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POLICY NUMBER: 1523011368497 COMMERCIAL AUTO <br />CA 04441013 <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 anothe r date is <br />indicated below . <br />Named Insured: American Asphalt Repair and Resurfacing Company, Inc. <br />Endorsement Effective Date: 12/31/2023 <br />SCHEDULE <br />Name(s) Of Person(s) Or Organization(s): As required by written contract. <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 />pe rson(s) or organization(s) shown in the Schedule , <br />but only to the extent that subrogation is waived <br />prior to the "accident" or the "loss " under a contract <br />with that person or organization. <br />CA 04441013 © Insurance Services Office , Inc ., 2011 Page 1 of 1 <br />DocuSign Envelope ID: E96A4C74-2FC7-4968-986D-B86E1F2596BA