SEC FORM
3
SEC Form 3
| FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
| 1150 NORTH ALMA SCHOOL ROAD |
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(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
04/04/2022
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3. Issuer Name and Ticker or Trading Symbol
VERRA MOBILITY Corp
[ VRRM ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
| X |
Officer (give title below) |
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Other (specify below) |
| EVP-Government Solutions |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
| Remarks: |
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| No securities are beneficially owned. |
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/s/ Jonathan Baldwin, by Rebecca Collins, as Attorney-in-Fact |
04/05/2022 |
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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
5
(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. |
LIMITED POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS, that the undersigned hereby constitutes and
appoints Kevin Criddle and Leslie A. Brault of DLA Piper LLP (US), and each of
them signing singly, and with full power of substitution and resubstitution,
each with the power to act alone for the undersigned and in the undersigned's
name, place and stead, in any and all capacities to:
(1) submit and/or execute for and on behalf of the undersigned, a Uniform
Application for Access Codes to File on EDGAR on United States Securities and
Exchange Commission ("SEC") Form ID, including any amendments thereto, and/or
any other documents necessary or appropriate to obtain codes and passwords
enabling the undersigned to make electronic filings with the SEC, including a
request to update passphrase (each, and together, the "EDGAR Access Code
Application");
(2) do and perform any and all acts for and on behalf of the undersigned which
may be necessary or desirable to complete and execute any such authentication
documentation in connection with the EDGAR Access Code Application, and timely
file such form with the SEC; and
(3) take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of such Attorney in Fact, may be of benefit to,
in the best interest of, or legally required by, the undersigned, it being
understood that the documents executed by the Attorney in Fact on behalf of the
undersigned pursuant to this Limited Power of Attorney shall be in such form and
shall contain such terms and conditions as such Attorney in Fact may approve in
such Attorney in Fact's discretion.
The undersigned hereby grants to such Attorney in Fact full power and authority
to do and perform any and every act and thing whatsoever requisite, necessary or
proper to be done in the exercise of any of the rights and powers herein
granted, as fully to all intents and purposes as the undersigned might or could
do if personally present, with full power of substitution or revocation, hereby
ratifying and confirming all that such Attorney in Fact, or such Attorney in
Fact's substitute or substitutes, shall lawfully do or cause to be done by
virtue of this Limited Power of Attorney and the rights and powers herein
granted.
The undersigned agrees that such Attorney in Fact herein may rely entirely on
information furnished orally or in writing by the undersigned to such Attorney
in Fact. The undersigned also agrees to indemnify and hold harmless such
Attorney in Fact against any losses, claims, damages or liabilities (or actions
in these respects) that arise out of or are based upon any untrue statements or
omission of necessary facts in the information provided by the undersigned to
such Attorney in Fact for purposes of executing, acknowledging, delivering or
filing the EDGAR Access Code Application, and agrees to reimburse such Attorney
in Fact for any legal or other expenses reasonably incurred in connection with
investigating or defending against any such loss, claim, damage, liability or
action.
This Limited Power of Attorney shall remain in full force and effect until the
earlier of (i) the undersigned is no longer required to submit an EDGAR Access
Code Application with respect to obtaining access codes to file on EDGAR, (ii)
with respect to each person(s) appointed as Attorney in Fact above, the time
that such person shall no longer be employed by DLA Piper LLP (US), and (iii)
unless earlier revoked by the undersigned in a signed writing delivered to the
foregoing Attorneys in Fact.
This Limited Power of Attorney shall be governed and construed in accordance
with the laws of the State of Delaware without regard to the laws that might
otherwise govern under applicable principles of conflicts of laws thereof.
IN WITNESS WHEREOF, the undersigned has caused this Limited Power of Attorney to
be executed as of March 2, 2022.
/s/ Jonathan Baldwin
Jonathan Baldwin
