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POLICY NUMBER: 012-32-7512 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 fallowing: <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 <br /> modified by the endorsement.. <br /> This endorsement changes the policy effective on the inception date of the policy unless another date is <br /> indicated below. <br /> Named Insured: XYLEM I NC. <br /> Endorsement Effective Elate: 10/31 12025 <br /> SCHEDULE <br /> Name(s) Of Person(s) Or Organization(s): <br /> ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED IS REQUIRED TO PROVIDE A <br /> WAIVER. <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 <br /> contract with that person or organization. <br /> CA 04 44 10 13 (D Insurance Services Office, Inc., 2011 Page 1 of 1 0 <br />