Text

Certificate of Liability Insurance
	ML16042A204
Person / Time
Site:	Yankee Rowe
Issue date:	01/19/2016
From:	Mukherjee M; Marsh USA
To:	; Document Control Desk, Office of Nuclear Material Safety and Safeguards
References
	Download: ML16042A204 (3)
	v • d • e

§;-o- *Wc 00 00 0 36 SP 0034 -C01-P00036-I Document Control Desk U.S. Nuclear Regulatory Commission*

Washington, DC 20555-0001

ACORD DATE (MMIDDIYYYY)

CERTIFICATE OF LIABILITY INSURANCE 01/19/2016 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, INC. NAME:

PHONE FAX 20 CHURCH STREET, 8TH FLOOR tAC. No Et; AOC No):

HARTFORD, CT 06103 E-MAIL Att: Hartford~certrequest@marsh.com IFax: 212-948-0186 ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #i 798153-NUC-16-17 INSURER A: American Nuclear Insurers INUEYankee Atomic Electric Company ISRRB:

49 Yankee Road INSURER C : ""_______

Rowe, MA 01367 INSURER D: _______

INSURER E :

____________________________________________________________INSURER F::______

COVERAGES CERTIFICATE NUMBER: NYC-007330'193-05 REVISION NUMBER:2 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.

IINSR LTR - TYPE OF INSURANCE ADDL NS SUBR

~* POLICY NUMBER POLICY EFF (MID/YY POLICY EXP (M/DYY LIMITS I- COMMERCIAL GENERAL I LIABILITY AAGOCCURRENCE ORETDEACH $

CLAIMS-MADE LJOCCUR PREMISES (Ea occurrence) $

__ _________________MED EXP (Any one person) $

_____________________PERSONAL & ADV INJURY $

GENtL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

POLICY JET LOC PRODUCTS - COMP/OP AGG $

OTHER: $

AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $

__ ~(Ea accident)

ANY AUTO BODILY INJURY (Per person) $

-- ALL OWNED -- SCHEDULED BODILY INJURY (Per accident) $

__AUTOS __AUTOS NON-OWNED PROPERTY DAMAGE

__HIRED AUTOS AUTOS (Per accident) $

-- UMBRELLA LIAB I 1OCCUR EACH OCCURRENCE $

EXCESS LIAB I CLAIMS-MADE AGGREGATE $

DlEDI RETENTION $ $

WORKERS COMPENSATION IPER 0 TH-AND EMPLOYERS' LIABILITY Y/N STIAITUTE LER ANY PROPRIETCR/PARTN ER/EXECUTIVE F1 E.L. EACH ACCIDENT $

OFFICER/MEMBER EXCLUDED? IjN I A IMandatory in NH) EL. DISEASE - EA EMPLOYEE $

If yes, describe under DESCRIPTION OF OPERATIONS below _______________ _____EL. DISEASE - POLICY LIMIT $

A Nuclear Energy Liability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101 Insurance DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

CERTIFICATE HOLDER CANCELLATION DocuentContol eskSHOULD 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.

Manashi Mukherjee . ,,,.ai~i.-i . K.,-.

ACORD 25 (20t4/01) The ACORD name and logo are registered marks of ACORD

AGENCY CUSTOMER ID: 798153 LOC #: Hartford ACORD ADDITIONAL REMARKS SCHEDULE Page 2 of2 AGENCY NAMED INSURED MARSH USA, INC. Yankee Atomic Electric Company

____________________________________________________________49 Yankee Road POLICY NUMBER Rowe, MA01367 CARRIER NAICCODE EFFECTIVE DATE:

[THIS ADDITIONAL REMARKS 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 dale 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. A Certificate willNOT he 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 &Tranaporters], ES- [Foreign Suppliers &Transporters]

COVERAGE FOR NUCLEAR FACILITIES:

1.SITE #1 - YANKEE ROWE LOCATION OF NUCLEAR FACILITY: Town of Rowe, State of Massachusetts NAMED INSURED [LISTED ON POLICY): Yankee Atomic Electric Company POLICY NUMBER: POLICY EFFECTIVE: LIMITOF LIABILITY:

NF-0076 10/23/1959 $100 Million NW-0522 10/23/11959 $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 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 illis 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 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.

The ACORD name and logo are registered marks of ACORD

§;-o- *Wc 00 00 0 36 SP 0034 -C01-P00036-I Document Control Desk U.S. Nuclear Regulatory Commission*

Washington, DC 20555-0001

ACORD DATE (MMIDDIYYYY)

CERTIFICATE OF LIABILITY INSURANCE 01/19/2016 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, INC. NAME:

PHONE FAX 20 CHURCH STREET, 8TH FLOOR tAC. No Et; AOC No):

HARTFORD, CT 06103 E-MAIL Att: Hartford~certrequest@marsh.com IFax: 212-948-0186 ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #i 798153-NUC-16-17 INSURER A: American Nuclear Insurers INUEYankee Atomic Electric Company ISRRB:

49 Yankee Road INSURER C : ""_______

Rowe, MA 01367 INSURER D: _______

INSURER E :

____________________________________________________________INSURER F::______

COVERAGES CERTIFICATE NUMBER: NYC-007330'193-05 REVISION NUMBER:2 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.

IINSR LTR - TYPE OF INSURANCE ADDL NS SUBR

~* POLICY NUMBER POLICY EFF (MID/YY POLICY EXP (M/DYY LIMITS I- COMMERCIAL GENERAL I LIABILITY AAGOCCURRENCE ORETDEACH $

CLAIMS-MADE LJOCCUR PREMISES (Ea occurrence) $

__ _________________MED EXP (Any one person) $

_____________________PERSONAL & ADV INJURY $

GENtL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

POLICY JET LOC PRODUCTS - COMP/OP AGG $

OTHER: $

AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $

__ ~(Ea accident)

ANY AUTO BODILY INJURY (Per person) $

-- ALL OWNED -- SCHEDULED BODILY INJURY (Per accident) $

__AUTOS __AUTOS NON-OWNED PROPERTY DAMAGE

__HIRED AUTOS AUTOS (Per accident) $

-- UMBRELLA LIAB I 1OCCUR EACH OCCURRENCE $

EXCESS LIAB I CLAIMS-MADE AGGREGATE $

DlEDI RETENTION $ $

WORKERS COMPENSATION IPER 0 TH-AND EMPLOYERS' LIABILITY Y/N STIAITUTE LER ANY PROPRIETCR/PARTN ER/EXECUTIVE F1 E.L. EACH ACCIDENT $

OFFICER/MEMBER EXCLUDED? IjN I A IMandatory in NH) EL. DISEASE - EA EMPLOYEE $

If yes, describe under DESCRIPTION OF OPERATIONS below _______________ _____EL. DISEASE - POLICY LIMIT $

A Nuclear Energy Liability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101 Insurance DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

CERTIFICATE HOLDER CANCELLATION DocuentContol eskSHOULD 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.

Manashi Mukherjee . ,,,.ai~i.-i . K.,-.

ACORD 25 (20t4/01) The ACORD name and logo are registered marks of ACORD

AGENCY CUSTOMER ID: 798153 LOC #: Hartford ACORD ADDITIONAL REMARKS SCHEDULE Page 2 of2 AGENCY NAMED INSURED MARSH USA, INC. Yankee Atomic Electric Company

____________________________________________________________49 Yankee Road POLICY NUMBER Rowe, MA01367 CARRIER NAICCODE EFFECTIVE DATE:

[THIS ADDITIONAL REMARKS 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 dale 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. A Certificate willNOT he 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 &Tranaporters], ES- [Foreign Suppliers &Transporters]

COVERAGE FOR NUCLEAR FACILITIES:

1.SITE #1 - YANKEE ROWE LOCATION OF NUCLEAR FACILITY: Town of Rowe, State of Massachusetts NAMED INSURED [LISTED ON POLICY): Yankee Atomic Electric Company POLICY NUMBER: POLICY EFFECTIVE: LIMITOF LIABILITY:

NF-0076 10/23/1959 $100 Million NW-0522 10/23/11959 $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 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 illis 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 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.

The ACORD name and logo are registered marks of ACORD

ML16042A204

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