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POLICY NUMBER, 313-57-27 COMMERCIAL AUTO <br /> CA04441013 <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 <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 INC, <br /> Endorsement.Effective Date: 1 0131/2024 <br /> SCHEDULE <br /> Name(s) Of Person(sl Or Organization(s): <br /> ANY PERSON OR ORGANIZATION FOR WHOM THE NAMEn INSURED IS REQUIRED TO PROVIDE A <br /> WAIVER, <br /> In€ormation 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 organizations) 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 *Insurance Services Office, Inc., 2011 Page 1 of 1 ❑ <br />