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POLICY NUMBER:AS5-Z11-C3H77D-023 COMMERCIAL AUTO <br /> CA 04 44 03 10 <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 /> 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 <br /> unless modified by the endorsement. <br /> SCHEDULE <br /> Name(s) Of Person(s) Or Organizations(s): <br /> Any person or organization for whom you perform work under a written <br /> contract if the contract requires you to obtain this agreement from us, <br /> but only if the contract is executed prior to the injury or damage <br /> 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 <br /> prior to the "accident"or the"loss" under a contract <br /> with that person or organization. <br /> Risk Management Division <br /> CA 04 44 03 10 Copyright, Insurance Services Office, Inc., 2009 R EWEEWED&APPROVED BY: <br /> /61iZtAowd4 <br /> ammani, <br /> Risk Management Specialist <br />