SEC FORM
4
SEC Form 4
FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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OMB APPROVAL |
OMB Number: |
3235-0287 |
Estimated average burden |
hours per response: |
0.5 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b). |
1. Name and Address of Reporting Person*
C/O PLATINUM EQUITY ADVISORS, LLC |
360 NORTH CRESCENT DRIVE, SOUTH BUILDING |
(Street)
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2. Issuer Name and Ticker or Trading Symbol
VERRA MOBILITY Corp
[ VRRM ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X |
Director |
X |
10% Owner |
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Officer (give title below) |
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Other (specify below) |
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3. Date of Earliest Transaction
(Month/Day/Year) 10/17/2018
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4. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Form filed by One Reporting Person |
X |
Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Security (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction Code (Instr.
8)
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4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
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5.
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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7. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
Amount |
(A) or (D) |
Price |
Class A common stock, par value $0.0001 per share |
10/17/2018 |
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M |
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1,893,798 |
A |
$0.00
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3,540,344 |
D
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Class A common stock, par value $0.0001 per share |
10/17/2018 |
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A |
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53,739,744 |
A |
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53,739,744 |
I |
See footnote
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
3)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction Code (Instr.
8)
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5.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
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6. Date Exercisable and Expiration Date
(Month/Day/Year) |
7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
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8. Price of Derivative Security (Instr.
5)
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9.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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11. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Class F common stock, par value $0.0001 per share |
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10/17/2018 |
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M |
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1,893,798 |
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Class A common stock, par value $0.0001 per share |
1,893,798
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$0.00
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0 |
D
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1. Name and Address of Reporting Person*
C/O PLATINUM EQUITY ADVISORS, LLC |
360 NORTH CRESCENT DRIVE, SOUTH BUILDING |
(Street)
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1. Name and Address of Reporting Person*
C/O PLATINUM EQUITY ADVISORS, LLC |
360 NORTH CRESCENT DRIVE, SOUTH BUILDING |
(Street)
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Explanation of Responses: |
Remarks: |
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See Exhibit 99.1 - Signatures |
10/19/2018 |
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** Signature of Reporting Person |
Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
* If the form is filed by more than one reporting person,
see
Instruction
4
(b)(v). |
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure. |
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |
Exhibit 99.1
PE GREENLIGHT HOLDINGS, LLC
By: /s/ Mary Ann Sigler
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Name: Mary Ann Sigler
Title: President and Treasurer
PLATINUM EQUITY CAPITAL PARTNERS IV, L.P.
By: Platinum Equity Partners IV, L.P.,
Its: General Partner
By: Platinum Equity Partners IV, LLC,
Its: General Partner
By: /s/ Mary Ann Sigler
-----------------------------------
Name: Mary Ann Sigler
Title: Vice President and Treasurer
PLATINUM EQUITY PARTNERS IV, L.P.
By: Platinum Equity Partners IV, LLC,
Its: General Partner
By: /s/ Mary Ann Sigler
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Name: Mary Ann Sigler
Title: Vice President and Treasurer
PLATINUM EQUITY PARTNERS IV, LLC
By: /s/ Mary Ann Sigler
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Name: Mary Ann Sigler
Title: Vice President and Treasurer
PLATINUM EQUITY INVESTMENT HOLDINGS IV, LLC
By: /s/ Mary Ann Sigler
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Name: Mary Ann Sigler
Title: Vice President and Treasurer
PLATINUM EQUITY INVESTMENT HOLDINGS IV MANAGER, LLC
By: /s/ Mary Ann Sigler
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Name: Mary Ann Sigler
Title: President
PLATINUM EQUITY INVESTCO, L.P.
By: Platinum Equity Investment Holdings IC (Cayman), LLC
Its: General Partner
By: /s/ Mary Ann Sigler
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Name: Mary Ann Sigler
Title: President
PLATINUM EQUITY INVESTMENT HOLDINGS IC (CAYMAN), LLC
By: /s/ Mary Ann Sigler
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Name: Mary Ann Sigler
Title: President
PLATINUM INVESTCO, LLC
By: /s/ Mary Ann Sigler
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Name: Mary Ann Sigler
Title: President
PLATINUM EQUITY, LLC
By: /s/ Mary Ann Sigler
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Name: Mary Ann Sigler
Title: Executive Vice President, Chief Financial Officer and Treasurer
TOM GORES
By: /s/ Mary Ann Sigler
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Name: Mary Ann Sigler
Title: Attorney-in-Fact