ML16032A124

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Resources, Inc., Certificate of Liability Insurance
ML16032A124
Person / Time
Site: Millstone, Kewaunee, Surry, North Anna  Dominion icon.png
Issue date: 02/01/2016
From:
Dominion Resources
To:
Document Control Desk, Office of Nuclear Reactor Regulation
References
Download: ML16032A124 (8)
v • d • e


Text

00 0 29 61 SP 0024

-C01-P02962-I Document Controi Desk U.S. Nuclear Regulatory Commission Washington, DC 20555-0001

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ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 01/08/2016 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 endorsementfs).

PRODUCER CONTACT Marsh Risk & Insurance Services PHONE:A CA License #04371 53 (I.

o 0

)

(A/C, No):

777 South Figueroa Street E-MAIL Los Angeles, CA 90017 ADDRESS:

Attn: LosAngeles.CertRequest~marsh.com/IF: 212-948-0535 INSURER(S) AFFORDING COVERAGE NAIC #

08819 -DRI-AI[-16-17 INSURER A : American Nuclear Insurers_______

INSURED INSURER B :

Dominion Resources, Inc.

ATrN: Leslie 0. Garber INSURER C: :___

Leslie.Garber@dom.com INSURER D :

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

________________________________________________________INSURER F: :_____

COVERAGES CERTIFICATE NUMBER:

LOS-001839081-05 REVISION NUMBER:6 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, F--AULUIUI'IO LIjU M, UUINUI I iiIUdJIJ O Ui-fl, r',JVLIiL, IC.

LIIVUI I O,flUVVP lt', IIT nflt'v* DCL1"4 IU',UULLV DT rt'/ilU,Lt~',IVIO,.

INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE Ili52 WV POLICY NUMBER IMM/DDIYyyy)

(MM/DD/YyyyI LIMITS COM MERCIAL GENERAL LIABILITY EACH OCCURRENCE 7]

DAMAGE TO RENTED CLAIMS-MADE LjOCCUR PREMISES (Ea occurrence)

_________________________MED EXP (Any one person)

_____________________PERSONAL

& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:

GENERAL AGGREGATE 7]PRO-7 POLICY ILI JECT LiLOC PRODUCTS - COMP/OP AGG OTHER:

AUTOOBIE LABIITYCOMBINED SINGt.E lI.MIlT AUTOMBILELIABIITYlEu accident)

ANY AUTO BODILY INJURY (Per person)

ALL OWNED SCHEDULED BDL NUY(e ciet

__AUTOS AUTOS BDL NUYIe ciel HIEATS iNON-OWNED PROPERTY DAMAGE HIRD ATOS AUTOS (Per accident)

~$

__UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB I

{CLAIMS-MADE AGGREGATE DEDI RETENTIONS WORKERS COMPENSATION PER 0H AND EMPLOYERS' LIABILITY Y I N J

I i~

ANY PROPRIETOR/PARTNER/EXECUTIVE rTF E.L. EACH ACCIDENT OFFICERIMEMBER EXCLUDED?

L*i N IA IMandatory in NH)

E.L. DISEASE - EA EMPLOYEE $

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

Nuclear Energy Uability See Attached 01/01/2016 01/01/2017 See Attached Acord Insurance "Acord 101"i 101 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)

CERTIFICATE HOLDER CANCELLATION Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE U.S. Nuclear Regulatoly Commission THE EXPIRATION DATE

THEREOF, NOTICE WILL BE DELIVERED IN Washington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services SShannon Moyer

  • '-t"

© 1988-2014 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD ACORD 25 (2014)01)

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um 0024-01-00-0002961-0002-0007887

AGENCY CUSTOMER ID: 08819 LOC #: Los Angeles ACO)RD ADDITIONAL REMARKS SCHEDULE Page 2

of3 AGENCY NAMED INSURED Marsh Risk & insurance Services Dominion Resources, Inc.

____________________________________________________________ATTN: Leslie 0. Garber POUCY NUMBER Leslie.Garber@dom.com 701 East Cary Street, 20th Floor Richmond, VA 23219 CARRIER

/NAIC CODE I

EFFECTIVE DATE:

ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:

25 FORM TITLE: Certificate of Liability Insurance 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 an indicated (Companies), to the tnuured named herein, with respect to the Nuclear Facility at the Location shown and/or with respect to the Insured's operations described herein. If such policy is cancelled or otherwise terminated prior to the end of December 31st of the calendar year in which the Effective Date of this Certficate occurs, notice will be delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate as of the end of such December 31st. A Certificate will NOT 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 FACILrITY:

North PAnna Nuclear Power Plant 40 Ml NW of Richmond, VA NAMED INSURED [LISTED ON POLICY]: Virginia Electric & Power Company POLICY NUMBER:

POLICY EFFECTIVE:

LIMIT OF LIABILITY:

NF-0240 03126/1976

$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 MI NW of Newport News, VA NAMED INSURED [LISTED ON POUCY]: Virginia Electric & Power Company POLICY NUMBER:

POLICY EFFECTIVE:

LIMIT OF LIABILITY:

N F-0186 06/15/1970

$375 Million NW-0571 06/15/1970

$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 MI WSW of New London, CT NAMED INSURED [LISTED ON POLICY]: Dominion Nuclear Connecticut, Inc.

POLICY NUMBER:

POLICY EFFECTIVE:

LIMIT OF LIABILITY:

N F-0173 05/01/1969

$375 Million NW-0563 05/01/1 969

$375 Million" N-0016 08/01/11977 N-0103 11/25/1985

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

POLICY NUMBER:

POLICY EFFECTIVE:

LIMIT OF UABILITY:

NF-0204 01/01/1972

$375 Million NW-0586 011/01/11972

$375 Million" ACORD 101 (2008/01)

© 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

S

=~

0024-01-00-0002961-0003-0007888

AGENCY CUSTOMER ID: 08819 LOCG#: Los Angeles ACORD ADDITIONAL REMARKS SCHEDULE Page 3

of 3

AGENCY NAMED INSURED Marsh Risk & Insurance Services Dominion Resources, Inc.

________________________________________________________ATTN:

Leslie 0. Garber POUCY NUJMBER Leslie.Garber@dom.com 701 East Cary Street, 20th Floor Richmond, VA 23219 CARRIER

[NAIC CODE 1

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 DF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.

The insurance afforded by the policyjies) is subject to the exclusions, conditions and other provisions of the policyjies). 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.

COMMENTSINOTES:

    • 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 (2008/01)

© 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

111111 IH IIIIH lllll IH II II III I Ulll i111 IIII

00 0 29 61 SP 0024

-C01-P02962-I Document Controi Desk U.S. Nuclear Regulatory Commission Washington, DC 20555-0001

~c-

-c

~3~e c5~Q -~39 '~

i

  • i I II IIIlllUlIJllUlLlIMIIHI III IIIIIHII

ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 01/08/2016 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 endorsementfs).

PRODUCER CONTACT Marsh Risk & Insurance Services PHONE:A CA License #04371 53 (I.

o 0

)

(A/C, No):

777 South Figueroa Street E-MAIL Los Angeles, CA 90017 ADDRESS:

Attn: LosAngeles.CertRequest~marsh.com/IF: 212-948-0535 INSURER(S) AFFORDING COVERAGE NAIC #

08819 -DRI-AI[-16-17 INSURER A : American Nuclear Insurers_______

INSURED INSURER B :

Dominion Resources, Inc.

ATrN: Leslie 0. Garber INSURER C: :___

Leslie.Garber@dom.com INSURER D :

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

________________________________________________________INSURER F: :_____

COVERAGES CERTIFICATE NUMBER:

LOS-001839081-05 REVISION NUMBER:6 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, F--AULUIUI'IO LIjU M, UUINUI I iiIUdJIJ O Ui-fl, r',JVLIiL, IC.

LIIVUI I O,flUVVP lt', IIT nflt'v* DCL1"4 IU',UULLV DT rt'/ilU,Lt~',IVIO,.

INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE Ili52 WV POLICY NUMBER IMM/DDIYyyy)

(MM/DD/YyyyI LIMITS COM MERCIAL GENERAL LIABILITY EACH OCCURRENCE 7]

DAMAGE TO RENTED CLAIMS-MADE LjOCCUR PREMISES (Ea occurrence)

_________________________MED EXP (Any one person)

_____________________PERSONAL

& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:

GENERAL AGGREGATE 7]PRO-7 POLICY ILI JECT LiLOC PRODUCTS - COMP/OP AGG OTHER:

AUTOOBIE LABIITYCOMBINED SINGt.E lI.MIlT AUTOMBILELIABIITYlEu accident)

ANY AUTO BODILY INJURY (Per person)

ALL OWNED SCHEDULED BDL NUY(e ciet

__AUTOS AUTOS BDL NUYIe ciel HIEATS iNON-OWNED PROPERTY DAMAGE HIRD ATOS AUTOS (Per accident)

~$

__UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB I

{CLAIMS-MADE AGGREGATE DEDI RETENTIONS WORKERS COMPENSATION PER 0H AND EMPLOYERS' LIABILITY Y I N J

I i~

ANY PROPRIETOR/PARTNER/EXECUTIVE rTF E.L. EACH ACCIDENT OFFICERIMEMBER EXCLUDED?

L*i N IA IMandatory in NH)

E.L. DISEASE - EA EMPLOYEE $

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

Nuclear Energy Uability See Attached 01/01/2016 01/01/2017 See Attached Acord Insurance "Acord 101"i 101 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)

CERTIFICATE HOLDER CANCELLATION Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE U.S. Nuclear Regulatoly Commission THE EXPIRATION DATE

THEREOF, NOTICE WILL BE DELIVERED IN Washington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services SShannon Moyer

  • '-t"

© 1988-2014 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD ACORD 25 (2014)01)

mm*

n mm mmm mm*nm ImmQm u

nmmm mm qmmm iN mm mm mmm mmmm u

n mmm mm n

um 0024-01-00-0002961-0002-0007887

AGENCY CUSTOMER ID: 08819 LOC #: Los Angeles ACO)RD ADDITIONAL REMARKS SCHEDULE Page 2

of3 AGENCY NAMED INSURED Marsh Risk & insurance Services Dominion Resources, Inc.

____________________________________________________________ATTN: Leslie 0. Garber POUCY NUMBER Leslie.Garber@dom.com 701 East Cary Street, 20th Floor Richmond, VA 23219 CARRIER

/NAIC CODE I

EFFECTIVE DATE:

ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:

25 FORM TITLE: Certificate of Liability Insurance 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 an indicated (Companies), to the tnuured named herein, with respect to the Nuclear Facility at the Location shown and/or with respect to the Insured's operations described herein. If such policy is cancelled or otherwise terminated prior to the end of December 31st of the calendar year in which the Effective Date of this Certficate occurs, notice will be delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate as of the end of such December 31st. A Certificate will NOT 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 FACILrITY:

North PAnna Nuclear Power Plant 40 Ml NW of Richmond, VA NAMED INSURED [LISTED ON POLICY]: Virginia Electric & Power Company POLICY NUMBER:

POLICY EFFECTIVE:

LIMIT OF LIABILITY:

NF-0240 03126/1976

$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 MI NW of Newport News, VA NAMED INSURED [LISTED ON POUCY]: Virginia Electric & Power Company POLICY NUMBER:

POLICY EFFECTIVE:

LIMIT OF LIABILITY:

N F-0186 06/15/1970

$375 Million NW-0571 06/15/1970

$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 MI WSW of New London, CT NAMED INSURED [LISTED ON POLICY]: Dominion Nuclear Connecticut, Inc.

POLICY NUMBER:

POLICY EFFECTIVE:

LIMIT OF LIABILITY:

N F-0173 05/01/1969

$375 Million NW-0563 05/01/1 969

$375 Million" N-0016 08/01/11977 N-0103 11/25/1985

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

POLICY NUMBER:

POLICY EFFECTIVE:

LIMIT OF UABILITY:

NF-0204 01/01/1972

$375 Million NW-0586 011/01/11972

$375 Million" ACORD 101 (2008/01)

© 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

S

=~

0024-01-00-0002961-0003-0007888

AGENCY CUSTOMER ID: 08819 LOCG#: Los Angeles ACORD ADDITIONAL REMARKS SCHEDULE Page 3

of 3

AGENCY NAMED INSURED Marsh Risk & Insurance Services Dominion Resources, Inc.

________________________________________________________ATTN:

Leslie 0. Garber POUCY NUJMBER Leslie.Garber@dom.com 701 East Cary Street, 20th Floor Richmond, VA 23219 CARRIER

[NAIC CODE 1

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 DF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.

The insurance afforded by the policyjies) is subject to the exclusions, conditions and other provisions of the policyjies). 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.

COMMENTSINOTES:

    • 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 (2008/01)

© 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

111111 IH IIIIH lllll IH II II III I Ulll i111 IIII

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