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HomeMy WebLinkAboutPD13-091 - Insurance Certificate - American Traffic Solutions (ATS) dba Verra Mobility - Liability Coverage - 07/01/2022Ho l d e r I d e n t i f i e r : 77 7 7 7 7 7 7 0 7 0 7 0 7 0 0 0 7 7 7 6 3 6 1 6 0 6 5 5 5 3 3 3 0 7 7 3 6 0 7 6 5 6 3 3 5 5 7 7 4 0 7 6 7 3 1 2 5 6 4 0 7 1 4 0 0 0 0 7 3 4 4 2 5 5 7 3 6 4 1 2 1 1 0 0 7 1 6 0 4 1 3 3 3 2 4 3 0 1 1 0 0 7 7 4 0 4 1 1 7 5 6 2 7 4 7 5 4 0 7 5 6 0 6 7 3 7 3 0 0 3 2 5 5 0 0 7 7 0 0 6 1 3 3 7 4 4 1 4 7 5 4 0 7 3 4 6 2 1 7 7 7 2 0 5 4 3 1 0 0 7 7 7 2 7 2 5 2 0 2 5 7 7 3 1 1 0 7 7 7 7 7 7 7 0 7 0 0 0 7 0 7 0 0 7 66 6 6 6 6 6 6 0 6 0 6 0 6 0 0 0 6 2 6 0 6 4 6 6 2 0 4 4 4 6 2 0 0 6 0 0 0 0 2 6 0 6 2 2 6 2 0 2 0 0 6 0 0 2 0 2 6 2 6 0 0 4 0 0 2 0 0 6 2 0 0 2 2 4 0 6 2 2 6 0 2 0 0 0 6 2 0 2 2 2 6 2 4 2 0 6 2 2 2 0 0 6 2 2 2 0 0 6 0 4 0 0 6 0 0 0 2 0 6 2 2 2 0 0 4 2 4 2 2 4 0 0 2 2 0 6 2 2 0 0 0 6 0 4 0 2 2 0 4 2 0 0 6 2 0 2 0 4 4 2 2 2 4 4 0 2 4 0 0 6 6 6 4 6 0 6 2 2 4 0 6 6 4 4 4 0 6 6 6 6 6 6 6 0 6 0 0 0 6 0 6 0 0 6 Ce r t i f i c a t e N o : 5 7 0 0 9 6 1 9 6 8 0 4 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/25/2022 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-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # (866) 283-7122 INSURED 25615The Charter Oak Fire Insurance CompanyINSURER A: 25674Travelers Property Cas Co of AmericaINSURER B: 19070The Standard Fire Ins CoINSURER C: 36940Indian Harbor Insurance CompanyINSURER D: INSURER E: INSURER F: FAX (A/C. No.):(800) 363-0105 CONTACT NAME: Verra Mobility Corporation 1150 N Alma School Rd Mesa AZ 85201-3000 USA COVERAGES CERTIFICATE NUMBER:570096196804 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) SUBR WVD INSR 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 A 07/01/2022 07/01/2023H6309K456809COF22 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) $1,000,000B07/01/2022 07/01/2023 COMBINED SINGLE LIMIT (Ea accident) 810-1N66741A-22-I3-G EXCESS LIAB X OCCUR CLAIMS-MADE AGGREGATE EACH OCCURRENCE DED $5,000,000 $5,000,000 07/01/2022UMBRELLA LIABB 07/01/2023CUP0L21652822I3 RETENTION X E.L. DISEASE-EA EMPLOYEE E.L. DISEASE-POLICY LIMIT E.L. EACH ACCIDENT $1,000,000 X OTH- PER STATUTEC07/01/2022 07/01/2023 $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 UB9K55644022I3G Each ClaimAggregateMTP90397620310/17/2022 10/17/2023 Claims Made $1,000,000SIR Cyber LiabilityD 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) Re: Name: Photo Enforcement; Locations: Neely-Obrien Elementary @ 64th Ave S Kent, Wa 98032 & Sunrise Elementary @ 132nd Ave Se, Kent, Wa 98042. The City Of Kent, its elected and/or appointed officials, its officers, employees, agents, volunteers, and representatives are additionally insured under the general liability insofar as the work, obligations and activities performed by the owner/developer and authorized by The City Of Kent permit are concerned as required by written contract. CANCELLATIONCERTIFICATE HOLDER AUTHORIZED REPRESENTATIVEJackie Bicknell City of Kent Engineering Department 220 4th Avenue South Kent WA 98032 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: 570096196804 570096196804 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 D E&O-PL-Primary MTP903976203 10/17/2022 10/17/2023 Aggregate $2,000,000 SIR $1,000,000 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 570096196804 570096196804 Page _ of _ Verra Mobility Corporation 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 (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.U.* 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 570096196804 570096196804 Page _ of _ Verra Mobility Corporation Redflex Holdings Pty Ltd Transtoll 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* T2 Systems Parent Corporation T2 Holding Corp. T2 Systems, Inc. Citation Collection Services, LLC United Public Safety, Inc. *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