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POLICY NUMBER: AS2661066493023 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 <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 <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 /> Risk Management Division <br /> REVIEWED&APPROVED BY: <br /> ;I.�l�lu PA Ada Buda <br /> mamma <br /> Risk Management Specialist <br /> CA 04 44 10 13 © Insurance Services Office, Inc., 2011 / <br />