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HomeMy WebLinkAbout4648 - COI_Verra Mobility Corporation_1ACORO� DATE07/ 6/ 2022YYY) CERTIFICATE OF LIABILITY INSURANCE 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. 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). PRODUCER CONTACT 'n NAME: Aon Risk insurance Services West, Inc. PHo E (866) 283-7122 FAX (800) 363-0105 Phoenix AZ office (Ac. No. Ext): A C. No.): 2555 East Camelback Rd. suite 700 ADDRESS: 2 Phoeni X Az 85016 USA RECEIVED INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Indian Harbor Insurance Company 36940 verra Mobility Corporation JUL 18 2022 INSURERB: The Charter oak Fire insurance company 25615 1150 N Alma School Rd INSURER C: Travelers Property cas Co of America 25674 Mesa Az 85201-3000 USA City of Bremerton City Attorneys Office INSURER D: The standard Fire Ins Co 19070 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570094445606 REVISION NUMBER: EM 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDIYYYY MMIDD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY H K COF EACH OCCURRENCE $1, OOO, 000 AGE TO RENTED CLAIMS -MADE X❑ OCCUR PREMISES Ea occurrence $1, 000, 000 MED EXP (Any one person) $10 , 000 PERSONAL & ADV INJURY $1, 000 0 000 p GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2 , OOO, 000 POLICY ❑X PRO- ❑X LOC I PRODUCTS- COMP/OPAGG $2,0009000 JECT o> 0 0 OTHER: C AUTOMOBILE LIABILITY 810-1N66741A-22-13-G 07/01/2022 07/01/2023 COMBINED SINGLE LIMIT $1, 000, 000 Ea accident .. BODILY INJURY ( Per person) C X ANYAUTO Z OWNED SCHEDULED BODILY INJURY (Per accident) ,a AUTOS ONLY AUTOS PROPERTY DAMAGE V HIREDAUTOS NON -OWNED Per accident);� ONLY AUTOS ONLY 0t d C X UMBRELLALIAB X OCCUR CUPOL2165282213 07 01 2022 07101 2023 EACH OCCURRENCE $55000,000 V EXCESS LIAR CLAIMS -MADE AGGREGATE $5 , OOO, 000 DEC) I RETENTION D WORKERS COMPENSATION AND UB9K5564402213G 07 01 2022 07 01 2023 X PER STATUTE ORH- EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1, 000, 000 OFFICER/MEMBER EXCLUDED? N / A (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE $1, 000 , 000 If yes, describe under E.L. DISEASE -POLICY LIMIT $1, 000 , 000 — DESCRIPTION OF OPERATIONS below A cyber Liability MTP903976202 10/17/2021 10/17/12011 Each C1aimAggregate 2,000,000 — claims Made SIR $1,000,000 SIR applies per policy ter s & condi ions DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) tin 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. o- CERTIFICATE HOLDER CANCELLATION 00 . s o 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE co EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE LO POLICY PROVISIONS. $ City Of Bremerton Financial Services AUTHORIZED REPRESENTATIVE 345 Sixth Street, Suite 600 --f Bremerton WA 98337-1873 USA o ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016I03) The ACORD name and logo are registered marks of ACORD AGENCY •' 1570000072487 • ADDITIONAL R ■ 1 a , AGENCY NAMEDINSURED Aon Risk Insurance services West, Inc. verra Mobility Corporation POLICY NUMBER See Certificate Number: 570094445606 CARRIER NAIC CODE see Certificate Number: 570094445606 EFFECTIVE DATE: HVvI � IVIVN6 rICIVIHr11�A Ha,vnv w i tzuuuiu i) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. Ail rights reserved. AGENCY CUSTOMER ID: 570000072487 .'�'` AGENCY Aon Risk Insurance Services West, Inc. POLICY NUMBER See Certificate Number: 570094445606 CARRIER NAIC CODE see Certificate Number: 570094445606 ADDITIONAL REMARKS LOC #: NAMED INSURED verra Mobility Corporation EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Named Insureds Schedule Verra Mobility Corporation verra Mobility Holdings, LLC Greenlight Holding Corporation Greenlight 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/I</a ATS Consolidated, Inc. American Traffic solutions, rnc. Mulvihill zCs, Inc. Verra Mobility Electrical Enterprises, Inc Lasercraft, Inc. Arerican Traffic Solutions Consolidated, LLC ATS Processing Services, LLC Platepass, LLC ATS Tolling, LLC Sunshine State Tag Agency, LLC (formerly Sunshine Acquisition z, LLC) Auto Tag of Americas LLC Auto Titles of America, LLC American Traffic Solutions, LLC Highway Toll Administration, LLc (HTA) Canadian Highway Toll Administration Ltd Toll Buddy, LLC Violation Management Solutions, LLC Euro Parking Collection plc (UI<)°'° Contractum Limited (UK)°'� EPC Hungary Kft (Hungary)° EPC Finance Limited (uK)°'° verra Mobility B.V. (Netherlands)°'° Verra Mobility France SAS (France)°'° Pagatelia, S.L.U.''° .verra Mobility Ireland Limited�'� °'°coverage applies to subsidiaries to the extent of the policy terms and conditions Page _ of _ c.�a ., e� ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD V 'LUUtl AGVHU GVHr'uF1A nuIV. Nn ngms reserves. AGENCY CUSTOMER ID: 570000072487 LOC #: ADDITIONAL Page _ of _ AGENCY NAMEDINSURED Aon Risk Insurance services West, Inc. Verra Mobility corporation POLICY NUMBER See Certificate Number: 570094445606 CARRIER NAIC CODE See Certificate Number: 570094445606 EFFECTIVE DATE: ADDITIONAL REMARKS ACORD 101 (2000/01) ©2000 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD