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POLICY NUMBER, AS2661066493025 COMMERCIAL AUTO <br />CA 04 4410 13 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />WAIVER OF TRANSFER OF RIGHTS OF RECOVERY 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 <br />written contract if the contract requires you to obtain this <br />agreement from us, but only if the contract is executed prior to <br />the injury or damage 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 prior <br />to the "accident" or the "loss" under a contract with <br />that person or organization. <br />CA 04 4410 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 <br />Docusign Envelope ID: B8E47CF4-39D0-4BA3-B2EE-99D4B92500B1