ML15065A238

Acord Certificate of Liability Insurance

ML15065A238
Person / Time
Site:	Millstone, Kewaunee, Surry, North Anna
Issue date:	02/06/2015
From:	Acord Corporation
To:	Document Control Desk, Office of Nuclear Reactor Regulation
References
Download: ML15065A238 (4)

Text

0005230 SP 0043 -C01-P05232-1 Document.Control Desk U.S. Nuclear Regulatory Comriission Washington, DC 20555-0001 M 661

DATE (MMIDDIYYYY)

ACCR" CERTIFICATE OF LIABILITY INSURANCE 02/06/2015 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 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 CONTACT NAME:

Marsh Risk & Insurance Services PHONE FAX CA License #0437153 IA/C. No. Ext):A/ No):

777 South Figueroa Street E-MAIL Annppqq.

Los Angeles, CA 90017 Attn: LosAngeles.CertRequest@marshcom /F: 212-948-0535 INSURER(S) AFFORDING COVERAGE 08819 -DRI-AII-15-16 INSURER A: American Nuclear Insurers INSURED INSURER B:

Dominion Resources, Inc.

ATTN: Leslie D.Garber INSURER C:

Leslie.Garber@dom.com INSURER D:

701 East Cary Street, 20th Floor Richmond, VA 23219 INSURER E:

COVERAGES CERTIFICATE 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.

INSR IADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE N POLICY NUMBER (MMIDD/YyyyJ IMMiDD/Yyyy) LIMITS GENERAL UABIUTY EACH OCCURRENCE $

DAMAGE TO RENTED MMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $

CLAIMS-MADE D OCCUR MED EXP (Any one person) $

0 _ _ PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $

POLICY -

"- - ROJECT '-]LOC $

COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accidentO $

ANY AUTO _BODILY INJURY (Per person) $

ALL OWVNED SCHEDULED BODILY INJURY (Per accident) $

AUTOS __AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident)_$

UMBRELLA LIAB OCCUR EACH OCCURRENCE $

EXCESS LIAB CLAIMS-MADE AGGREGATE $

SDED I RETENTION$ $

WORKERS COMPENSATION WC STATU- OTH-AND EMPLOYERS' LIABIUTY NR YIN TORY LIMITS ANY PROPRIETORIPARTNER/EXECUTIVE r E.L EACH ACCIDENT $

OFFICER/MEMBER EXCLUDED? L.j N INA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $

If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $

A Nuclear Energy Liability See Attached 01/01/2015 01/01/2016 See Attached Acord Insurance "Acord 101" 101 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)

CERTIFICATE HOLDER CANCELLATION Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE U.S. Nudear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Washington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE of Marsh Risk & InsuranceServices Shannon Moyer

© 1988-2010 ACORD CORPORATION. All rights reserved.

ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD

AGENCY CUSTOMER ID: 08819 LOC #: Los Angeles ACC>R0 ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED Marsh Risk &Insurance Services Dominion Resources, Inc.

ATTN: Leslie D. Garber POUCY NUMBER Leslie.Garber@dom.com 701 East Cary Street, 20th Floor Richmond, VA 23219 CARRIER NAIC CODE EFFECTIVE DATE:

ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance I CERTIFICATE OF NUCLEAR ENERGY LIABILITY INSURANCE EFFECTIVE DATE OF THIS CERTIFICATE: January 1, 2015 This is to certify that there is in force as of the effective date of this Certificate a Nuclear Energy Liability Insurance Policy issued by members of American Nuclear Insurers as indicated (Companies), to the Insured named herein, with respect to the Nuclear Facility at the Location shown and/or with respect to the Insured's operations described herein. Ifsuch policy is cancelled or otherwise terminated prior to the end of December 31st of' the calendar year in which the Effective Date of this Certificate occurs, notice willbe delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate as of the end of such December 31st. A Certificate willNOT be issued for any subsequent calendar year unless requested in writing.

Types of Insurance: NF - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's &Transporters], FS - [Foreign Suppliers & Transporters], N - [Secondary Financial Protection Certificate]

COVERAGE FOR NUCLEAR FACILITIES:

1. SITE #1 - NORTH ANNA LOCATION OF NUCLEAR FACILITY: North Anna Nuclear Power Plant 40 MINW of Richmond, VA NAMED INSURED [LISTED ON POLICY]: Virginia Electric &Power Company POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:

NF-0240 03/26/1976 $375 Million NW-0610 03/26/1976 $375 Million-N-0063 11/26/1977 -

N-0070 04/11/1980

2. SITE #2 - SURRY LOCATION OF NUCLEAR FACILITY: Surry Nuclear Power Plant 17 MINW of Newport News, VA NAMED INSURED [LISTED ON POLICY]: Virginia Electric & Power Company POLICY NUMBER: POLICY EFFECTIVE: LIMITOF LIABILITY:

NF-0186 06/15/1970 $375 Million NW-0571 06/1511970 $375 Million-N-0027 08/01/1977 ...

N-0028 08/01/1977 ...

3. SITE #3 - MILLSTONE LOCATION OF NUCLEAR FACILITY: Millstone Nuclear Power Plant 3.2 MIWSW of New London, CT NAMED INSURED [LISTED ON POLICY]: Dominion Nuclear Connecticut, Inc.

POLICY NUMBER: POLICY EFFECTIVE: LIMITOF LIABILITY:

NF-0173 05/01/1969 $375 Million NW-0563 05/0111969 $375 Million-N-0016 08/0111977

• N-0103 11/25/1985

4. SITE #4 - KEWAUNEE LOCATION OF NUCLEAR FACILITY: Kewaunee Nuclear Power Plant in the Town of Carlton, Kewaunee County, Wisconsin NAMED INSURED [LISTED ON POLICY]: Dominion Energy Kewaunee, Inc.

POLICY NUMBER: POLICY EFFECTIVE: LIMITOF LIABILITY:

NF-0204 01/01/1972 $375 Million NW-0586 01/01/1972 $375 Million-N-0044 08/01/1977

• ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

AGENCY CUSTOMER ID: 08819 LOC #: Los Angeles AC40RD ADDITIONAL REMARKS SCHEDULE Page 3 of 3 AGENCY NAMED INSURED Marsh Risk & Insurance Services Dominion Resources, Inc.

ATTN: Leslie D. Garber POLICY NUMBER Leslie.Garber@dom.com 701 East Cary Street, 20th Floor Richmond, VA 23219 CARRIER NAIC CODE EFFECTIVE DATE:

ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.

The insurance afforded by the policy(ies) is subject to the exclusions, conditions and other provisions of the policy(ies). Neither this Certificate nor any contract or other document with respect to which it is issued shall amend, extend or alter the coverage afforded by the policy. The Limit of Liability shown above may have been reduced by payment of claims or claims expenses.

COMMENTS/NOTES:

Master Worker Certificate - This limit is shared by all Certificates to the Master Worker Policy of which each Certificate is a part and is subject to all of the provisions of such Policy and Certificate having reference thereto. Such limit may have been reduced by payment of claims or claims expenses.

- Secondary Financial Protection Certificate -Financial protection available under an industry retrospective rating plan.

ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD