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POLICY NUMBER INSURED NAME AND ADDRESS <br /> 5088174785 Buxton Company <br /> 2651 S.Polaris Drive <br /> Fort Worth,TX 76137 <br /> POLICY CHANGES <br /> BLANKET WAIVER CG2404 <br /> This Change Endorsement changes the Policy. Please read it carefully. <br /> This Change Endorsement is a part of your Policy and takes effect on the <br /> effective date of your Policy, unless another effective date is shown. <br /> CG 24 04 SCHEDULE <br /> Name of Person or Organization: <br /> Any person or organization with whom you have agreed in writing <br /> in a contract or agreement to waive any right of recovery <br /> against such person or organization, but only if the contract <br /> or agreement: <br /> 1. Is in effect or becomes effective during the term <br /> of this policy; and <br /> 2. Was executed prior to loss. <br /> s <br /> s <br /> s <br /> Seereftary•�' <br /> Chairman of the Board <br /> G-56015-13 (ED. 11/91) <br />