br />With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- <br />fied 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 />Endorsement Effective: <br />Countersigned By: <br />11/17/2025 12:01 AM <br />Named Insured: <br />M. BREY INC <br />(Authorized Representative) <br />SCHEDULE <br />Name Of Person(s) Or Organization(s): <br />City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers <br />220 S. Daisy Ave. <br />Santa Ana, CA 92701 <br />Additional Premium I $ <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as <br />applicable to this endorsement.) <br />The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to the person (s) or organiza- <br />tion(s) shown in the Schedule. We will retain the additional premium shown above, regardless of any early termi- <br />nation of this endorsement or the policy. <br />Includes copyrighted material of Insurance Services Office, Inc. with its permission. <br />M-5144a (06/2007) 11/21/2024 <br />