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POLICY NUMBER: RAC9438325 COMMERCIAL AUTO <br />CA 04 44 10 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 />This endorsement changes the policy effective on the inception date of the policy unless another date is indicated <br />below. <br />Named Insured: Obsidian Group Holdings, LLC <br />Endorsement Effective Date: May 1, 2024 <br />SCHEDULE <br />Name(s) Of Person(s) Or Organization(s): <br />Any person or organization where required by written contract provided that such contract was executed prior <br />to the date of loss. <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 />APPROVED <br />By Cynthia Mora at 11:18 am, Dec 05, 2024 <br />CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 <br />