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Certificate of Liability Insurance
	ML16032A125
Person / Time
Site:	San Onofre
Issue date:	01/08/2016
From:	Gist C; Marsh Risk & Insurance Services
To:	; Document Control Desk, Office of Nuclear Reactor Regulation
References
	Download: ML16032A125 (6)
	v • d • e

O0 004 9 7 SP 0023 -C01-P04978-1 Document Control Desk U.S. Nuclear Regulatory Commission Washington, DC 20555-0001 6c~~36e/

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a 0023-01-00-0004976-0001-001 3945

D ATE (MMIDD/YYYY)

ACR CERTIFICATE OF LIABILITY INSURANCE 01082016 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 Marsh Risk &Insurance Services NHOMEFA CA License #0437153 tAC O. ) (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 #

53370 -NLSAN-CAS-18-17 INSURER A : American Nuclear Insurers INSURED INSURER B: ______

EDISON INTERNATIONAL 2244 WALNUT GROVE AVENUE INSURER C :

ROSEMEAD, CA 91770 INSURER D:

INSURER E :

________________________________________________________ INSURER F: ______

COVERAGES CERTIFICATE NUMBER: LOS-001710439-09 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.

LTR __ TYPE OF INSURANCE INDWDPOUCY NUMBER (MMIDD/YYYY: 'MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH- OCCURRENCE $

m DAMAGE TO RENTED JCLAIMS-MADE [jI OCCUR PREMISES (Ea occurrence) $

___________________________MED EXP (Any one person) $

___________________PERSONAL &ADV INJURY $

DPRO-POLICY LWJECT m

GEN'L AGGREGATE LIMIT APPLIES PER:

LWLOC GENERAL AGGREGATE PRODUCTS -COMPIOP AGG OTHER: $

AUTOMBILELIABLITYCOMBINED SINGLE LIMIT $

AUTOMBILE IABILTY Ba accident) $-

ANY AUTO BODILY INJURY (Per person) $

ALL OWNED SCHEDULED BDL NUY(e ciet

__AUTOS __AUTOS BDL NUY(e ciet NON-OWNED PROPERTY DAMAGE

__HIRED AUTOS __AUTOS (Per accident) $

__UMBRELLA LIAB OCCUR E.ACH OCCURRENCE S EXCESS LIAB ICLAIMS-MADE AGGREGATE $

DED t RETENTIONS$ $

WORKERS COMPENSATION IPER 0H AND EMPLOYERS' LIABIUTY Y IN LIAILL~

ANY PROPRIETOR/PARTNER/EXECUTIVE l*~ E.L. EACH ACCIDENT $

OFFICER/M EMBER EXCLUDED? i NI A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $

Ifyes, describe under D_ESCRIPTION OF OPERATIONS below ___________E.L. DISEASE - POLICY LIMIT $

A Nuclear Energy Uiability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101 Insurance DESCRIPTION OF OPERATIONS)I LOCATIONS IVEHICLES (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 Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WiLL BE DELIVERED iN Washington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.

The ACORD name and logo are registered marks of ACORD ACORD 25 (2014101 )

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i 0023-01°00-0004976-0002.001 3946

AGENCY CUSTOMER ID: 53370 LOC #: Los Angeles ACORD ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh Risk & Insurance Services EDISON iNTERNATIONAL

__________________________________________________ 2244 WALNUT GROVE AVENUE POLICY NUMBER ROSEMEAD, CA 91770 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 CERTIFICATE OF NUCLEAR ENERGY LIABILITY INSURANCE This is to certify that there is in force as of the effechve 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. If such policy is cancelled or otherwise terminated prior to the end of December 31 st 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 writng.

Types of Insurance: NP - [Facility Form], NW- [Master Worker Certificate], NS - [US Domeshc Suppliur's &Transporters], FS - [Foreign Suppliers &Transporters], N- [Secondary Financial Protecton Certificate]

COVERAGE FOR NUCLEAR FACILITIES:

1. SITE #1 -SAN ONOFRE LOCATION OF NUCLEAR FACILITY: San Onofre Nuclear Generating Station 3 miles S of City of San Clemente inSan Diego County, California NAMED INSURED [LISTED ON POLICY]: Southern California Edison Company, San Diego Gas & Electric Company, The City of Anaheim, The City of Riverside POLICY NUMBER: POLICY EFFECTIVE: LIMITOF LIABILItY:

NF-0143 04/06/i 966 $375 Million NW-0549 01/01/1998 $375 Million"*

N-0081 02/16/1982 **

N-0087 11/15/1982**

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.

The insurance afforded by the policyjius) 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 Limitof Liability shown above may have been reduced by payment of claims or claims expenses.

COMMENTS/NOTES:

- Master Worker Certificate - This limit is shared by allCertificates to the Master Worker Policy of which each Certificate is a part and is subject to allof 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.

The ACORD name and logo are registered marks of ACORD

11 I~Ifil MIJIllJ11Hli i ENll lilt tlttt 111 ItOl lilt

O0 004 9 7 SP 0023 -C01-P04978-1 Document Control Desk U.S. Nuclear Regulatory Commission Washington, DC 20555-0001 6c~~36e/

=

a 0023-01-00-0004976-0001-001 3945

D ATE (MMIDD/YYYY)

ACR CERTIFICATE OF LIABILITY INSURANCE 01082016 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 Marsh Risk &Insurance Services NHOMEFA CA License #0437153 tAC O. ) (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 #

53370 -NLSAN-CAS-18-17 INSURER A : American Nuclear Insurers INSURED INSURER B: ______

EDISON INTERNATIONAL 2244 WALNUT GROVE AVENUE INSURER C :

ROSEMEAD, CA 91770 INSURER D:

INSURER E :

________________________________________________________ INSURER F: ______

COVERAGES CERTIFICATE NUMBER: LOS-001710439-09 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.

LTR __ TYPE OF INSURANCE INDWDPOUCY NUMBER (MMIDD/YYYY: 'MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH- OCCURRENCE $

m DAMAGE TO RENTED JCLAIMS-MADE [jI OCCUR PREMISES (Ea occurrence) $

___________________________MED EXP (Any one person) $

___________________PERSONAL &ADV INJURY $

DPRO-POLICY LWJECT m

GEN'L AGGREGATE LIMIT APPLIES PER:

LWLOC GENERAL AGGREGATE PRODUCTS -COMPIOP AGG OTHER: $

AUTOMBILELIABLITYCOMBINED SINGLE LIMIT $

AUTOMBILE IABILTY Ba accident) $-

ANY AUTO BODILY INJURY (Per person) $

ALL OWNED SCHEDULED BDL NUY(e ciet

__AUTOS __AUTOS BDL NUY(e ciet NON-OWNED PROPERTY DAMAGE

__HIRED AUTOS __AUTOS (Per accident) $

__UMBRELLA LIAB OCCUR E.ACH OCCURRENCE S EXCESS LIAB ICLAIMS-MADE AGGREGATE $

DED t RETENTIONS$ $

WORKERS COMPENSATION IPER 0H AND EMPLOYERS' LIABIUTY Y IN LIAILL~

ANY PROPRIETOR/PARTNER/EXECUTIVE l*~ E.L. EACH ACCIDENT $

OFFICER/M EMBER EXCLUDED? i NI A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $

Ifyes, describe under D_ESCRIPTION OF OPERATIONS below ___________E.L. DISEASE - POLICY LIMIT $

A Nuclear Energy Uiability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101 Insurance DESCRIPTION OF OPERATIONS)I LOCATIONS IVEHICLES (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 Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WiLL BE DELIVERED iN Washington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.

The ACORD name and logo are registered marks of ACORD ACORD 25 (2014101 )

m

/

m

/

m i

/

i 0023-01°00-0004976-0002.001 3946

AGENCY CUSTOMER ID: 53370 LOC #: Los Angeles ACORD ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh Risk & Insurance Services EDISON iNTERNATIONAL

__________________________________________________ 2244 WALNUT GROVE AVENUE POLICY NUMBER ROSEMEAD, CA 91770 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 CERTIFICATE OF NUCLEAR ENERGY LIABILITY INSURANCE This is to certify that there is in force as of the effechve 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. If such policy is cancelled or otherwise terminated prior to the end of December 31 st 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 writng.

Types of Insurance: NP - [Facility Form], NW- [Master Worker Certificate], NS - [US Domeshc Suppliur's &Transporters], FS - [Foreign Suppliers &Transporters], N- [Secondary Financial Protecton Certificate]

COVERAGE FOR NUCLEAR FACILITIES:

1. SITE #1 -SAN ONOFRE LOCATION OF NUCLEAR FACILITY: San Onofre Nuclear Generating Station 3 miles S of City of San Clemente inSan Diego County, California NAMED INSURED [LISTED ON POLICY]: Southern California Edison Company, San Diego Gas & Electric Company, The City of Anaheim, The City of Riverside POLICY NUMBER: POLICY EFFECTIVE: LIMITOF LIABILItY:

NF-0143 04/06/i 966 $375 Million NW-0549 01/01/1998 $375 Million"*

N-0081 02/16/1982 **

N-0087 11/15/1982**

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.

The insurance afforded by the policyjius) 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 Limitof Liability shown above may have been reduced by payment of claims or claims expenses.

COMMENTS/NOTES:

- Master Worker Certificate - This limit is shared by allCertificates to the Master Worker Policy of which each Certificate is a part and is subject to allof 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.

The ACORD name and logo are registered marks of ACORD

11 I~Ifil MIJIllJ11Hli i ENll lilt tlttt 111 ItOl lilt

ML16032A125

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