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POLICY NUMBER: AS2-691-467423-011 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 <br />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 by <br />the endorsement. <br />SCHEDULE <br />Name(s) Of Person(s) Or Organization(s): <br />Any person or organization for whom you perform work under a written contract if the contract requires you to obtain this <br />agreement from us, but only if the contract is executed prior to the injury or damage 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, but <br />only to the extent that subrogation is waived prior to the <br />"accident" or the "loss" under a contract with that person <br />or organization. <br />CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 <br />Attachment Code: D580222 Certificate ID: 16927711 <br />    <br /> <br />   <br />Document Ref: N7EW3-SGCO5-ACZIS-EK5UO Page 34 of 41 <br />Docusign Envelope ID: 46E32969-D741-4B7D-842F-E8234CE75451