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POLICY NUMBER: Ass-all-C3H77D-a23 <br />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 thisagreement 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 />CA 04 44 03 10 Copyright, Insurance Services Office, Inc., 2009 <br />Risk Mvugesie rd Division <br />Rime o&APPROVS)Rr <br />1�S}1llt1 A+ fp Aw4i- <br />�, Risk Management Specialist <br />