ML16042A177
| ML16042A177 | |
| Person / Time | |
|---|---|
| Site: | Browns Ferry, Watts Bar, Sequoyah  |
| Issue date: | 01/11/2016 |
| From: | Santaniello R Marsh USA |
| To: | Document Control Desk, Office of Nuclear Reactor Regulation |
| References | |
| Download: ML16042A177 (4) | |
Text
5"0t
.000;2365 SP 0027
- C..-C01"-P02366-1 "Document Control Desk U.S;.4N*.clear. R~egulatory Commission
,,,,Was~hingtor, DC 20555-0001
~-zAL~2 Sz 5 iYJ Ul
ACOIRD CERTIFICATE OF LIABILITY !NSURANCE S DATE (MM/DD/YYYY) 01/11/12016 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 TCONTACT-MARSH USA, INC.
NAME:FA PlHONEFA TWO ALLIANCE CENTER Ac, No.x)
(A)CNo):
3560 LENOX ROAD, SUITE 2400 E-MAIL-ATLANTA, GA 30326 ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
S77608-NucI-Nuke-16-17 INsuRER A : American Nuclear Insurers INSURED INSURER B :
Tennessee Valley Authority Attention: Kirk Kelley INSURER C:
400 W. Summit Hill Drive, WT 4CINUED Knoxville, TN 37919 ISRRD INSURER E :
INSURER F: :_____
COVERAGES CERTIFICATE NUMBER:
ATL-003494057-06 REVISION NUMBER:21 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 TERM.,S, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE INDWV POLICY NUMBER IMMIDD/Yyyy)
)MMIDD/Yyyy LIMITS COMMERCIAL GENERAL LIABILITY
[EACH OCCURRENCE Ii DAMAGE TO RENTED SCLAIMS-MADE L*j OCCUR PREMISES (Ea occurrence)
_______________________MED EXP (Any one person)
____________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE S
SPOLICY JECT-PRO JI LOC PRODUCTS -COMP/OP AGG OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT tEa accident)
A,..
AU.TO BDILY IrJ[ RY (Per person)
ALL OWNED SCHEDULED BODILY IN JURY (Per accident)
__AUTOS AUTOS NON-OWNED PROPERTY DAMAGE
__ HIED AUOS
__AUTOS(Per accident)
__UMBRELLA LIAB K
1 OCCUR EACH OCCURRENCE EXCESS LIAB I I CLAIMS-MADE AGETE$
DEDI RETENTION $$
WORKERS COMPENSATION IPRTTUEIITH -E AND EMPLOYERS' LIABILITY Y/ I NITLtt ANY PROPRIETOR/PARTNER/EXECUTIVE F*F EL. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
Li N/IA (Mandatory in NH)
EL. DISEASE - BA EMPLOYEE $
If yes, describe under
___DESCRIPTION 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 see addl page text Insurance DESCRIPTION OF OPERATIONS I LOCATIONS)I VEHICLES (ACORD 101, Additlonc.l Ren~ar:*s Schtedul'e, may, be attached If more space Is required)
CERTIFICATE HOLDER CANCELLATION Document Control Desk iSHIOULD 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Ronsld A. Santaniello,
/-
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: S77608 LOC #: Atlanta ACO RD ADDITIONAL REMARKS SCHEDULE Page 2
of 3
AGENCY NAMED INSURED MARSH USA, INC.
Tennessee Valley Authority Attention: Kirk Kelley POLICY NUMBER 400 W. Summit Hill Drive, WT 4C Knoxville, TN 37919 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 effective date of this Certificate a Nuclear Energy Liability Insurance Policy issued by members of Americas 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 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 - BROWNS FERRY LOCATION OF NUCLEAR FACILITY: Browns Ferry Nuclear Power Plant 10 MI NW of Decatur, AL NAMED INSURED [LISTED ON POLICY]: Tennessee Valley Authority POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-01988 0912211971
$375 Million NW-0581 09/2211971
$375 Million**
N-0038 08/01/1977**
N-0039 08/0111977 N-0040 08/0111977**
- 2. SiTE #2 -SEOUOYAH LOCATION OF NUCLEAR FACILITY: Sequoyah Nuclear Power Plant 9.5 MI NE of Chattanooga, TN NAMED INSURED [LISTED ON POLICY]: Tennessee Valley Authority POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0247 03/11/1977
$375 Million NW-0614 03/11/1977
$375 Million**
N-0066 02/29/1980 N-0075 06/25/1981
- 3. SITE #3 -WATTS BAR LOCATION OF NUCLEAR FACILITY: Watts Bar Nuclear Power Plant 10 MI S of Spring City, TN NAMED INSURED [LISTED ON POLICY]:. Tennessee Valley Authority POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0256 09/04/1979
.$375 Million NW-0618 09104/1979
$375 Million**
N-0080 11/09/1995 N-0120 10/22/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF 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 Umit of Liability shown above may have been reduced by payment of claims or claims expenses.
COMMENTS/NOTES:
ACORD 101 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: S77608 LOC #: Atlanta AW*RD*
ADDITIONAL REMARKS SCHEDULE Page 3
of3 SAGENCY NAMED INSURED MARSH USA, INC.
Tennessee Valley Authority Attention: Kirk Kelley POLICY N*UMBER 400 W. Summit Hill Drive, WT 4C Knoxville, TN 37919 CARRIER
!NAIC CODE J
EFFECTIVE DATE:
ADDITIONAL REMARKS
[THIS ADDITIONAL REMARKS FORM iS A SCHEDULE TO ACORD FORM, FORM NUMBER:
25 FORM TITLE: Certificate of Liability Insurance
- 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 bees reduced by payment of claims or claims expenses.
- Secondary Financial Protection Certificate - Financial protection available under an industry retrospective ruling plan.
ACORD 101 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD na.me and logo are registered marks of ACORD
5"0t
.000;2365 SP 0027
- C..-C01"-P02366-1 "Document Control Desk U.S;.4N*.clear. R~egulatory Commission
,,,,Was~hingtor, DC 20555-0001
~-zAL~2 Sz 5 iYJ Ul
ACOIRD CERTIFICATE OF LIABILITY !NSURANCE S DATE (MM/DD/YYYY) 01/11/12016 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 TCONTACT-MARSH USA, INC.
NAME:FA PlHONEFA TWO ALLIANCE CENTER Ac, No.x)
(A)CNo):
3560 LENOX ROAD, SUITE 2400 E-MAIL-ATLANTA, GA 30326 ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
S77608-NucI-Nuke-16-17 INsuRER A : American Nuclear Insurers INSURED INSURER B :
Tennessee Valley Authority Attention: Kirk Kelley INSURER C:
400 W. Summit Hill Drive, WT 4CINUED Knoxville, TN 37919 ISRRD INSURER E :
INSURER F: :_____
COVERAGES CERTIFICATE NUMBER:
ATL-003494057-06 REVISION NUMBER:21 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 TERM.,S, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE INDWV POLICY NUMBER IMMIDD/Yyyy)
)MMIDD/Yyyy LIMITS COMMERCIAL GENERAL LIABILITY
[EACH OCCURRENCE Ii DAMAGE TO RENTED SCLAIMS-MADE L*j OCCUR PREMISES (Ea occurrence)
_______________________MED EXP (Any one person)
____________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE S
SPOLICY JECT-PRO JI LOC PRODUCTS -COMP/OP AGG OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT tEa accident)
A,..
AU.TO BDILY IrJ[ RY (Per person)
ALL OWNED SCHEDULED BODILY IN JURY (Per accident)
__AUTOS AUTOS NON-OWNED PROPERTY DAMAGE
__ HIED AUOS
__AUTOS(Per accident)
__UMBRELLA LIAB K
1 OCCUR EACH OCCURRENCE EXCESS LIAB I I CLAIMS-MADE AGETE$
DEDI RETENTION $$
WORKERS COMPENSATION IPRTTUEIITH -E AND EMPLOYERS' LIABILITY Y/ I NITLtt ANY PROPRIETOR/PARTNER/EXECUTIVE F*F EL. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
Li N/IA (Mandatory in NH)
EL. DISEASE - BA EMPLOYEE $
If yes, describe under
___DESCRIPTION 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 see addl page text Insurance DESCRIPTION OF OPERATIONS I LOCATIONS)I VEHICLES (ACORD 101, Additlonc.l Ren~ar:*s Schtedul'e, may, be attached If more space Is required)
CERTIFICATE HOLDER CANCELLATION Document Control Desk iSHIOULD 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Ronsld A. Santaniello,
/-
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: S77608 LOC #: Atlanta ACO RD ADDITIONAL REMARKS SCHEDULE Page 2
of 3
AGENCY NAMED INSURED MARSH USA, INC.
Tennessee Valley Authority Attention: Kirk Kelley POLICY NUMBER 400 W. Summit Hill Drive, WT 4C Knoxville, TN 37919 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 effective date of this Certificate a Nuclear Energy Liability Insurance Policy issued by members of Americas 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 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 - BROWNS FERRY LOCATION OF NUCLEAR FACILITY: Browns Ferry Nuclear Power Plant 10 MI NW of Decatur, AL NAMED INSURED [LISTED ON POLICY]: Tennessee Valley Authority POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-01988 0912211971
$375 Million NW-0581 09/2211971
$375 Million**
N-0038 08/01/1977**
N-0039 08/0111977 N-0040 08/0111977**
- 2. SiTE #2 -SEOUOYAH LOCATION OF NUCLEAR FACILITY: Sequoyah Nuclear Power Plant 9.5 MI NE of Chattanooga, TN NAMED INSURED [LISTED ON POLICY]: Tennessee Valley Authority POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0247 03/11/1977
$375 Million NW-0614 03/11/1977
$375 Million**
N-0066 02/29/1980 N-0075 06/25/1981
- 3. SITE #3 -WATTS BAR LOCATION OF NUCLEAR FACILITY: Watts Bar Nuclear Power Plant 10 MI S of Spring City, TN NAMED INSURED [LISTED ON POLICY]:. Tennessee Valley Authority POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0256 09/04/1979
.$375 Million NW-0618 09104/1979
$375 Million**
N-0080 11/09/1995 N-0120 10/22/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF 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 Umit of Liability shown above may have been reduced by payment of claims or claims expenses.
COMMENTS/NOTES:
ACORD 101 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: S77608 LOC #: Atlanta AW*RD*
ADDITIONAL REMARKS SCHEDULE Page 3
of3 SAGENCY NAMED INSURED MARSH USA, INC.
Tennessee Valley Authority Attention: Kirk Kelley POLICY N*UMBER 400 W. Summit Hill Drive, WT 4C Knoxville, TN 37919 CARRIER
!NAIC CODE J
EFFECTIVE DATE:
ADDITIONAL REMARKS
[THIS ADDITIONAL REMARKS FORM iS A SCHEDULE TO ACORD FORM, FORM NUMBER:
25 FORM TITLE: Certificate of Liability Insurance
- 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 bees reduced by payment of claims or claims expenses.
- Secondary Financial Protection Certificate - Financial protection available under an industry retrospective ruling plan.
ACORD 101 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD na.me and logo are registered marks of ACORD