ML16032A127
| ML16032A127 | |
| Person / Time | |
|---|---|
| Site: | Zion File:ZionSolutions icon.png |
| Issue date: | 01/07/2016 |
| From: | Poulsen M Marsh USA |
| To: | Document Control Desk, Office of Nuclear Reactor Regulation |
| References | |
| Download: ML16032A127 (6) | |
Text
0 0 017?56 SP 0022 -C01-P01756-l DOCUMENT CONTROL DESK U.S. NUCLEAR REGULATORY COMMIlSSION WASHINGTON, DC 20555-0001
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AWORD S DATE (MMIDDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 01/07/2016 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 endorsement(s).
PRODUCER CONTACT Marsh USA Risk &Insurance Services PHONE:FA l5 West South Temnple, Suite 700 -c Co, Ext-; (AC, No):
Salt Lake City, UT 84101 E-MAIL Attn: SaltLakeCity.certrequest~marsh.com;Fax212.948.4373 -ADES ______
INSURER(S) AFFORDING COVERAGE NAIC #
J36105-NRC-NEL-16-17 INSURER A : American Nuclear Insurers INSURED INSURER B :
ZionSo1utions, LLC_______
and Exelon Generation Company, LLC INSURER C :
Attn: Layne Ashton INSURER D :
423 West 300 South, Suite 200 ______
Salt Lake City, UT 84101 INSURER E: _______
________________________________________________________INSURER F: ______
COVERAGES CERTIFICATE NUMBER: SEA-002671 181-03 REVISION NUMBER:4 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 IS8 SUBJECT TO ALL THE TERMS, FXCJ I I5IfIlNR ANfl PflNIl1TIfIN5 CIF *I IflI- PCI ICIF5( I IMITR RHOIVVN MAY HAVIF RFFN RFflI I*FlD RY PAfLE CL AIMS POLICY EFF POLICY EXP POLICY NUMBER (MMIDD/YYYY1I(MMIDD/YYYYI LIMITS EACH OCCURRENCE $
DAMAGE TO RENTED PREMISES (Ea occurrence) $
MED EXP (Any one person) $
PERSONAL &ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMPIOP AGG $
COMBINED SINGLE L*IMIT... $. - . -
(En accioent)
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
(Per accident)
EACH OCCURRENCE $
AGGREGATE $
PER EJWLR __________
EL. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
______________________ _______ _______EL.L DISEASE - POLICY LIMIT $
NF-0201 01/01/2016 *10217 See attached Acord 101
'SeeAttached Acord 101'__10/0/01 __________________________
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
CERTIFICATE HOLDE-R ______________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 DELIVERE=D IN WASHINGTON, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE of Marsh USA Risk & Insurance Services Monica Poulsen .**----------
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014101)
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0022-01-00-0001756-0002-0006729
AGENCY CUSTOMER ID: J36105 LOCG#: Salt Lake City AcO3RD ADDITIONAL REMARKS SCHEDULE Page 2 of2 AGENCY NAMED*INSURED Marsh USA Risk &Insurance Services I ZionlSolutionis, LLC I and Exelon Generation Company, LLC POLICY NUMBER I Attn: Layne Ashton 423 West 300 South, Suite 200 Salt Lake City, UT 84101
- I EFFECTIVE DATE
ADDITIONAL REMARKS ITHIS ADDITIONAL REM*ARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability InsuranceI CERTIFICATE OF NUCLEAR ENERGY LIABILITY INSURANCE 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, 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 Certificate occurs, notice willbe delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate as of the end of such December 31st. ACertificate willNOT be issued for any subsuquent calendar year unless requested inwriting.
Types of Insurance: NF - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's &Transporters], FS - [Foreign Suppliems &Transporters]
COVERAGE FOR NUCLEAR FACILITIES:
1.SITE #1- ZION NUCLEAR STATION LOCATION OF NUCLEAR FACILITY: Zion Nuclear Station, located on the Western Edge of Lake Michigan in Lake County,.IL NAMED INSURED [LISTED ON POLICY]: Zion Solutions, LLC and Exelon Generation Company, LLC [NOTE 1]
POLICY NUMBER: POLICY EFFECTIVE: LIMITOF LIABILITY:
NF-0201 2/116/1971 $100 Million NW-0584 12/16/1971 $375 Million**
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 itis issued shall amend, extend or alter the coverage afforded by the policy. The Umit of Liability shown above may have been reduced by payment of claims or claims expenses.
COMMENTS/NOTES:
NOTE 1 - Additional Insured Definition: Any other person or organization with respect to his legal responsibility for covered damages or covered environmental cleanup costs because of bodily injury, property damage or environmental damage caused by the nuclear energy hazard. (does not include as an insured the United States of America or any of its agencies, except the Tennessee Valley Authority)
- 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 allof the provisions of such Policy and Certificate having reference thereto. Such limit may have been reduced by payment of claims or claims expenses.
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
mm 0022-01-00-0001756-0003-0006730
0 0 017?56 SP 0022 -C01-P01756-l DOCUMENT CONTROL DESK U.S. NUCLEAR REGULATORY COMMIlSSION WASHINGTON, DC 20555-0001
- o--7776f 3D L_
- ooI
RgL9000-LOOO-99L LOOO-OO-LOt~OO P.. P ut .~ i-A: . 3/4 m,
m
'{' " ji'
- P
'- .,. :'" ,.v " L y* i ' : , ** . .'*' p1
.i i """ '*
- I *~ p.~ 'ALA mm'" , .m AI' ..
AWORD S DATE (MMIDDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 01/07/2016 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 endorsement(s).
PRODUCER CONTACT Marsh USA Risk &Insurance Services PHONE:FA l5 West South Temnple, Suite 700 -c Co, Ext-; (AC, No):
Salt Lake City, UT 84101 E-MAIL Attn: SaltLakeCity.certrequest~marsh.com;Fax212.948.4373 -ADES ______
INSURER(S) AFFORDING COVERAGE NAIC #
J36105-NRC-NEL-16-17 INSURER A : American Nuclear Insurers INSURED INSURER B :
ZionSo1utions, LLC_______
and Exelon Generation Company, LLC INSURER C :
Attn: Layne Ashton INSURER D :
423 West 300 South, Suite 200 ______
Salt Lake City, UT 84101 INSURER E: _______
________________________________________________________INSURER F: ______
COVERAGES CERTIFICATE NUMBER: SEA-002671 181-03 REVISION NUMBER:4 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 IS8 SUBJECT TO ALL THE TERMS, FXCJ I I5IfIlNR ANfl PflNIl1TIfIN5 CIF *I IflI- PCI ICIF5( I IMITR RHOIVVN MAY HAVIF RFFN RFflI I*FlD RY PAfLE CL AIMS POLICY EFF POLICY EXP POLICY NUMBER (MMIDD/YYYY1I(MMIDD/YYYYI LIMITS EACH OCCURRENCE $
DAMAGE TO RENTED PREMISES (Ea occurrence) $
MED EXP (Any one person) $
PERSONAL &ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMPIOP AGG $
COMBINED SINGLE L*IMIT... $. - . -
(En accioent)
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
(Per accident)
EACH OCCURRENCE $
AGGREGATE $
PER EJWLR __________
EL. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
______________________ _______ _______EL.L DISEASE - POLICY LIMIT $
NF-0201 01/01/2016 *10217 See attached Acord 101
'SeeAttached Acord 101'__10/0/01 __________________________
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
CERTIFICATE HOLDE-R ______________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 DELIVERE=D IN WASHINGTON, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE of Marsh USA Risk & Insurance Services Monica Poulsen .**----------
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014101)
I L '.
N
.1~ I' *.. . .
e I
i i.
0022-01-00-0001756-0002-0006729
AGENCY CUSTOMER ID: J36105 LOCG#: Salt Lake City AcO3RD ADDITIONAL REMARKS SCHEDULE Page 2 of2 AGENCY NAMED*INSURED Marsh USA Risk &Insurance Services I ZionlSolutionis, LLC I and Exelon Generation Company, LLC POLICY NUMBER I Attn: Layne Ashton 423 West 300 South, Suite 200 Salt Lake City, UT 84101
- I EFFECTIVE DATE
ADDITIONAL REMARKS ITHIS ADDITIONAL REM*ARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability InsuranceI CERTIFICATE OF NUCLEAR ENERGY LIABILITY INSURANCE 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, 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 Certificate occurs, notice willbe delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate as of the end of such December 31st. ACertificate willNOT be issued for any subsuquent calendar year unless requested inwriting.
Types of Insurance: NF - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's &Transporters], FS - [Foreign Suppliems &Transporters]
COVERAGE FOR NUCLEAR FACILITIES:
1.SITE #1- ZION NUCLEAR STATION LOCATION OF NUCLEAR FACILITY: Zion Nuclear Station, located on the Western Edge of Lake Michigan in Lake County,.IL NAMED INSURED [LISTED ON POLICY]: Zion Solutions, LLC and Exelon Generation Company, LLC [NOTE 1]
POLICY NUMBER: POLICY EFFECTIVE: LIMITOF LIABILITY:
NF-0201 2/116/1971 $100 Million NW-0584 12/16/1971 $375 Million**
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 itis issued shall amend, extend or alter the coverage afforded by the policy. The Umit of Liability shown above may have been reduced by payment of claims or claims expenses.
COMMENTS/NOTES:
NOTE 1 - Additional Insured Definition: Any other person or organization with respect to his legal responsibility for covered damages or covered environmental cleanup costs because of bodily injury, property damage or environmental damage caused by the nuclear energy hazard. (does not include as an insured the United States of America or any of its agencies, except the Tennessee Valley Authority)
- 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 allof the provisions of such Policy and Certificate having reference thereto. Such limit may have been reduced by payment of claims or claims expenses.
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
mm 0022-01-00-0001756-0003-0006730