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POLICY NUMBER: AS6 -641- 439037 -024 <br />COMMERCIAL AUTO <br />CA04440310 <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 />BUSINESS AUTO COVERAGE FORM <br />BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM <br />GARAGE COVERAGE FORM <br />MOTOR CARRIER COVERAGE FORM <br />TRUCKERS COVERAGE FORM <br />With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply <br />unless modified by the endorsement. <br />SCHEDULE <br />Name(s) Of Person(s) Or Organizations(s): <br />Any person or organization for whom you perform work under a written <br />contract if the contract requires you to obtain this agreement from us, but <br />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 <br />Schedule, but only to the extent that <br />subrogation is waived prior to the "accident" or <br />the 'loss" under a contract with that person or <br />organization. <br />CA04 44 03 10 Copyright, Insurance Services Office, Inc., 2009 Page 9 of 1 <br />