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HomeMy WebLinkAboutCity of Bremerton Financial Services COIHolder Identifier : 7777777707070700077761616045571110766707007315446207443036662517300072651566057221130763514013167111207526111772334552075637234224773300777701504715574707361011671337502076727242035772000777777707000707007 7777777707070700073525677115456000743732646716777407260411121361130072310441246331620703333730243710107033336246123044071677326560371000746277335202354107063333206172011077756163351765540777777707000707007Certificate No :570088683426CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/03/2021 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. PRODUCER Aon Risk Insurance Services West, Inc. Phoenix AZ Office 2555 East Camelback Rd. Suite 700 Phoenix AZ 85016 USA PHONE(A/C. No. Ext): E-MAILADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # (866) 283-7122 INSURED 36940Indian Harbor Insurance CompanyINSURER A: 25674Travelers Property Cas Co of AmericaINSURER B: 25615The Charter Oak Fire Insurance CompanyINSURER C: 19070The Standard Fire Ins CoINSURER D: INSURER E: INSURER F: FAX(A/C. No.):(800) 363-0105 CONTACTNAME: Verra Mobility Corporation 1150 N Alma School RdMesa AZ 85201-3000 USA COVERAGES CERTIFICATE NUMBER:570088683426 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.Limits shown are as requested POLICY EXP (MM/DD/YYYY)POLICY EFF (MM/DD/YYYY)SUBRWVDINSR LTR ADDL INSD POLICY NUMBER TYPE OF INSURANCE LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR POLICY LOC EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG X X X X GEN'L AGGREGATE LIMIT APPLIES PER: $1,000,000 $1,000,000 $10,000 $1,000,000 $2,000,000 $2,000,000 C 07/01/2021 07/01/20226309K456809 PRO- JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON-OWNED AUTOS ONLY BODILY INJURY ( Per person) PROPERTY DAMAGE (Per accident) X BODILY INJURY (Per accident) $1,000,000B07/01/2021 07/01/2022 COMBINED SINGLE LIMIT (Ea accident) 810-1N66741A-21-I3-G EXCESS LIAB X OCCUR CLAIMS-MADE AGGREGATE EACH OCCURRENCE DED $5,000,000 $5,000,000 07/01/2021UMBRELLA LIABB 07/01/2022CUP0L21652821I3 RETENTION X E.L. DISEASE-EA EMPLOYEE E.L. DISEASE-POLICY LIMIT E.L. EACH ACCIDENT $1,000,000 X OTH-ERPER STATUTED07/01/2021 07/01/2022 $1,000,000 Y / N (Mandatory in NH) ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED?N / AN WORKERS COMPENSATION AND EMPLOYERS' LIABILITY If yes, describe under DESCRIPTION OF OPERATIONS below $1,000,000 UB9K55644021I3G Each ClaimAggregateMTP90397620110/17/2020 10/17/2021 Claims Made $500,000SIR Cyber LiabilityA SIR applies per policy terms & conditions $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Please See Attached Named Insured Schedule.Re: Activities performed by or on behalf of the permittee or contractor as required by contract. City of Bremerton, WA its agents, representatives and employees are included as Additional Insured in accordance with the policy provisions of the General liability and Auto Liability policy. A Waiver of Subrogation is granted in favor of Certificate Holder in accordance with the policy provisions of the General liability, Auto Liability, and Workers Comp policy. CANCELLATIONCERTIFICATE HOLDER AUTHORIZED REPRESENTATIVECity of Bremerton Financial Services 345 Sixth Street, Suite 600 Bremerton WA 98337-1873 USA ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AGENCY CUSTOMER ID: ADDITIONAL REMARKS SCHEDULE LOC #: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:ACORD 25 FORM TITLE:Certificate of Liability Insurance EFFECTIVE DATE: CARRIER NAIC CODE POLICY NUMBER NAMED INSUREDAGENCY See Certificate Number: See Certificate Number: 570088683426 570088683426 Aon Risk Insurance Services West, Inc. 570000072487 ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSURER INSURER INSURER INSURER INSURER(S) AFFORDING COVERAGE Page _ of _ NAIC # Verra Mobility Corporation TYPE OF INSURANCE POLICY NUMBER LIMITS OTHER A E&O-PL-Primary MTP903976201 10/17/2020 10/17/2021 Aggregate $2,000,000 SIR $100,000 Prof Liab - Claims Made ADDL INSD INSR LTR SUBR WVD POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) SIR applies per policy terms & conditions ACORD 101 (2008/01)© 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Named Insureds Schedule AGENCY CUSTOMER ID: ADDITIONAL REMARKS SCHEDULE LOC #: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:ACORD 25 FORM TITLE:Certificate of Liability Insurance EFFECTIVE DATE: CARRIER NAIC CODE POLICY NUMBER NAMED INSUREDAGENCY See Certificate Number: See Certificate Number: Aon Risk Insurance Services West, Inc. 570000072487 570088683426 570088683426 Page _ of _ Verra Mobility Corporation Verra Mobility Corporation Verra Mobility Holdings, LLCGreenlight Holding CorporationGreenlight Intermediate Holding Corporation Greenlight Acquisition Corporation VM Consolidated, Inc. (f/k/a Verra Mobility Corp f/k/a ATS Consolidated, Inc.) Verra Mobility Corporation f/k/a ATS Consolidated, Inc. American Traffic Solutions, Inc. Mulvihill ICS, Inc. Mulvihill Electrical Enterprises, Inc. Lasercraft, Inc. American Traffic Solutions Consolidated, LLC ATS Processing Services, LLC Platepass, LLC ATS Tolling, LLC Sunshine State Tag Agency, LLC(formerly Sunshine Acquisition I, LLC)Auto Tag of America, LLCAuto Titles of America, LLCAmerican Traffic Solutions, LLCHighway Toll Administration, LLC (HTA)Canadian Highway Toll Administration Ltd Toll Buddy, LLC Violation Management Solutions, LLC Euro Parking Collection plc (UK)* Contractum Limited (UK)* EPC Hungary Kft (Hungary)* EPC Finance Limited (UK)* Verra Mobility B.V. (Netherlands)* Verra Mobility France SAS (France)* Pagatelia, S.L.* Verra Mobility Ireland Limited* *coverage applies to subsidiaries to the extent of the policy terms and conditions ACORD 101 (2008/01)© 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Named Insureds Schedule Continued AGENCY CUSTOMER ID: ADDITIONAL REMARKS SCHEDULE LOC #: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:ACORD 25 FORM TITLE:Certificate of Liability Insurance EFFECTIVE DATE: CARRIER NAIC CODE POLICY NUMBER NAMED INSUREDAGENCY See Certificate Number: See Certificate Number: Aon Risk Insurance Services West, Inc. 570000072487 570088683426 570088683426 Page _ of _ Verra Mobility Corporation Redflex Holdings LimitedTranstoll Pty Ltd*Redflex Pty Ltd* RTS R&D Pty Ltd* Redflex Traffic Pty Ltd* Redflex Traffic Systems Pty Ltd* Redflex Traffic Systems Inc. Redflex Guardian Inc. Redflex Traffic Systems (California), Inc. Redflex Traffic Systems Limited* Redflex Traffic Systems (Canada) Limited* Redflex Traffic Systems Malaysia Sdn. Bhd.* Redflex Irish Investments Pty Ltd* T/A Go Safe Ireland* Redflex Enforcement Services Pty Ltd* Redflex Traffic Systems India Private Limited* Traffic Operating Services (Saudi Arabia) LLC* *coverage applies to subsidiaries to the extent of the policy terms and conditions ACORD 101 (2008/01)© 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD