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0 <br />ZURICH <br />Waiver Of Transfer Of Rights Of Recovery Against Others To Us <br />olicy No. <br />ff. Date of Pol. <br />xp. Dade of Pol. <br />Dade of End. <br />gency No. <br />dal. Prem <br />b.P.. <br />AP 5965893 04 <br />flfU <br />!1113 <br />�ff. <br />This endorsement is issued by the company named in the Declarations. It changes the policy on the effective date listed above at <br />the hour stated in the Declarations. <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />Named Insured: <br />Address (including ZIP code): <br />This endorsement modifies insurance provided under the: <br />Busiress Auto Coverage Form <br />Truckers Coverage Form <br />Garage Coverage Form <br />Motor Carrier Coverage Form <br />SCHEDULE <br />Name of Person or Organization: <br />ONLY THOSE WERE REQUIRED B Y WRITTEN CONTRACT. <br />We waive any right of recovery we may have against the designated person or organization shown in the schedule because of <br />payments we make forinjury or damage caused byan "accident" or "loss" resulting from the ownership, maintenance, or use of <br />a covered "auto" for which a Waiver of Subrogation is required in conjunction with work performed by you for the designated <br />person or organization. The waiver applies only to the designated person or organization shown in the schedule. <br />Countersigned: <br />Date: <br />U -CA -324B CW (4194) <br />Page 1 of l <br />