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Waiver Of Subrogation

POLICY NUMBER:

COMMERCIAL AUTO

CA 04 44 10 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US (WAIVER OF SUBROGATION)

This endorsement modifies insurance provided under the following:

AUTO DEALERS COVERAGE FORM

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless

modified by the endorsement.

This endorsement changes the policy effective on the inception date of the policy unless another date is indicated

below.

Named Insured:

Endorsement Effective Date:

SCHEDULE

Name(s) Of Person(s) Or Organization(s):

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

The Transfer Of Rights Of Recovery Against Others

To Us condition does not apply to the person(s) or

organization(s) shown in the Schedule, but only to

the extent that subrogation is waived prior to the

‘‘accident’’ or the ‘‘loss’’ under a contract with that

person or organization.

CA 04 44 10 13

Insurance Services Office, Inc., 2011

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Waiver Of Subrogation