Auto Wavier of Sub - Vendtronics.pdf

COMMERCIAL AUTO

POLICY NUMBER: ISSUE DATE:

This endorsement modifies insurance provided under the following:

AUTO DEALERS COVERAGE FORM

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

SCHEDULE

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

CA 04 44 10 13 © Insurance Services Office, Inc., 2011

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

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US (WAIVER OF SUBROGATION)

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

STATE OF ARIZONA

DEPARTMENT OF ECONOMIC SECURITY

STATE OF ARIZONA, AND ITS DEPARTMENTS, A

GENCIES, BOARDS, COMMISSIONS, UNIVERSITI

ES, OFFICERS, OFFICIALS, AGENTS, AND EMP

LOYEES PO BOX 6123SITE CODE 930APHOENIX,

AZ 85005-3123

The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or or-ganization(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.

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

BA-7Y855503-25-42-G 08-20-25

POLICY NUMBER:

COMMERCIAL AUTO POLICY

IT IS AGREED THAT:

** THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. **

ENDORSEMENT -

BA-7Y855503-25-42-G

ADDITIONAL INSURED

CA T8 01 09 25

STATE OF ARIZONA,

AND ITS DEPARTMENTS, AGENCIES, BOARDS,

COMMISSIONS, UNIVERSITIES, OFFICERS, OFF

ICIALS, AGENTS, AND EMPLOYEES DEPARTMENT

OF ECONOMIC SECURITYPO BOX 6123SITE COD

E 930APHOENIX, AZ 85005-3123

Page of

EFFECTIVE DATE: EXPIRATION DATE:

DATE OF ISSUE: 08-20-25 1 1

09-05-2609-05-25