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POLICY NUMBER: 72 APB 012913 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: Countersigned By: <br /> 11/17/2025 12:01 AM <br /> Named Insured: <br /> M. BREY INC (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 $ <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 />