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HomeMy WebLinkAbout4648 - COI_Verra Mobility Corporation_2CERTIFICATE OF LIABILITY INSURANCE DATE(OM 5/D�/2YYY) 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 `'"ry' ~`'' Aon Risk Insurance Services West, Inc. NAME: Phoenix AZ Office (A/cNtJo. Ext): (866) 283-7122 iaC, No.): {800) 363-0105 2555 East Camelbaclt Rd. E-MAIL SUl to 700 ADDRESS: Phoenix Az 85016 USA INSURERS) AFFORDING COVERAGE NAIC N INSURED INSURER A: The Charter oak Fire Insurance Company 25615 Verra Mobility Corporation INsuRERB: Travelers Property Cas Co of America 25674 1150 N Alma School Rd Mesa AZ 85201-3000 USA INSURER C: The standard Fi re Ins Co 19070 INsuRERO: Indian Harbor insurance Company 36940 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570096196488 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDIYYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY H K COF EACH OCCURRENCE $1, OOO, OOO CLAIMS -MADE X❑ OCCUR PREMISES Ea occurrence $1, 000, OOO MED EXP (Any one person) $10, 000 PERSONAL&ADVINJURY $1,000,000 GEN'LAGGREGATELIMITAPPLIESPER: POLICY �X PRO � LOC JECT GENERALAGGREGATE $2,000,000 PRODUCTS-COMPlOPAGG $2,000,000 OTHER: B AUTOMOBILE LIABILITY 810-1N66741A-22-13-G 07/Ol/2022 07/Ol/2023 COMBINED SINGLE LIMIT Ea accident $1,000,000 X ANYAUTO BODILY INJURY (Per person) OWNED SCHEDULED AUTOS ONLY AUTOS HIRED AUTOS NON -OWNED ONLY AUTOS ONLY BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident B X UMBRELLALIAB X OCCUR CUPOL2165282213 07 Ol 2022 07 01 2023 EACH OCCURRENCE S,O 0,000 EXCESSLIAB CLAIMS -MADE AGGREGATE $S,000,OOO DED RETENTION C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER I EXECUTIVE Y� OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) II yes, describe undor DESCRIPTION OF OPERATIONS below N / A UB9K5564402223G 07 Ol 2022 07 Ol 2023 X PER STATUTE oRH- E.L. EACH ACCIDENT $1 , OOO, OOO E.L. DISEASE -EA EMPLOYEE $1, 000, 000 E.L. DISEASE -POLICY LIMIT $1, 000, OOO D Cyber Liability MTP903976203 claims Made SIR applies per policy ter 10/17/2022 s & condi 10/17/2023 ions Each C1ailnAggregate SIR 2,000,000 $1,000,000 DESCRIPTION OFOPERATIONS /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 Colnp policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. "' City Of Bremerton Financial SerV1Ce5 AUTHORIZED REPRESENTATIVE 345 sixth street, Suite 600 Bremerton wA 98337-1873 USA ��y � ��tGl[�tanc� e/Gt�u�G!O / �✓eta ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD d 't, O 2 r� ?� 0> 0 0 a O Z w �� d V �+ AGENCY CUSTOMER ID: 570000072487 LOC #: Page _ of _ AGENCY NAMEDINSURED Aon Risk Insurance Services West, Inc. verra Mobility Corporation POLICY NUMBER See Certificate Number: 570096196488 CARRIER NAIC CODE EFFECTIVE DATE; See Certificate Number: 570096196488 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES if a policy below does not include limit information, refer to d)e corresponding policy on the ACORD certificate form for policy limits. INSR TYPE OF INSURANCE AllUL INSD SUBR NVVD POLICYNUNIISER POLICY IsIrhLC:rIVE DATE (NINI/DD/YYYY) POLICY E%PIRA1'ION DATE (N1M/DD/YYYY) LIDiI'1'S OTHER D E&O—PL—Primary MTP903976203 Prof Liab - claims Made SIR applies per policy to 10/17/2022 ms & condit 10/17/2023 ons Aggregate $2,0000000 SIR $1,000,000 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. AGENCY CUSTOMER ID: 570000072487 i AGENCY Aon Risk Insurance Services West, Inc. see Certificate Number: 570096196488 CARRIER NAIC CODE See Certificate Number: 570096196488 ADDITIONAL REMARKS NAMEDINSURED verra Mobility corporation EFFECTIVE DATE: TNIS 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/k/a ATs consolidated, Inc. American Traffic solutions, Inc. Mulvihill Ics, Inc. verra Mobility 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, 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 (uio* 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 _ ACOflD 101 (200FS/01) The ACORD name and logo are registered marks of ACORD v Novo ,a.vnu a.vnrvne�� ww, .v� � rynw �vac� .�... AGENCY CUSTOMER/ 570000072487 • ADDITIONAL AGENCY NAMED INSURED Aon Risk Insurance services west, Inc. verra Mobility Corporation POLICY NUMBER see certificate Number: 570096196488 CARRIER =CODEsee certificate Number: 570096196488EFFECTIVE DATE: i ivrvru, ncivlrinno Hwnu wi izuua�u�i ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD