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HomeMy WebLinkAboutCity of Bremerton Financial Services_SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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 THISCERTIFICATE 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY A 1,000,000 3608-38-32 X SEA-004024824-03 1,000,000 15,000,000 X 10052 15,000,000 SIR: $1,000,000 SAN FRANCISCO, CA 94111 N X07/01/2024 0 07/01/2025 11/17/2023 25,000 07/01/2025 7363-48-77 Cyber/Professional Liability B 2,000,000 1,000,000 36940 Chubb National Insurance Co. 1,000,000 X C X 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. 09/19/2024 07/01/2024 5,000,000 Re: Activities performed by or on behalf of the permittee or contractor as required by contract. X Bremerton, WA 98337-1873 City of Bremerton Financial Services 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 Indian Harbor Insurance Company CN138000917--GAUWC-24-25 Limit 10,000 07/01/2025 2,000,000 7819-96-74 2,000,000 20281 1,000,000 1,000,000 05/17/2025 X (25) 7183-90-57 FOUR EMBARCADERO CENTER, SUITE 1100 MARSH RISK & INSURANCE SERVICES X CALIFORNIA LICENSE NO. 0437153 1150 North Alma School Road Verra Mobility Corporation Mesa, AZ 85201 X MTP9039762 04 07/01/2024 345 Sixth Street, Suite 600 07/01/2024 A 07/01/2025 Federal Insurance Company ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: EPC Finance Limited (UK)*� Mulvihill ICS, Inc.� Verra Mobility France SAS (France)*� Lasercraft, Inc.� Redflex Traffic Systems Malaysia Sdn. Bhd.*� Verra Mobility Ireland Limited*� ATS Processing Services, LLC� Canadian Highway Toll Administration Ltd� Violation Management Solutions, LLC� (formerly Sunshine Acquisition I, LLC)� Redflex Traffic Systems (Canada) Limited*� 3 Redflex Irish Investments Pty Ltd*� Redflex Holdings Pty Ltd� Redflex Traffic Systems Inc.� Redflex Traffic Systems India Private Limited*� 2 VM Consolidated, Inc. � Greenlight Intermediate Holding Corporation� San Francisco Greenlight Holding Corporation� Verra Mobility Corporation � Greenlight Acquisition Corporation� Verra Mobility Holdings, LLC� � �� � Additional Named Insureds: � Certificate of Liability Insurance Auto Titles of America, LLC� CN138000917 Transtoll Pty Ltd*� (f/k/a Verra Mobility Corp f/k/a ATS Consolidated, Inc.)� EPC Hungary Kft (Hungary)*� American Traffic Solutions, Inc.� Verra Mobility B.V. (Netherlands)*� Verra Mobility Electrical Enterprises, Inc� Platepass, LLC� American Traffic Solutions Consolidated, LLC� Redflex Pty Ltd*� Euro Parking Collection plc (UK)*� Toll Buddy, LLC� Auto Tag of America, LLC� Redflex Traffic Systems Limited*� Redflex Traffic Pty Ltd*� American Traffic Solutions, LLC� Redflex Enforcement Services Pty Ltd*� MARSH RISK & INSURANCE SERVICES� RTS R&D Pty Ltd*� T/A Go Safe Ireland*� 1150 North Alma School Road� Verra Mobility Corporation� Mesa, AZ 85201 Sunshine State Tag Agency, LLC� Pagatelia, S.L.U.*� Highway Toll Administration, LLC (HTA)� Contractum Limited (UK)*� 25 Redflex Traffic Systems Pty Ltd*� Verra Mobility Corporation f/k/a ATS Consolidated, Inc.� ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: 33 Coverage applies to subsidiaries to the extent of the policy terms and conditions� San Francisco Citation Collection Services, LLC� T2 Systems Canada, Inc.� � United Public Safety, Inc.� T2 Systems Parent Corporation� Traffic Operating Services (Saudi Arabia) LLC*� T2 Systems, Inc.� T2 Holding Corp.� Certificate of Liability Insurance CN138000917 MARSH RISK & INSURANCE SERVICES� 1150 North Alma School Road� Verra Mobility Corporation� Mesa, AZ 85201 25