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POLICY NUMBER: AS2-661-067353-024 COMMERCIAL AUTO <br /> CA04441013 <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 modified <br /> by the endorsement. <br /> SCHEDULE <br /> Name(s) Of Person(s) Or Organization(s): <br /> Any person or organization for whom you perform work under a written contract if the contract requires you to <br /> obtain this agreement from us, but only if the contract is executed prior to the injury or damage occurring. <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 Others <br /> To Us condition does not apply to the person(s) or <br /> organization(s) shown in the Schedule, but only to the <br /> extent that subrogation is waived prior to the"accident" <br /> or the "loss" under a contract with that person or <br /> organization. <br /> -- Risk MwwgemadElMsian <br /> t RmAEwm&APPROvBD BY: <br /> �1r�li�l��L �►�+a�laaVesdn <br /> '�--�-� Risk Management Specialist <br /> CA 04 44 10 13 O Insurance Services Office, Inc., 2011 Page 1 of 1 <br />