ML16056A014
| ML16056A014 | |
| Person / Time | |
|---|---|
| Site: | Beaver Valley, Millstone, Hatch, Monticello, Calvert Cliffs, Dresden, Davis Besse, Peach Bottom, Browns Ferry, Salem, Oconee, Mcguire, Nine Mile Point, Palo Verde, Perry, Kewaunee, Catawba, Harris, Wolf Creek, Saint Lucie, Oyster Creek, Watts Bar, Sequoyah, Byron, Braidwood, Susquehanna, Summer, Prairie Island, Columbia, Seabrook, Brunswick, Surry, Limerick, North Anna, Turkey Point, Crystal River, Haddam Neck, Ginna, Diablo Canyon, Vogtle, Duane Arnold, Farley, Robinson, Clinton, San Onofre, Comanche Peak, Yankee Rowe, Maine Yankee, Quad Cities, Humboldt Bay, Zion, Fort Calhoun, McGuire, LaSalle, Levy County, BWX Technologies, Saxton, Lee, Crane |
| Issue date: | 02/19/2016 |
| From: | Evans D Marsh USA |
| To: | Document Control Desk, Office of Nuclear Material Safety and Safeguards, Office of New Reactors, Office of Nuclear Reactor Regulation |
| References | |
| Download: ML16056A014 (61) | |
Text
Dan Evans t4MARSH Marsh USA Inc.
Three Logan Square 1717 Arch Street, Suite 1100 Philadelphia, PA 19103
+1 215 246 1463 Danie.R.Evans@marsh.com www.marsh.com U.S. Nuclear Regulatory Commission ATTN: Document Control Desk Washington, DC 20555-0001 February 19, 2016
Subject:
2016 Nuclear Liability Certificates of Insurance Enclosed, please find the 2016 Nuclear Liability Certificates Marsh for insurance' brokerage services. The Certificate financial protection.
of Insurance for licensees that utilize of Insurance provides evidence of If you have any questions, please do not hesitate to contact me.
Best regards,............
Dan Evans Nuclear Client Advisor, U.S. Nuclear Energy Practice Enclosure Copy:
T. Farward, C. Hardie i* MARSH &McLENNAN g
~PCOMPANIES SOLUTIONS...DEFINED, DESIGNED, AND DELIVERED.
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ACO9RD CERTIFICATE OF LIABILITY INSURANCE SDATE (MMIDD/YYYY) 02/12/2016 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 ANOC No, Ext :
(A/C, No:
HARTFORD, CT 06103 E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
282248-NUC-16-17 INSURER A : American Nuclear Insurers INUEConnectfcut Yankee Atomic Power Company INSURER B :
362 Injun Hollow Road INSURER C :
East" Hampton, CT 06424 INSURER D :
INSURER E :
_________________________________________________________INSURER F:
COVERAGES CERTIFICATE NUMBER:
NYC-007079786-02 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 HAVEF BEEN REDUCED RY PAID CLAIMS.
INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE 5NP V
POLICY NUMBER IMMIDD/YYYYI (MMIDD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CIMSMD I[
CU DAMAGE TO RENTED CLAMSMAD L
OCURPREMISES (Ea occurrence)
___________________________MED EXP (Any one person)
_____________________PERSONAL
& ADV INJURY GENtL AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE POLICY LJ JECT
[J LOC PRODUCTS -COMP/OP AGG
__OTHER:
_AUTOMOBILE LIABILITY COMBINED(E cietSINGLE LIMIT ANY AUTO BODILY INJURY (Per person)
ALL OWNED SCHEDULED BODILY INJURY (Per accident)
__AUTOS
__AUTOS NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS
__AUTOS IPer accident)$
__UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB ICLAIMS-MADE AGGREGATE DEDI RETENTIONS$
WORKERS COMPENSATION
]PERsTTT 0 THER AND EMPLOYERS' LIABILITY Y I NL.L&
ANY PROPRIETORJPARTNEPJE.XECUTIVE E.L. EACH ACCIDENT OFFICERJMEMBER EXCLUDED?
N 1 NI A (Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below E.L. 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 /LOCATIONS/IVEHICLES (ACORD I01, Additional Remarks Schedule, may be attached if more apace Is requiredl 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Craig A. Parrow
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 282248 LOC #: Hartford ACOIRD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED MARSH USA, INC.
Connecticut Yankee Atomic Power Company
___________________________________________________________362 Injun Hollow Road POLICY NUMBER East Hampton, CT 06424 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 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 operafions 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 will he delivered is accordance with the policy provisions. Otherwise this Certificate shall terminate as of the end of such December 31st. A Certificate will NOT be lossed for any subsequent calendar year unless requested in mritfing.
Types of Insurance: NE - [Facility Form], NW-
[Master Worker Certificate], NS - [US Domestic Supplier's & Transporters], FS - [Foreign Suppliers & Transporters]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 -CONNECTICUT YANKEE LOCATION OF NUCLEAR FACILITY: Connecticut Yankee Plant located in Middlesex County, State of Connecticut NAMED INSURED [LISTED ON POLICY]: Connecticut Yankee Atomic Power Company POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0151 09/15/1 966
$100 Million NW-0552 09/1 5/1 966
$375 Million**
THIS CERTIFICATE IS ISSUED AS A MArIER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policy(ies) is subject to the exclusions, condifions and other provisions of the policy(ies). 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 Uimit of Liability shown above may have been reduced by payment ot 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 sublect 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.
ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
A CORD*
CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 02/12/2016 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 AIc. No, Ext)
(A/C, No:
HARTFORD, CT 06103 EMI INSURER(S) AFFORDING COVERAGE NAIC U J44032-NUC-15-16 INSURER A : American Nuclear Insurers INSU RED INSURER B :
Maine Yankee Atomic Power Company 321 Old Ferry Road INSURER C :
Wiscasset, ME 04578 INSURER D :
INSURER E :
INSURER F: :_____
COVERAGES CERTIFICATE NUMBER:
NYC-007316427-02 REVISION NUMBER: 5 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 REOUIREMENT, 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.
INSR ADDL SUBRc POLICY EFF POLICY EXP LTR TYPE OP INSURANCE Img WVP POLICY NUMBER (MMIDD/YYYYI IMMIDD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE m
DAMAGE TO RENTED CLAIMS-MADE
[jOCCUR PREMISES (Es occurrence)
___________________________MED EXP (Any one personl
__________________PERSONAL
&ADV INJURY GENtL AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE POLICY JECT LI LOC PRODUCTS - COMPIOP AGO OTHER:
AUTOMBILELIABLITYCOMBINED SINGLE LIMIT AUTOMBILELIABLITY(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 t*
OCCUR EACH OCCURRENCE
,EXCESS LIAR CLAIMS-MADE AGGREGATE
_ EDDED RETENTIONS$
WORKERS COMPENSATION
!PERSTTT 0 TH-E AND EMPLOYERS' LIABILITY ERN ANY P ROPRI ETOR/PARTN ER/EXECUTIVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?_jjjN I A (Mandatory in NH)
E.L. DISEASE - BA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below
_E.L.
DISEASE - POLICY LIMIT A
Nuclear Energy Liability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101 Insurance DESCRIPTION OP OPERATIONSI LOCATIONS IVEHICLES (ACORD 1O1, 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Manashi Mukherjee J.a"*wswokL
.t*M[a,*
e4-t,.*
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014101)
AGENCY CUSTOMER ID: J44032 LOC #: Hartford
.0*
ACO9RD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED MARSH USA, INC.
Maine Yankee Atomic Power Company
___________________________________________________________321 Old Ferry Road POLICY NUMBER Wiscasset, ME 04578 CARRIER
/NAIC CODE l
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 LIABIUTY INSURANCE Thin is to certify that there is in force as of the effective date of this Certificate a Nuclear Energy Uability 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 31sat of the calendar year in which the Effective Date of this Ceritifcate 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]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - MAINE YANKEE LOCATION OF NUCLEAR FACILITY: TOWN OF WISCASSET, LINCOLN COUNTY, STATE OF MAINE NAMED INSURED [LISTED ON POLICY]: Maine Yankee Atomic Power Company POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY3:
NF-0194 08/0111971
$100 Million NW-0578 08101/1971
$375 Million" THIS CERTIFICATE IS ISSUED AS A MATI'ER 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 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 paywent of claims or claims expenses.
COMMENTS/NOTES:
Muster 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 sand 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
ACORD CERTIFICATE OF LIABILITY INSURANCE SDATE (MM/DDIYYYY) 021122016 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 MARSHUSAINC.NAME:
MRHUAIN.PHONE FAX TWO ALLIANCE CENTER AIC.No.Exth (A/C No):
3560 LEN OX ROAD, SUITE 2400 E-MAIL ATLANTA, GA 30326 ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
J21970-4-Nuke.-16-17 INSUJRER A: American Nuclear Insurers INUESouthern Company Services, Inc.INUEB:
Attn: Deborah Ga~frney INSURER C :
dsgaffne~southemco.com INSURER D :
30 Ivan Allen Jr. Boulevard NW Bin SC1 404 INSURER E :
Atlanta, GA 30308 INSURER F:
COVERAGES CERTIFICATE NUMBER:
ATL-003946656-02 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, FXCI ISI(ONS ANfl CONDITIONS OF SUICH P0OLICIFS. LIMITS SHOWN MAY HAVF RFFN REflIJCED RY PAIfl Cl AIMS INS ADL SUB~R POLICY EFF POLICY EXP LTR TYPE OF INSURANCE
- NSD *VI0g POLICY NUMBER (MMIDD/YYYYI IMM/DD/YYYYI LIMITS
.* COMMERCIAL GNRLIALIYEACH OCCURRENCE
-FCAMSMD 1
CU DAMAGE TO RENTED CLAMSMAD K
OCURPREMISES (Ea occurrence)
____________________MED EXP (Any one person)
_____________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE D
PRO-° POLICY JECT LOC PRODUCTS - COMP/OP AGG
__OTHER:
AUTOMBILELIABLITYCOMBINED SINGLE LIMIT BODILY INJURY (Prpro)$
ALL WNED
__]
U~osCHEDLEDBODILY INJURY (Per accident) $
AUOSNN-WNDPROPERTY DAMAGE
[_.*
IRED UTOS UTOS(Per accident)$
UMRELALIB
.*OCUREACH OCCURRENCE EXESLA CAM-AEAGGREGATE AND EMPLOYERS' LIABILITY ERI I__________
ANY PROPRIETORJPARTNERIEXECUTIVE E.L. EACH ACCIDENT OFFICERJMEMEER EXCLUDED?
[jN I A
'(Mandatory in NH)
EL. DISEASE - EA EMPLOYEE $
If yes, describe under SDESCRIPTION OF OPERATIONS below
_____E.L DISEASE - POLICY LIMIT A
Nuclear Energy Liability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101 see addi page text Insurance DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If mome apace 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Manashi Mukherjee 3 4
-O.'L9,.*,..i dAL,JJ.
a.LL-.*
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: J21970 LOC #: Atlanta ACORD ADDITIONAL REMARKS SCHEDULE Page 2
of 3
AGENCY NAMED INSURED MARSH USA, INC.
Southern Company Services, Inc.
_______________________________________________________________Attn: Deborah Gaiffney POLICY NUMBER dsgaffne@southernco.com 30 Ivan Allen Jr. Boulevard NW Bin SC1404 CARRIER NAIC CODE Atlanta, GA 30308 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 ot the etfective date ot this Certificate a Nuclear Energy Uiability Insurance Policy issued by members ot 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 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 & Tranuporters], FS - [Foreign Suppliers & Transporters], N -[Secondary Financial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - JOSEPH M. FARLEY LOCATION OF NUCLEAR FACILITY: Joseph M. Fardey Nuclear Power Plant 16.5 MI E of Dothan, AL NAMED INSURED [LISTED ON POLICY]: Alabama Power Company and Southern Nuclear Operating Company POUiCY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0238 02/01/1976
$375 Million NW-0609 02101/1976
$375 Million" N-0052 08/01/1977 N-0073 10/23/11980**
- 2. SITE #2 -HATCH LOCATION OF NUCLEAR FACILITY: Hatch Nuclear Power Plant 11 MI N of Basley, GA NAMED INSURED [LISTED ON POLICY]: Georgia Power Company, Southemn Nuclear Operating Company, Oglethorpe Power Corporation, Municipal Electric Authority of Georgia, City of Dalton, Georgia POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0215 06/26/1973
$375 Million NW-0594 06/26/1 973
$375 Million*
N-0051 08/01/1 977 N-0067 06/1 3/1 978**
- 3. SITE #3 - ALVIN W. VOGTLE LOCATION OF NUCLEAR FACILITY:
Alvin W. Vogtie Nuclear Power Plant 26 Ml SSE of Augusta, GA NAMED INSURED [lISTED ON POLICY]: Georgia Power Company, Southern Nuclear Operating Company, Oglethorpe Power Corporation, Municipal Electric Authority of Georgia, MEAG Power SPVM, LLC, MEAG Power SPVJ, LLC, MEAG Power SPVP, LLC and City of Dalton, Georgia POLICY NUMBER:
POUiCY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0302 06/01/11986
$375 Million NW-0653 06/01/1986
$375 Million" N-0111 01/16/1987 N-01 17 02/09/1 989 THIS CERTIFICATE IS ISSUED AS A MAtTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policylies) 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 it is issued shall amend, estend or alter the coverage afforded by the policy. The Limit of Liability shown shove 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
AGENCY CUSTOMER ID: J21 970 LOC #: Atlanta AWORD ADDITIONAL REMARKS SCHEDULE Page 3
of3 AGENCY NAMED INSURED MARSH USA, INC.
Southern Company Servces, Inc.
__________________________________________________________Attn: Deborah Gaffney POLICY NUMBER dsgaffne@southernco.com 30 Ivan Allen Jr. Boulevard NW Bin 601404 CARRIER NAIC CODE Atlanta, GA 30308 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 sublect 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 Certiticate - 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
AGENCY CUSTOMER ID: 798153 LOC #: Hartford ACO~RD ADDITIONAL REMARKS SCHEDULE Page 2
of 2
AGENCY NAMED INSURED MARSH USA, INC.
Yankee Atomic Electric Company
______________________________________________________________49 Yankee Road POLICY NUMBER Rowe, MA 01367 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 CERTIFICATE OF NUCLEAR ENERGY LIABILITY INSURANCE This is to certify that there is is force as of the effective date st this Certificate a Nuclear Energy Uability 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 shows and/or with respect to the Issured's operations described herein, It such policy is cancelled or otherwise terminated prior to the end of December 31st of the calender year in which the Effective Date of this Certifi cafe occurs, notice will be delivered in accordance with the policy pruvinions. Otherwise this Certificate shall terminate as of the end of such December 31st. A Certifcate 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]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - YANKEE ROWE LOCATION OF NUCLEAR FACILITY:
Town of Rowe, State of Massachusetts NAMED INSURED [USTED ON POLICY]: Yankee Atomic Electric Company POLICY NUMBER:
POLICY EFFECTIVE:
NF-0076 10/23/1959 LIMIT OF LIABILITY:
$100 Million
$375 Miilion**
NW-0522 10/23/1959 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 Certifi cafe 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 Uiability 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 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.
ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/ODDYYYY) 01/1912016 w
I 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(sl.
PRODUCER CONTACT MARSHUSAINC.NAME:
MRHUAIC.PHONE IFAX 20 CHURCH STREET, 8TH FLOOR (AC, No, Eat:
I(CO NO):
HARTFORD, CT 06103 E-MAIL Attn: Hartford certrequest~marsh com I Fax: 212-948-01866ADES INSURER(SI AFFORDING COVERAGE NAIC #
7981 53--NUC-16-17 INSURER A : American Nuclear Insurers INSUREDINUEB:
Yankee Atomic Electric Company ISRRB 49 Yankee Road INSURER C :
Rowe, MA 01367 INSURER 0:
INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER:
NYC-007330493-03 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.
NOTIWITHSTANDING 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.
INSR ADDL SUiBR POLICY EFF POLICY EXP
-T TYPE OF INSURANCE
!NSD WVIM POLICY NUMBER (M(DDYyy 9{MiD/Yyy LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE II DAMAGE TO RENTED SCLAIMS-MADE KJ OCCUR PREMISES lEa occurence)
____________________________MED EXP (Any one person)
_______________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE D
PRO-[
POLICY JECT LOC PRODUCTS-COMP/OP AGO
__OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea 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) i I $
__UMBRELLA LIAB
[*
OCCUR EACH OCCURRENCE EXCESS LIAB I ICLAIMS-MADE AGGREGATE DED!
RETENTION S WORKERS COMPENSATION STATUERE AND EMPLOYERS' LIABILITY Y/NIR ANY PROPRIETORIPARTNERJEXECUTIVE FTF E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
[JN1 A
A_________
(Mandatory In NH)
EL. DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below
___________E.L.
DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached Acoid 101 01/01/2016 01/01/2017 See Attached Acord 101 Insurance DESCRIPTION OF OPERATIONS I LOCATIONS)I VEHICLES (ACORD 1 01, Additional Remarks Schedule, may be attached If mome space Is required)
CERTIFICATE HOLDER CANCELLATION Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE U.S. Nuclear Regu~latory 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
..,* ~
~
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AwD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 12/08/2015 I
THIS CERTIFICATE IS ISSUED AS A MA'n'ER 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 500 Dallas St, Suite 1500 nc. No. Ext; (AC, No):
Houston, TX 77002 EMI INSURER(S) AFFORDING COVERAGE NAIC #
897592-Energ-Nucle-16-17 INSURER A : American Nuclear Insurers INSURED INSURERB :
Energy Future Holdings Corp.
1601 Bryan Street INSURER C :
Dallas, TX 75201 INSURER D :
INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER:
HOU-002497200-03 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 IS SUBJECT TO ALL THE TERMS, I:Y I IQI~l(kIO Akflr ('IMflTICIFI t(l C1 I(PW Dfl Ir'II=
I IIWllTO QWr~lA/el I~AlV WA'.I= DFI*I= iOflIr ifltrl IV DAIR t' AIIUIO INSR ADDL SUBR~
POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INp WVw POLICY NUMBER IMMIDD/YYYY I (MMIDD/YYYY)
LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1
DAMAGE TO RENTED JCLAIMS-MADE OCCUR PREMISES (Ea occurrence)
____________________MED EXP (Any one person)
_____________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
[m PRO-II POLICY LiJECT LOC PRODUCTS -COMPIOPAGG
__OTHER:
AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT
{lEa 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 LUAB OCCUR EACH OCCURRENCE EXCESS LIABR CLAIMS-MADE AGGREGATE
_ EDDED RETENTIONS$
WORKERS COMPENSATION IPER 0H AND EMPLOYERS' LIABILITY YIN ER ANY PROPRI ETORIPARTNERJEXECUTiVE FF E.L. EACH ACCIDENT OFFICERIMEMBER EXCLUDED?
[JN I A (Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OP OPERATIONS below E.L 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 iai, Addit~onal Remarks Schedule, may be attached If more apace 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
I
~ ~~Jessie Guerrero ACORD 25 (2014101)
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 897592 LOC #: Houston A CORD ADDITIONAL REMARKS SCHEDULE Page 2
of 2
AGENCY NAMED INSURED Marsh USA Inc.
Energy Future Holdings Corp.
-1601 Bryan Street POLICY NUMBER Dallas, TX 75201 CARRIER NAIC CODE L
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 theme is in force as of the effective date of fhis Certificate a Nuclear Energy Uabilify 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 Insumeds 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 mill he 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 unleus requested in writing.
Types of Insurance: NE - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's & Transporters], ES
- [Eoreign Suppliers & Transporters], N- [Secondary Financial Protect ion Certificate]
COVERAGE EOR NUCLEAR FACILITIES:
- 1. SITE #1 - COMANCHE PEAK LOCATION OF NUCLEAR FACILITY: Comanche Peek Nuclear Power Plant is located on the south hunk of Squaw Creek Reservoir near the town of Glen Rose in Somervell County, Texas approximately 35 miles southwest of Fort Worth and 67 miles southwest of Dallas, Texas.
NAMED INSURED [LISTED ON POLICY]: Luminant Generation Company LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0274 01101/1983
$375 Million NW-0631 01/01/1983
$375 Million" N-0090 02/08o990 N-OilS 02102/1993 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS ND 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 Uability 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 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 Proftaction 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
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 02/10/2016 THIS CERTIFICATE IS ISSUED AS A MATT'ER 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(lest 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 Mars USAInc.NAME:
Mas S n.PHONE FAX 100 North Tryon Street, Suite 3600 A/c, No, Extt:
A/C, No):
Charlotte, NC 28202 E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
22830 -ONE-1/1-16-17 INSURER A : American Nuclear Insurers INSURED INSURER B :
Duke Energy Corporation ATTN: Ed Adams IINSURER C :
ed.adams@duke-energy.com INSURER D :
550 S. Tryon Street DEC40-C INSURER E :
Charlotte, NC 28202 INSURER F :
COVERAGES CERTIFICATE NUMBER:
ATL-003526555-06 REVISION NUMBER: 19 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, INSR ADDL S5UBR-POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INS WVD POLICY NUMBER IMMIDD/YYYY'
'MM/DD/YYYY)
LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE II DAMAGE TO RENTED
]CLAIMS-MADE I
OCCUR PREMISES tEa occurrence)
___________________________MED EXP (Any one person)
_____________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE 7 PRO-7 POLICY I JECT LOC PRODUCTS - COMP/OP AGG
__OTHER:
AUTOMBILELIABLITYCOMBINED SINGLE LIMIT AUTOMBILELIABIITYtEa accident)
ANY AUTO BODILY IN JURY (Per person)
ALL OWNED SCHEDULED BODILY iNJURY tPer accident)
__AUTOS
__AUTOS NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS
__AUTOS (Per accident)
__UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAB I
CLAI MS-MADE AGGREGATE DEDDED RETENTIONS WORKERS COMPENSATION
{PER OH AND EMPLOYERS' LIABILITY Y I N ER ANY PROPRIETORJPARTNERJEXECUTIVE flf E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
[ 2 N
A (Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below EL. DISEASE - POLICY LIMIT $
A Nuclear Energy Uiability SEE ATTACHED 01/01/2016 01/01/2017 SEE ATTACHED 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 Commnission THE EXPIRATION DATE
- THEREOF, NOTICE WILL BE DELIVERED IN Washington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Karen A. Burke Kd-J.*-
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
V AGENCY CUSTOMER ID: 22830 LOC #: Charlotte ACO9RD ADDITIONAL REMARKS SCHEDULE Page 2of 4
AGENCY NAMED INSURED Marsh USA Inc.
Duke Energy Corporation
_________________________________________________ATTN: Ed Adams POLICY NUMBER ed.adams@duke-energy.com 550 S. Tryon Street DEC40-C CARRIER
/NAIC CODE Charlotte, NC 28202 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 theme is in force as of the effective date of this Certificate a Nuclear Energy Uability Insurance Policy issued hy members of American Nuclear Insurers as indicated (Companies), to the Insured named herein, mith respect to the Nuclear Facility at the Location shown sod/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 ot the end of such December 31st. A Certificate will NOT be issued for any subsequent calendar year unless requested is writing.
Types of Insurance: NP - [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 - CATA WBA LOCATION OF NUCLEAR FACILITY: Catawba Nuclear Power Plant in the NE portion of York County, SC NAMED INSURED [LISTED ON POLICY]: Duke Energy Carolinas, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0281 12/01/1983
$375 Million NW-0637 12/01/1983
$375 Million" N-0097 07/18/1 984 N-0106 12/01/1983
- 2. SITE #2-MCGUIRE LOCATION OF NUCLEAR FACILITY: McGuire Nuclear Power Plant located 17 ml N/NW of Chariotte, NC NAMED INSURED [USTED ON POLICY]: Duke Energy Carolinas, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF UABIUITY:
NF-0248 05/01/1977
$375 Million NW-0615 05/01/1977
$375 Million**
N-0069 01/23/1981 N-0092 03/03/11983
- 3. SITE #3 - OCONEE LOCATION OF NUCLEAR FACILITY: Oconee Nuclear Power Plant in Oconee County, South Carolina NAMED INSURED [LISTED ON POLICY]: Duke Energy Carolinas, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0182 03/01 /1 970
$375 Million NW-0569 03/01/1970
$375 Million**
N-0022 08/01/11977 N-0023 08/01/11977 N-0024 08/01/1 977**
- 4. SITE # BRUNSWICK LOCATION OF NUCLEAR FACILITY: Brunswick Nuclear Power Plant 2.5 MI N of Sosthport, NC NAMED INSURED [LISTED ON POLICY]: Duke Energy Progress, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0218 10/25/11973
$375 Million NW-0597 10/25/1973
$375 Million**
N-0054 08/01/1977 N-0055 08/01/1977 ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 22830 LOC #: Charlotte ACO9RD ADDITIONAL REMARKS SCHEDULE Page 3
of 4
AGENCY NAMED INSURED Marsh USA Inc.
Duke Energy Corporation
________________________________________________ATTN: Ed Adams POLICY NUMBER ed.adams@duke-energy.com 550 S. Tryon Street DEC40-C CARRIER
/NAIC CODE Charlotte, NC 28202 EFFECTIVE DATE:
ADDITIONAL REMARKS
[THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:
25 FORM TITLE: Certificate of Liability Insurance
- 5. SITE #5 - CRYSTAL RIVER LOCATION OF NUCLEAR FACILITY:
Crystal River Nuclear Power Plant 7.5 MI NW of Crystal River, Citros County, FL NAMED INSURED [LISTED ON POLICY]:
Duke Energy Floride, inc.; Seminole Electric Cooperative, Inc.; Orlando Utilities Commission and City of Odando; City of Gainesville, Florida; City of Ocala; City of Leesbarg, Florida; City of Kissimmee, Florida, A Municipal Corporation; City of New Smymna Beach, Florida and Utilities Commission of New Smymna Beach, Florfda; City of Alachua, Florida; The City of Bushnell; Florida Progress Corporation POLICY NUMBER:
PDUCY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0195 07/01/1971
$375 Million NW-0579 07/01/1971
$375 Million**
- 6. SITE #6 - SHEARON HARRIS LOCATION OF NUCLEAR FACILITY:
Shearon Heelis Nuclear Power Plant 20 MI SW of Raleigh, NC NAMED INSURED [LISTED ON POLICY]; Duke Energy Progress, Inc.
POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
N F-0288 06101/1984
$375 Million NW-0642 06101/1984
$375 Million**
N-0112 10/24/1986
- 7. SITE #7-H. B. ROBINSON LOCATION OF NUCLEAR FACILITY:
H.B. Robinnon Nuclear Power PlantS5 MI WNW from Hertsville, SC NAMED INSURED [LISTED ON POLICY]: Duke Energy Progress, Inc.
POLICY NUMBER:
POUCY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0180 10/1 5/1 969
$375 Million NW-0567 10/15/1969
$375 Million**
N-0021 08/01/11977**
- 8. SITE #8 -LEVY LOCATION OF NUCLEAR FACILITY:
Levy Nuclear Plant 39 MI SW of Gainsville, FL NAMED INSURED [LISTED ON POLICY]: Duke Energy Florida, Inc.
POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF -0354 01/01/2015
$1 Million
- 9. SITE #9 - LEE LOCATION OF NUCLEAR FACILITY:
Lee Nuclear Site 6 Ml S of Blacksburg, SC NAMED INSURED [USTED ON POLICY]: Duke Energy Carolinas, LLC POUCY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0355 1/1/2016
$1 Million THIS CERTIFICATE IS ISSUED AS A MATIER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policylies) is subject to the encluoions, conditions and other provisions of the pelicylies). 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 Uimit of Uability shown above may have been reduced by payment of claims or claims expenses.
COMMENTS/NOTES:
ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 22830 LOC #: Charlotte A CORD ADDITIONAL REMARKS SCHEDULE Page 4
of 4
AGENCY NAMED INSURED Marsh USA Inc.
Duke Energy Corporation
_______________________________________________________ATTN: Ed Adams POLICY NUMBER ed.adams~duke-energy.com 550 S. Tryon Street DEC4O-C CARRIER
/NAIC CODE Charlotte, NC 28202 EFFECTIVE DATE:
ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:
25 FORM TITLE: Certificate of Liability InsuranceI
- Master Worker Certificate - This limit is shared by all Certificates to the Master Worker Policy of which each Certificate is a part and is sabject to all of the provisions of such Policy and Certificate having reference thereto. Sach limit may have been reduced by payment of claims or claims enpenses.
- Secondary Financial Protection Certificate - Financial protection available ander an industry retrospective rating plan.
ACORD 101 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACO~RD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 02/10/2016 THIS CERTIFICATE IS ISSUED AS A MATT-ER 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 100 North Tryon Street, Suite 3600 A/c. No. Extl:
(A/C, No):
Chadotte, NC 28202 E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
070250-SCAN-NUKE-16-17 INSURER A : American Nuclear Insurers INUESCANA CorporationINUEB:
ATTN: John Mellette INSURER C :
JMELLETTE@scana.com INSURER D :
100 SCANA Parkway Cayce, SC 29033 INSURER E :
_________________________________________________________INSURER F: :_____
COVERAGES CERTIFICATE NUMBER:
ATL-003396433-02 REVISION NUMBER:3 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWIMTHSTANDING 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.
INSR ADDL SUB~R POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN*;u *V'"
POLICY NUMBER (MMIDD/YYYY1 IMMIDD/YYYY)
LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE II DAMAGE TO RENTED CLAIMS-MADE KJOCCUR PREMISES (Ea occurrence)
___________________________MED EXP (Any one person)
PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
- O ICYI PRO-m-
PLCLJJECT LiLOC PRODUCTS - COMPIOP AGG OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accidenlt 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 l
OCCUR EACH OCCURRENCE EXCESS LIAB I ICLAIMS-MADE AGGREGATE DEDBED RETENTIONS 5
WORKERS COMPENSATION IPERTAT TE I°TH-E AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORJPARTNERJEXECUTIVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
N 1 N A (Mandatory In NH)
E.L. DISEASE - RA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below E.L. 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 / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If mome space Ia 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 070250 LOG #: Charlotte ACORD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED Marsh USA Inc.
SCANA Corporation
_______________________________________________________________ATTN: John Mellette POLICY NUMBER JMELLETTE@scana.com 100 SCANA Parkway Cayce, SC 29033 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 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 Uability Insurance Policy issued hy 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, It such policy is cancelled or otherwise terminated pdor to the end of December 3lst of the calendar year in which the Effective Date of this Certificate occurs, notice will he 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 wdting.
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 - VIRGIL C. SUMMER NUCLEAR STATION LOCATION OF NUCLEAR FACILITY: Virgil C. Summer Nuclear Station 2.5 miles N of Purr, Fairfield County, South Carolina NAMED INSURED [LISTED ON POLICY]: South Carolina Electric & Gas Company and South Carolina Public Service Authority POUCY NUMBER:
POLICY EFFECTIVE:
LIMIT OF UABILITY:
NF-0252 03/21/1978
$375 Million NW-0616 03/21/1978
$375 Million" N-0078 08/05/1 982 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policylies) 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 in issued shall amend, extend or alter the coverage afforded by the policy. The Umit of Liability ahown above may have been reduced by payment of claims or claims expenses.
COMMENTS/NOTES:
"Master Worker Certificate - This limit is shared by all Certiticates to the Master Worker Policy of which each Certificate is a part and is subject to nil of the provisions of ouch 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
ACOIRD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 02/10/2016 THIS CERTIFICATE IS ISSUED AS A MA'I-ER 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 Mars USAinc.NAME:
Mas S n.PHONE FAX 100 North Tryon Street, Suite 3600 A/C.No.Extl:
A/C, No):
Charlotte, NC 28202 E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #t 936236-*..-FinPr-16-17 INSURER A : American Nuclear Insurers INSURED INSURERSB:
BWXT Nuclear Operations Group, Inc.
2016 Mt. Athos Road INSURER C :
Lynchburg, VA 24504 INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER:
ATL-003416213-02 REVISION NUMBER:7 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, aALI f OlaJIlNO flNlr' a,a"JI"aLITI r".,In tsrou r
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INRADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INsla
- p POLICY NUMBER IMM/DD/YYYYI IMM/DD/VYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED
]CLAIMS-MADE Li OCCUR PREMISES (Ea occurrencel
___________________________MED EXP (Any one person)
___________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE POLICY LJ PEOT LJ LOC PRODUCTS -COMP/OP AGG
__OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident)
ANY ATOEDGILY INJURY (Per person)
ALL WNED SCHEULEDBODILY INJURY (Per accident)
NNONDPROPERTY DAMAGE HIEDAUTS UTOS(Per accident)
__UMRELALIB
-* OCUREACH OCCURRENCE EXESLAB LIM-AEAGGREGATE AND EMPLOYERS' LIABILITY ERIN ANY PROPRIETORIPARTNER(EXECUTIVE r---
E.L. EACH ACCIDENT OFFICERJMEMBER EXCLUDED?
L2NI/
A (Mandatory In NH)
EL. DISEASE - CA EMPLOYEE $
If yes, describe under DE:SCRIPTION OF OPERATIONS below
______E.L.
DISEASE - POLICY LIMIT A Nuclear Energy Uability See Attached 01/01/2016 01/01/2017 See Attached Insurance "Acord 101' Acord 101 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1011, Additional Remarks Schedule, may be attached If more apace 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 936236 LOC #: Charlotte ACO~RD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED Marsh USA Inc.
BWXT Nuclear Operations Group, Inc.
___________________________________________________________2016 Mt. Athos Road POLICY NUMBER Lynchburg, VA 24504 CARRIER NAIC CODE L
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 Uability 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 31sat of the calendar year in which the Effective Date of this Certificate occars, 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 reqaested in wrilting.
Types of Insurance: NF - [Facility Form], NW-
[Master Worker Certificate], NS - [US Domestic Suppliers & Transporters], FS - [Foreign Suppliers & Transporters]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - LYNCHBURG FUEL FABRICATION FACILITY LOCATION OF NUCLEAR FACILITY: Lynchburg Fuel Fabrication Facility 550 acre plant site, approx 7mi east of Lynchburg, VA NAMED INSURED [LISTED ON POLICY): BWXT Nuclear Operations Group, Inc. and AREVA Inc.
POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0111 10/01/1961
$200 Million NW-0533 10/01/1961
$375 MIllion" THIS CERTIFICATE IS ISSUED AS A MATIER 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 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.
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 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.
ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 02/09/2016 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 Risk & Insurance Services NAME:FA PHONEFA 4445 Eastgate Mall
{AIC, No, Ext):
A/C, No):
San Diego, CA 92121 E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC 1/
03434B-NRC-GA-16-17 INSURER A : American Nuclear Insurers INSURED ISRRB General AtomicsINUEB:
P0 Box 85608 INSURER C :
San Diego, CA 92138 INSURER D :
INSURER EB:
INSURER F :
COVERAGES CERTIFICATE NUMBER:
LOS-001836936-03 REVISION NUMBER:3 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 INp V
POLICY NUMBER IMM/DD/YYYYI IMM/DD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE II DAMAGE TO RENTED CLAIMS-MADE LiOCCUR PREMISES (Ea occurrence)
__________________________MED EXP (Any one person)
___________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE II PRO-7--
POLICY ~jJECT LOC PRODUCTS-COM P/OPAGO OTHER:$
AUTOMBILELIABLITYCOMBINED SINGLE LIMIT AUTOMBILELIABIITYlEa accident)
ANY AUTO BODILY INJURY (Per person)
ALL OWNED SCHEDULED BODILY INJURY (Per accident)
__AUTOS
__AUTOS NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS
__AUTOS (Per accidentl 5
UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE
__ flED RETENTIONS WORKERS COMPENSATIONST TPER 0 ITH-E AND EMPLOYERS' LIABILITY ERY________N_
ANY PROPRIETORJPARTNER/EXECUTIVE r1 E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
IJ NA (Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached 01/01/2016 01/01/2017 See Attached DESCRIPTION OF OPERATIONS I LOCATIONS/IVEHICLES IACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION Document Centro[ 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.
AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 034348 LOC #: San Diego A CORD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED Marsh Risk & Insurance Services General Atomics PG Box 85608 POLICY NUMBER San Diego, CA 92138 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 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 hy members of American Nuclear Insurers as indicated (Companies), In the Insured named herein, with respect to the Nuclear Facility at the Location shown and/or with respect to the Insured's operations descrtbed 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 Certiti cafe occurs, notice will be delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate us 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 Certficate), NS - [US Domestic Supplier's & Transporters], PS
- [Foreign Suppliers & Transoporters]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - GENERAL ATOMICS LOCATION OF NUCLEAR FACIUITY:
Sun Diego, CA NAMED INSURED [LISTED ON POLICY]: General Atomics POLICY NUMBER:
POLICY EFFECTIVE:
NF-0034 0313111958 NW-051 2 03/31/1958 LIMIT OF UIABIUITY:
$40 Million
$375 Million" THIS CERTIFICATE IS ISSUED AS A MATTFER 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 contruct or other document with respect to which it is issued shall amend, estend 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.
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 all of the provisions of such Policy and CertiJficate having reference thereto. Ssch limit may have been reduced by payment of claims or claims expenses.
ACORO 101 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 02109/2016 THIS CERTIFICATE IS ISSUED AS A MATT'ER 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 1717 Arch Street AC, NoExt):
(AC, No):
Philadelphia, PA 19103-2797 E-MAIL Attn: Philadelphia.Certs@marsh.com/ fax - 212-948-0360 ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #I S27324-NUC-ENR-16-17 INSURER A : American Nuclear Insurers INSURED INSURER B :
Susquehanna Nuclear, LLC and Allegheny Electric Cooperative, Inc.
INSURER C :
Corporate Risk & Insurance INSURER D :
835 Hamilton Street, Suite 150, GENPL7N Allentown, PA 18101 INSURER B :
_________________________________________________________INSURER F:
COVERAGES CERTIFICATE NUMBER:
CLE-004443748-05 REVISION NUMBER:9 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 CONflITIONS OF SI ICH P0OLICIES L IMITS SHOWN MAY HAVF RFFN R~FlIIJCI:: RY PAIDi CI AIMS INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE yN*D WVD' POLICY NUMBER (MMIDD/YYYYI IMMIDD/YYYY1 LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 77 DAMAGE TO RENTED CLAIMS-MADE LiOCCUR PREMISES (Ea occurrence)
__________________________MED EXP (Any one person)
______________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE D
PRO-° POLICY JECT LOC PRODUCTS - COMP/OP AGG S
__OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 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 OCCUR EACH OCCURRENCE EXCESS LIAR ICLAIMS-MADE AGGREGATE
__DED RETENTIONS$
WORKERS COMPENSATION IPER 0H AND EMPLOYERS' LIABILITY Y I NIJL~
ANY PROPRIETORJPARTNERIEXECUTIVE F1 E.L. EACH ACCIDENT OFFICERJMEMBER EXCLUDED?
[hNt A
A________
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE $
If yen, describe under DESCRIPTION OP OPERATIONS below E.L. DISEASE - POLICY LIMIT $
ANuclear Energy Liability See Attached 01/01/2016 01/01/2017 See Attached Acord 101 Insurance Acord 101 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Manashi Mukherjee
..3"i4.e.*.J Ltc..CJt
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: S27324 LOC #t: Philadelphia A CORD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED Marsh USA Inc.
Susquehanna Nuclear, LLC and Allegheny
-Electric Cooperative, Inc.
POLICY NUMBER Corporate Risk & Insurance 835 Hamilton Street, Suite 150, GENPL7N
-Allentown, PA 18101 CARRIER NAIC CODE L
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 American Nuclear Insurers as indicated (Companies), to the insured named herein, with inspect to the Nuclear Facility at the Location shown and/or with respect to the Insredas 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 Etfective 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 issaued for any sabsequent 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]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - SUSOUEH-ANNA LOCATION OF NUCLEAR FACILITY: Sasquehanna Naclear Power Plant is Salem Township, Luzeme Coanty, Pennsylvania NAMED INSURED [LISTED ON POLICY]: Susquehanna Nuclear, LLC & Allegheny Electric Cooperative, Inc.
POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0262 01/01/1981
$375 Million NW-0622 0110111981
$375 Million's N-0084 07/17/1982 N-0096 03/23/1 984 THIS CERTIFICATE IS ISSUED AS A MATTFER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policy(ies) is sabject to the euclasions, conditions and other provisions of the policy(ies). Neither this Certificate nor any contract or other docament with respect to which it is issued shall amend, extend or alter the coverage afforded by mhe policy. The Limit of 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 Cerfif cafes 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 espouses.
NOTE 1 -NS-0422: Suppliers & Transporters Coverage - Additional Named Insured - Restricted Coverage Such insarance as is afforded by the policy shall also apply to Allegheny Electric Cooperative, Inc. and Tales Energy Corporation, but solely with respect to liability for bodily injury, property damage or environmental damage which arises oat of naclear material which has been sused or is to be used, or baa been irradiated in the course of the operation of a meactor in which it has an ownership interest, located at the Sasqaehanna Steam Electric Station.
ACORD 101 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACO~RD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 01/0812016 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 NAME:FA PHONEFA CA License #0437153 inc.NoExt):
(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-16-17 INSURER A : American Nuclear Insurers EDISON INTERNATIONAL ISRRB 2244 WALNUT GROVE AVENUE INSURER C :
ROSEMEAD, CA 91770 INSURER D0:
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 CI AIMS.
INSR
- .D SUBS POLICY EFF POLICY EXP LTR TYPE OF INSURANCE rNp raVjp POLICY NUMBER (MM/DD/YYYYI)
MMIDD/YYYY)
LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE m
DAMAGE TO RENTED SCLAIMS-MADE LJ OCCUR PREMISESlEa.... urre..e )
__________________________M ED EXP (Any one person)
___________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE S
POLICY D* PRO-
[*
LOC PRODUCTS -COMPIOP AGO OTHER:
AUTOMOBILE LIABILITY (ea accidenit)
ANY AUTO BODILY INJURY (Per person)
ALL OWNED SCHEDULED BODILY INJURY (Per accident)
__AUTOS
__AUTOS NON-OWNED PROPERTY DAMAGE
__HI RED AUTOS
__AUTOS (Per accident)
__UMBRELLA LIABR
- OCCUR EACH OCCURRENCE S
EXCESS LIAB I
ICLAIMS-MADE AGGREGATE
__DED!
RETENTION $
WORKERS COMPENSATION LI A PER
~
AND EMPLOYERS' LIABILITY Y I NIE ANY PROPRIETORJPARTNER/EXCCUTIVE F*1 EL. EACH ACCIDENT OFFICERJMEMBER EXCLUDED?
Li N I A (Mandatory 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 mome space is requiredl 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.
AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services Cynthia Guist
- o.,lr,,*.
.1
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 53370 LOC #: Los Angeles ACORD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED Marsh Risk & Insurance Services EDISON INTERNATIONAL 2244 WALNUT GROVE AVENUE POLICY NUMBER ROSEMEAD, CA 91770 CARRIER NAIC CODE
.L 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 torce as of the effective dale 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, It sach policy is cancelled or otherwise terminated prior to the end of December 31 st of the calendar year in which the Effectiye 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 suhsequent calender year unless requested in writing.
Types of Insurance: NE - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's & Transporters], ES
- [Foreign Suppliers & Transporters], N - [Secondary Financial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 -SAN ONOFRE LOCATION OF NUCLEAR FACILITY:
San Onotre Nuclear Generating Station 3 miles S of City of San Clemente in San Diego County, California NAMED INSURED [USTED ON POLICY]: Southern Califomnia Edison Company, San Diego Gas & Electric Company, The City of Anaheim, The City of Riverside POLICY NUMBER:
POUCY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0146 04/06/1966
$375 Million NW-0549 01/01/1998
$375 Million" N-008l1 02/16t/1 982 N-00fl7 11/15/1982**
THIS CERTIFICATE IS ISSUED AS A MAlT-ER 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 it is issued shall amend, extend or alter the coverage afforded by the policy. The Uimit of Liability shown shove 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 all ot 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 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACO2RD CERTIFICATE OF LIABILITY INSURANCE SDATE (MM/DD/YYYY) 02109/2016 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 500 Dallas St, Suite 1500 (A/C, No, Ext):
(A/C, No):
Houston, TX 77002 E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIc #
J03175-Sp-16-17 INSURER A : American Nuclear Insurers INSURED INSURER E :
Arizona Public Service Company, et al Mail Station: 9618 PO Box 53999 INSURER C :
Phoenix, AZ 85072-3999 INSURER D :
INSURER E :
_________________________________________________________INSURER F: :_____
COVERAGES CERTIFICATE NUMBER:
HOU-002668951-05 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 TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE I*p VVV POLICY NUMBER (MID/YY (MMID/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE II 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 POLICY D PRO-D---
LOC PRODUCTS-COMP/OP AGG
__OTHER:
AUTOMOBILE LIABILITY COMEINED 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 OCCUR EACH OCCURRENCE EXCESS LIAB i
CLAIMS-MADE AGGREGATE
__DEDI RETENTIONS WORKERS COMPENSATIONST~TPR I
ITE AND EMPLOYERS' LIABILITY Y I NJ~L~
ANY PROPRIETOR/PARTNER/EXECUTIVE r1 E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
N 1 N A___________
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYES If yes, describe under D)ESCRIPTION OP OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Uability See Attached 01/01/2016 01/01/2017 See Attached Acord 101 Insurance Acord 101 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mome 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Manashi Mukherjee
.. t"4,kj; L,-
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: J03 175 LOC #: Houston ACORD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED Marsh USA Inc.
Arizona Public Service Company, et al
______________________________________________________________Mail Station: 9618 P0 Box 53999 POLICY NUMBER Phoenix, AZ 85072-3999 CARRIER NAIC CODE
.L 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 American Nuclear Insurers us indicated (Companies), to the Insured named herein, with respect to the Nucleer 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 will be delivered is accordance with the policy provisions. Otherwise this Certificate shall terminate as ot 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 - PALO VERDE LOCATION OF NUCLEAR FACILITY: Palo Verde Nuclear Generating Station located in Wintersburg, Arizona NAMED INSURED [LISTED ON POLICY]: Arizona Public Service Company, at al POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0266 08/07/1 981
$375 Million NW-0625 08/07/1 981
$375 Million' N-0088 12131/1984 N-0107 12109/1985 N-01 14 03/25/1987**
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 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.
COMMENTS/NOTES:
- Muster 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 nil of 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
AC1R CERTIFICATE OF LIABILITY INSURANCE
[/DAE(MDD/YYY THIS CERTIFICATE IS ISSUED AS A MATT-ER 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 1301 5th Avenue, Suite 1900 A/C. No. Ext-;
(A/C, No):
Seattle, WA 98101 E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
J26976-NUC2-16-17 INSURER A : American Nuclear Insurers INSURED INSURER B:
Energy Northwest Attn: Marie Thomas INSURER C :
P.O. Box 968 INSURER D0:
Richland, WA 99352 INSURER E :
INSURER F: :______
COVERAGES CERTIFICATE NUMBER:
SEA-002714992-02 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.
INSR ADDL SUBR~
POLICY EFF POLICY EXP LTR TYPE OF INSURANCE ffl@
WV POLICY NUMBER IMM/DD/YYYY)
IMM/DD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE II DAMAGE TO RENTED
. CLAIMS-MADE L..... OCCUR PREMISES lEa occurrence)
___________________________MED EXP (Any one person)
_____________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE POLICY D JPRO LOC PRODUCTS -COMP/OPAGG
__OTHER:$
_AUTOMOBILE LIAEILITY (ECOMBINEDacietSINGLE LIMIT ANY AUTO BODILY INJURY (Per person)
ALL OWNE*D SCHEDULED BDL NUY(e ciet
__AUTOS
__AUTOS BDL NUYle ciet NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS
__AUTOS (Per accident)$
__UMBRELLA LIABR [
OCCUR EACH OCCURRENCE EXCESS LIAB I
CLAIMS-MADE AGGREGATE
__DED RETENTIONS $______$__
WORKERS COMPENSATION IPERSTTT 0 TH-R AND EMPLOYERS' LIABILITY YN ER ANY PROPRIETOR/PARTNER/EXECUTIVE r7F EL. BACH ACCIDENT OFFICER/MEMBER EXCLUDED?
2 j I A (Mandatory In NH)
EL. DISEASE - BA EMPLOYEE $
If yes. describe under DESCRIPTION OF OPERATIONS below
_______________E.L.
DISEASE - POLICY LIMIT $
A Nuclear Energy Uabilty See Attached Acord 101 01/01(2016 01/01/2017 See Attached Acord 101 Insurance DESCRIPTION OF OPERATIONS I LOCATIONS/IVEHICLES (ACORD l01, Additional Remarks Schedule, may be attached if more space is requlredi 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
I
~ ~~Van H. Vong"7'z
© 1988-2014 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD ACORD 25 (2014101)
AGENCY CUSTOMER ID: J26976 LOC #: Seattle
ACO~RD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED Marsh USA, Inc.
Energy Northwest
_________________________________________________________________tn:__MaArie Mrieohoma POLICY NUMBER P.O. Box 968 Richiand, WA 99352 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 torce as of the effective date of this Certificate a Nuclear Energy Uability 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 will be delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate as of the end of such December 31sat A Certificate will NOT be lossed 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]
CDVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - COLUMBIA GENERATING STATION LOCATION OF NUCLEAR FACILITY:
All of the premises including the land and all building and structures of Energy Northwest Columbia Generating Station including bat not limited to the reactors formerly knlown as WNP 1, WNP 2 and WNP located approximately 12 miles NW of Richiand, Washington.
NAMED iNSURED [LISTED ON POLICY]: Energy Northwest POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0270 08/01/1982
$375 Million NW-0628 08/01/1982
$375 Million**
N-0091 12120/1983 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 conhract or other document with respect to which it is issued shall amend, extend or alter the coverage afforded by the policy. The Uimit of 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 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 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACO9RD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 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 RISK & INSURANCE SERVICES PHNAE:A 345 CALIFORNIA STREET, SUITE 1300 IA/C. No. Extt:
(A/C, Nol:
CALIFORNIA LICENSE NO. 0437153 E-MAIL SAN FRANCISCO, CA 94104 ADES INSURER(S) AFFORDING COVERAGE NAIC #
021716-NUC2-16-17 INSURER A : American Nuclear Insurers INSURED INSURER B :
PACIFIC GAS & ELECTRIC COMPANY ONE MARKET SPEAR TOWER INSURER C :
SUITE 2400 INSURER D :
SAN FRANCISCO, CA 94105 INSURER EB:
INSURER F COVERAGES CERTIFICATE NUMBER:
SEA-002937975-03 REVISION NUMBER: 3 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 INj*p W3*
POLICY NUMBER IMMIDD/YYYYI IMM/DD/YY'YYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE m
DAMAGE TO RENTED CLAIMS-MADE U OCCUR PREMISES lEa occurrence)
S
___________________________MED EXP (Any one person)
S
_____________________PERSONAL
& ADV INJURY S
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE POLICY [j PRO-
[j LOC PRODUCTS-COMP/OPAGG OTHER:
AUTOMBILELIABLITYCOMBINED SINGLE LIMIT AUTOMBILELIABIITY Ea accident)$
ANY AUTO BODILY IN JURY (Per person)
ALL OWNED SCHEDULED BODILY INJURY IPer accident) $
__AUTOS
__AUTOS NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS
__AUTOS (Per accident)$
__UMBRELLA LIAB OCCUR EACH OCCURRENCE S
EXCESS LIAB CLAIMS-MADE AGGREGATE DEDDED RETENTIONS$
WORKERS COMPENSATION IPER OH AND EMPLOYERS' LIABILITY Y'
ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
[ 2 JN/ A A__________
(Mandatory 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 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 apace 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.
AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services Eric t Kolstad E
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 021716 LOC #: San Francisco ACORD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED MARSH RISK & INSURANCE SERVICES PACIFIC GAS & ELECTRIC COMPANY
__________________________________________________ONE MARKET SPEAR TOWER POLICY NUMBER SUITE 2400 SAN FRANCISCO, CA 94105 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 LIABIUITY INSURANCE This is to certify that there is in force as of the effective date of this Certificate a Nuclear Energy Uiability Insursance 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 pdior to the end of December 31 st of the calender year in which the Effective Date of this Certificate occurs, notice mill be delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate an of the end of such December 31st. A Certificate mill 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 FACILUTIES:
- 1. SITE #1 - DIABLO CANYON LOCATION OF NUCLEAR FACILITY: Diablo Canyon Nuclear Power Plant 12 MI WSW of San Luis Obispo, CA NAMED INSURED [LISTED ON POLICY]: Pacific Gas and Electric Company POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
N F-0228 07/05/1 974
$376 Million NW-0605 07/05/1 974
$375 Million**
N-0074 09/22/1981 N-0076 04/26/1 985
- 2. SITE #2 - HUMBOLDT BAY LOCATION OF NUCLEAR FACILITY: Humboldt Bay Nuclear Power Plant (Shutdown July 76) in Humboldt County, Californie NAMED INSURED [LISTED ON POLICY]: Pacific Gas and Electric Company POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0113 01/01/1962
$53.3 Million NW-0534 01/01/1 998
$375 Million**
THIS CERTIFICATE IS ISSUED AS A MATIER 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 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 Uability shown above may have been reduced by payment of claims or claims expenoes.
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 all of the provisions of such Policy and Certificate having reference thereto. Such limit may have been reduced by payment of claims or cinims 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
ACO1RD CERTIFICATE OF LIABILITY INSURANCE S DATE (MMIODDYYYY) 01/11/12016 THIS CERTIFICATE IS ISSUED AS A MATTrER 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 MARSHUSAINC.NAME:
MRHUA N.PHONE FAX TWO ALUIANCE CENTER ANCNoExt):
(A/C No):
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 INSU RED INSURER B:
Tennessee Valley Authority Attention: Kirk Kelley INSURER C :
400 W. Summit Hill Drive, WT 4C INSURER D0:
Knoxville, TN 37919 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 TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADOL. SUBIt POLICY EFF POLICY EXP LTR TYPE OF INSURANCE gR*p WVp POLICY NUMBER IMMIDDIYYYYI
{MMIDD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE II DAMAGE TO RENTED CLAIMS-MADE Lj OCCUR PREMISES lEa occurrence)
____________________________MED EXP (Any one person)
_________________PERSONAL
&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE SPOLICY JEC PRO
[
LOC PRODUCTS -COMP/OPAGG OTHER:$
_AUTOMOBILE LIABILITY COMBINED(E acetSINGLE LIMIT ANY AUTO BODILY INJURY (Per person)
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS
__AUTOS (Per accidenlt)
-- UMBRELLA LIAB
[*
OCCUR EACH OCCURRENCE EXCESS LIABR CLAIMS-MADE AGGREGATE S
DEDDED RETENTIONS $______________$_____
WORKERS COMPENSATION PER 0H AND EMPLOYERS' LIABILITY YIN' EA~IJR ________
ANY PRO PRIETOR/PARTNERJEXECUTIVE F1 E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
[+/-N/
A (Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below
___E.L.
DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101 see addl page text Insurance DESCRIPTION OF OPERATIONS ( LOCATIONS ( VEHICLES (ACORD l01, 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Ronald A. Santaniello.
_*¢,,.J
© 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 AWORD ADDITIONAL REMARKS SCHEDULE Page 2
of3 AGENCY NAMED INSURED MARSH USA, INC.
Tennessee Valley Autthonty Attention: Kirk Kelley POLICY NUMBER 400 W. Summit Hill Drive, WVT 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 CERTIFICATE OP NUCLEAR ENERGY LIABIUTY INSURANCE This is to certify that there is in force as of the effective date of this Certificate a Nuclear Energy Uability Insurance Policy issued by members of American Nuclear Insurers as indicated (Companies), to the Innured named herein, with raspect to the Nuclear Facility at the Location shown and/or with respect to the Insured's operations described herein, if such policy in cancelled or otherwise terminated prior to the end of December 31st of the calendar year in which the Effective Date ot this Certificate occurs, notice will be delivered in accordance with the policy provisions. Dtheawse this Certificate shall terminate as of the end of such December 31st. A Certifcate 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 Supplieris & Transporters], ES - [Foreign Suppliers & Transporters], N - [Secondary Financial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - BROWNS FERRY LOCATION OF NUCLEAR FACILITY:
Browss 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-01g8 09122/1971
$375 Million NW-0581 09/22/1971
$375 Million**
N-0038 08101/1977 N-003g 08/01/1977 N-0040 08101/1977
- 2. SITE #2 - SEOUOYAH LOCATION OF NUCLEAR FACILITY:
Sequsyati 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-06514 03/11/1977
$375 Million**
N-0066 02/29/1980 N-0075 0812511981
- 3. SITE #3 - WATTS BAR LOCATION OF NUCLEAR FACILITY:
Watts Bar Nuclear Power Plant 10 MI S of Spring City, TN NAMED INSURED [USTED ON POLICY]: Tennessee Valley Authority POUCY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0256 09/04/1979
$375 Million NW-0618 09/04/1979
$375 Million" N-0080 11/09/11995**
N-0120 10/22/2015 THIS CERTIFICATE IS ISSUED AS A MATrER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the poilcylies) 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 it is issued shall amesnd, extend or alter the coverage afforded by the policy. The Umit of Uability shown above may have been reduced by payment of claims or claims enpenses.
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 ACORD ADDITIONAL REMARKs scHEDULE Page 3
of3 AGENCY NAMED INSURED MARSH USA, INC.
Tennessee Valley Authority Attention: Kirk Keiley POLICY NUMBER 400 W. Summit Hill Drive, WT 40
~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 Master Worker Certificate - This limint 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 reterence 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
ACORD CERTIFICATE OF LIABILITY INSURANCE SDATE (MMIDD/YYYY) 0110812016 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 NAME:FA PHONEFA CA Ucense #0437153 AIc. No, Extl:
AC, No):
777 South Figuerea Street E-MAIL Los Angeles, CA 90017 ADDRESS:
Attn: LosAngeles.CertRequest~marsh.com IF: 212-948-0535 INSURER(SI AFFORDING COVERAGE NAIC #
08819 -DRI-AII-16-17 INSURER A :American Nuclear Insurers INUEDominion Resources, Inc.INUEB ATTN: Leslie D. Garber INSURER C :
Leslie.Garber@dom.com INSURER D :
701 East Cary Street, 20th Floor Richmond, VA 23219 INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER:
LOS-001839081-05 REVISION NUMBER:8 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWIWTHSTANDING 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.
INSR ADDL SUBH POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INB p V
POLICY NUMBER IMMIDD/YYYY1 IMMIDD/YYYY)
LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE m
DAMAGE TO RENTED CLAIMS-MADE KJOCCUR PREMISES (Ea occurrence)
___________________________MED EXP (Any one personi
_____________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE POLICY LJPJCT :OHR[
LaOC PRODUCTS -OOMP/OP AGO AUTOMOBILE LIABILITY COMEINED 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
- _*OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DEDDED RETENTION $
WORKERS COMPENSATION FI PERH AND EMPLOYERS' LIABILITY Y I NI ELR ANY PROP RIETORIPARTNER/EXECUTrIVE m
E.L. EACH ACCIDENT OFFICERIMEMBER EXCLUDED?
[IjN A
/______A__
tMandatory in NH)
E.L. DISEASE - BA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Liability Sue Attached 01/01/2016 01/01/2017 See Attached Acord Insurance
'Acord 101" 101 DESCRIPTION OF OPERATIONS ILOCATIONS 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.
AUTHORIZED REPRESENTATIVE of March Rick & insurance Services Shannon Moyer
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 08819 LOC #: Los Angeies
.T ACO~RD ADDITIONAL REMARKS SCHEDULE Page 2
of3 AGENCY NAMED INSURED Marsh Risk & Insurance Services Dominion Resources, Inc.
___________________________________________________________ATTN: Leslie D. Garber POLICY NUMBER Leslie.Garber@dom.com 701 East Cary Street, 20th Floor Richmond, VA 23219 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 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 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 termilnated pdior to the end of December 31sat of the calendar year in which the Effective Date of this Certificate occurs, nofice will be delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate as of the end of such December 31sat. A Certificate will NOT be issued for any subsequent calendar year unless requested in writing.
Types of Insurance: NF - [Facility Fermi, NW- [Master Worker Certificate], NS - [US Dowestic Supplier's & Transporters], FS - [Foreign Suppliers & Transporters], N - [Secondary Financial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - NORTH ANNA LOCATION OF NUCLEAR FACILITY: North Anna Nuclear Power Plant 40 MI NW of Richmond, VA NAMED INSURED [LISTED ON POLICY]: Virginia Electric & Power Company POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0240 03/26/1976
$375 Million NW-O610 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 POLICY]: Virginia Electric & Power Company POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0186 06/15/1970
$375 Million NW-0571 06/15/1970
$375 Million" N-0027 08/01/1977 N-0028 06/01/1977
- 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:
NF-0173 05/01/1 969
$375 Million NW-0563 05/01 /1 969
$375 Million**
N-0016 08/01/1977**
N-0103 11/25/1985
- 4. SITE #4 - KEWAUNEE LOCATION OF NUCLEAR FACILITY: Kewaunee Nuclear Power Plant in the Town of Caditon, Kewaunee County, Wisconsin NAMED INSURED [LISTED ON POLICY]: Dominion Energy Kewaunee, Inc.
POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0204 01 /01/1 972
$375 Million NW-0586 01/01/1972
$375 Million**
ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 08819 LOC #: Los Angeles ACORD ADDITIONAL REMARKS SCHEDULE Page 3
of3 AGENCY NAMED INSURED Marsh Risk & Insurance Services Dominion Resources, Inc.
POLICY NUMBER Leslie.Garber@dom.com 701 East Cary Street, 20th Floor CARRIER
/NAIC CODE RcmnV 31 I
EFFECTIVE DATE:
ADDITIONAL REMARKS
[THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:
25 FORM TITLE: Certificate of Liability InsuranceI THIS CERTIFICATE IS ISSUED AS A MATTqER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policylies) is subject to the exclusions, conditions and other provisions of the policylies). 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:
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 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACO2RD CERTIFICATE OF LIABILITY INSURANCE S DATE (MMIDD/YYYY) 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, INC.
NAME:
PHONE FAX TWO ALLIANCE CENTER (A/C, No, Eat):
(A/C, Nol:
3560 LENOX ROAD, SUITE 2400 E-MAIL ATLANTA, GA 30326 ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
713170-NUCLE-*16-17 INSURER A : American Nuclear Insurers INSURED INSURER B :
NextEra Energy, Inc.
A~tn: Erica McNabb INSURER C :
'Edca.A.McNabb@FPL.com INSURER D :
700 Universe Blvd P.O. Box 14000 INSURER E :
Juno Beach, FL 33408 INSURER F: :______
COVERAGES CERTIFICATE NUMBER:
ATL-003533264-06 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE INSD yWV3(
POLICY NUMBER (MMIDDIYYYYI IMMIDDIYYYY)
LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE m
DAMAGE TO RENTED CLAIMS-MADE U OCCUR PREMISES (Ea occurrence)
SMED EXP (Any one person)
SPERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE POLICY D JPO-T LOC PRODUCTS-COMP/OP AGO OTHER:
AUTOOBIL LIAIUTYCOMBINED SINGLE LIMIT AUOOIELlBLT 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 LIABR~
OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DEDBED RETENTION $
WORKERS COMPENSATION FI FF5ER AND EMPLOYERS' LIABILITY Y I NJ~
ANY PROPRIETOR/PARTNER/EXECUTIVE r1 E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
)
N/ A (Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below
______E.L.
DISEASE - POLICY LIMIT A
NUCLEAR ENERGY LIABILITY (see attached) 01/01/2016 01/01/2017 SEE ATTACHED ACORD 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 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
,,,4--",.*,,..o,,L
- ,]u
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 713170 LOC #: Atlanta ACORD ADDITIONAL REMARKS SCHEDULE Page 2
of 3
AGENCY NAMED INSURED MARSH USA, INC.
NextEra Energy, Inc.
___________________________________________________________________Attn:
Erica McNabb POLICY NUMBER Erica.A.McNabb@FPL~com 700 Universe Blvd P.O. Box 14000 CARRIER
/NAIC CODE Juno Beach, FL 33408 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 Thin is to certify that there is in force as of the effective date of this Certificate a Nuclear Energy Uability Inaurance Policy issued by members of American Nuclear Insurers as indicated (Companies), to the Insured named herein, with respect to fhe Nuclear Facility at the Location shown and/or with respect fo the Insured's operations described herein. If such policy is cancelled or otherwise terminated prior to the end ot December 31sat of the calender year in which the Effective Date of this Certificate occurs, notice will be delivered in accordance with the policy provisions. Otherwse this Certificate shall terminate as of the end of such December 31st. A Certificate will NOT be issued for any subsequent caiendar 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 -ST. LUCIE LOCATION OF NUCLEAR FACILITY: St. Lucie Nuclear Power Plant on Hutchinson Island, St Lacde County, Ftorida NAMED INSURED [LISTED ON POLICY]: Florida Power & Ught Company, Ftorida Municipal Power Agency, and Orlando Utilities Commission of the City of Orlando POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0227 06/01/1974
$375 Million NW-0604 06/01 /1 974
$375 Million*
N-0059 08/01/1977 N-0089 04/06/1 983**
- 2. SITE #2 - TURKEY POINT LOCATION OF NUCLEAR FACILITY: Turkey Point Nuclear Power Plant in the Southeast part of Dade County, Florida NAMED INSURED [LISTED ON POLICY]: Florida Power & Ught Company POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
N F-0185 06/01/1970
$375 Million NW-0570 06/01/1970
$375 Million*
N-0025 08/01/1977 N-0026 08/01/1977**
- 3. SITE #3 - SEABROOK LOCATION OF NUCLEAR FACILITY: Seabmook Nuclear Power Plant in Seabreok Township, Rockingham County, New Hampshire NAMED INSURED [LISTED ON POLICY]: NeutEra Energy Seabrook, LLC; Massachusetts Municipal Wholesale Electric Company; Taunton Municipal Light Plant; and Hudson Light and Power Department POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABiLITY:
NF-0296 12/15/1985
$375 Million NW-0647 12115/1985
$375 Million**
N-0109 10/17/1986**
- 4. SITE #4-DUANE ARNOLD LOCATION OF NUCLEAR FACILITY: Duane Arnold Nuclear Power Plant on the Cedar River approx 2 and 1/3 Miles NNE of Palo, Iowa NAMED INSURED [LISTED ON POLICY]: NextEra Energy Duane Arnold, LLC, Central Iowa Power Cooperative and Corn Belt Power Cooperative POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF.0214 05/1 5/1 973
$375 Million NW-0593 05/1 5/1 973
$375 Million" N-0050 08/01/1977**
ACORD 101 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 713170 LOC #: Atlanta ACORD ADDITIONAL REMARKS SCHEDULE Page 3
of3 AGENCY NAMED INSURED MARSH USA, INC.
NextEra Energy, Inc.
_______________________________________________________________Attn:
Erica McNabb POLICY NUMBER Erica.A.McNabb@FPL~com 700 Universe Blvd P.O. Box 14000 CARRIER NAIC CODE Juno Beach, FL 3340B EFFECTIVE DATE:
ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:
25 FORM TITLE: CertifiCate of Liability Insurance
- 5. SITE #5-POINT BEACH LOCATION OF NUCLEAR FACILITY:
Point Beach Nuclear Power Plant in the Town of Two Creeks, Manitowoc County, Wisconsin NAMED INSURED [LISTED ON POLICY]: NextEra Energy Point Beach, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0178 0811211969
$375 Million NW-0565 08/1211969
$375 Million*
N-0018 08/01/1977**
N-0019 08/01/1977**
THIS CERTIFICATE IS ISSUED AS A MATITER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policyyies) is subject to the exclusions, conditions end other provisions of the policyjies). Neither this Certificate nor any contract or other document with inspect to which it is issued shall amend, extend or alter the coverage afforded by the policy. The Umit of Usbility shown above may hnve 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 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
ACcORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 01122/2016 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 445 SOUTH STREET AiCNoExt):
AIC, No}:
MORRISTOWN, NJ 07960-6454 E-MAIL Attn: Morristown.CertRequest@mrnash.corn ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #t 074725-OTU-NUCLE-16-17 INSURER A : American Nuclear Insurers INSURED INSURER B :
PSEG NUCLEAR LLC ATTN: ROBERT GREEN INSURER C :
ROBERT.GREEN2@PSEG.COM INSURER D :
80 PARK PLAZA, MAIL CODE T-6B NEWARK, NJ 07101 INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER:
NYC-007087875-03 REVISION NUMBER: 11 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 IN;D*
POLICY NUMBER IMalDD/Yyyy)'~'
(MMIDD/YyyyI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE II DAMAGE TO RENTED SCLAIMS-MADE U* OCCUR PREMISES (Ea occurrence)
___________________________MED EXP (Any one person)
_____________________PERSONAL
& ADV INJURY GENtL AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE POLICY J ~ECTr LOC PRODUCTS - COMPIOP AGO
__OTHER:
AUTOMOBILE LIABILITY (Ea accident)
ANY AUTO BODILY INJURY (Per person)
ALL OWSNED SCHEDULED BODILY IN JURY (Per accident) $
__AUTOS
__AUTOS NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS
__AUTOS (Per accident)
__UMBRELLA LIAB
[*
OCCUR EACH OCCURRENCE EXCESS LIAB
!CLAIMS-MADE AGGREGATE EDDED RETENTIONS$_____________
WORKERS COMPENSATION IPERSTTT 0 TH-R AND EMPLOYERS' LIABILITY YIN ERN_______
ANY PROPRIETOR/PARTNERIEXECUTIVE r--
E.L. EACH ACCIDENT OFFRCERJMEMBER EXCLUDED?
L iN A
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under D)ESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A NUCLEAR ENERGY LIABILITY SEE ATTACHED ACORD 101 01/0112016 01/0112017 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 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.
AUTHORIZED REPRESENTATIVE of Marsh USA (no.
Manashi Mukherjee
..S"4c.u*,
k.t *Ae*;.AJ-L
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 074725 LOC #: Morristown ACORD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED MARSH USA, INC.
____________________________________________________ATTN: ROBERT GREEN POLICY NUMBER ROBERT. GREEN2@PSEG.C0M 80 PARK PLAZA, MAIL CODE T-6B NEWARK, NJ 07101 CARRIER
/NAIC CODE L
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 Uability 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 31st 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], ES- [Foreign Suppliers & Transporters], N - [Secondary Financial Protection Certficate]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - SALEM NUCLEAR POWER STATIONS AND HOPE CREEK NUCLEAR POWER STATION LOCATION OF NUCLEAR FACILITY: Salem Nuclear Power Plant and Hope Creek Nuclear Power Plant in Lower Alloways Creek Township, Salem County, New Jersey NAMED INSURED [LISTED ON POLICY]: PSEG Nuclear LLC and Exelon Generation Company, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF UABILITY:
NF-0230 10/15/1974
$375 Million NW-0606 10/15/1974
$375 Million*
N-0060 08/01/1977 N-0072 04/1 8/1 980 N-0104 04/1 4/1 986 THIS CERTIFICATE IS ISSUED AS A MATI'ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policy(ies) is subject to the eoclusions, conditions end other provisions of the policy(ies). 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 Uability shown above may have been reduced by payment of claims or claims expenses.
COMMENTS/NOTES:
- Master Worker Certificate - This limit is shared by all Certiticates to the Master Worker Policy ot 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 expeases.
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
AGENCY CUSTOMER ID: ____________________
LeoC #: Minneapolis ACORD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED Marsh USA Inc.
Xcel Energy, Inc.
______________________________________________________________Attn: Robert L. Miller POLICY NUMBER Robert.L.Miller@xcelenergy.com 414 Nicollet Mall, 4th Floor Minneapolis, MN 55401 CARRIER JNAIC CODE L
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 theme is is 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 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 unles;s mequesfed 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 Certitcate]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - PRAIRIE ISLAND LOCATION OF NUCLEAR FACILITY:
Prairie Island Nuclear Power Pleant on the Mississippi River in Goodhue County, Minnesota NAMED INSURED [LISTED ON POLICY]: Northern States Power Company POUCY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0197 09/0f/1 971
$375 Million NW-0580 09/01/1971
$375 Million**
N-0036 08/01/1977**
N-0037 08/01/1977**
- 2. SITE #2 - MONTICELLO LOCATION OF NUCLEAR FACILITY:
Monticello Nuclear Power Plant on the Mississippi River in Wright County, Minnesota NAMED INSURED [LISTED ON POLICY]: Northern States Power Compasy POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0174 06/09/1969
$375 Million NW-0564 06/09/1969
$375 Million" N-0017 08/01/1977 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 policy(ies). Neither this Certificate nor any contract or other document with respect to whigh it is issued shall amend, extend or alter the coverage afforded by the policy. The Umit of Uability 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 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
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 01/12/2016 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 FA 333 South 7th Street, Suite 1400 tAC. No. Ext):
(A/C No):
Minneapolis, MN 55402-2400 E-MAIL ADDRESS:
INSURERtS) AFFORDING COVERAGE NAIC #
-..-NUCLR-15--16 INSURER A : American Nuclear insurers INSURED INSURER B :
Xcel Energy, Inc.
Attn: Robert L. Miller INSURER C :
RobertL.Mi~ler@xcelenergy.com INSURER D :
414 Nicollet Mali, 4th Floor Minneapolis, MN 55401 INSURER B :
INSURER F :
COVERAGES CERTIFICATE NUMBER:
CHI-006140703-03 REVISION NUMBER:9 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWIA'THSTANDING 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.
INSRADOUR POLICY EFF POLICY EXP LTR "FTYPE OF INSURANCE N
V POLICY NUMBER
'MM/DD/YYYY)
(M/DyYYYl LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE m
DAMAGE TO RENTED CLAIMS-MADE [JOCCUR PREMISES lEa occurrencel
____________________________MED EXP (Any one person)
_______________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE D--PRO-I POLICY JECT LOC PRODUCTS -COMP/OP AGO
__OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
~lEa 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*
OCCUR
__ACHOCCURRENCE_
EXCESS LIAB I ICLAIMS-MADE AGGREGATE DEDDED RETENTION $
I$
WORKERS COMPENSATION IPERSTTT 0 TH-E AND EMPLOYERS' LIABILITY Y IN N~AhJS ANY PROPRIETORIPARTNERJEXECUTIVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
L*
N I A_________
(Mandatory In NH)
E.L DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below E.L. 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 Remartrs 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Manashi Mukherjee
..3#o,*.=
© 1988-2014 ACORD CORPORATION. All rights reserved.
The A CORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 01107/2016 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(lest 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 MARS USAINC.NAME:
MAS S N.PHONE FAX 540 W. MADISON tA/C, No, Extt (A/C, No):
CHICAGO, IL 60661 E-MAIL Attn: chicago.CertRequest@marsh.com ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
01 6265-Nucle-Nucle-16-17 INSURER A : American Nuclear Insurers INSURED INSURER B :
FirstEnergy Corporation Attn: Pete Nadel INSURER C :
pnadel@ftrntenergycorp.com INSURER D :
76 South Main Street Akron, OH 44308 INSURER E :
_________________________________________________________INSURER F: :_____
COVERAGES CERTIFICATE NUMBER:
CHI-005417270-04 REVISION NUMBER:7 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 INP V
POLICY NUMBER iMMiDD/YyyyI IMMiDD/Yyyy1 LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE m[
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 m--
PRO-II POLICY LiJECT LOC PRODUCTS-COMP/OP AGO
__OTHER:
AUTOMBILELIABLITYCOMBINED SINGLE LIMIT AUTOMBILELIABIITY Ea accidentt ANY AUTO BODILY INJURY (Per person)
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS
__AUTOS NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS
__AUTOS (Per accidenlt
__UMBRELLA LIAB I-*OCCUR EACH OCCURRENCE EXCESS LIABR
]CLAIMS-MADE AGGREGATE DEDDED RETENTION $
WORKERS COMPENSATION PER 0H AND EMPLOYERS' LIABILITY Y IN ERI_______
ANY PROPRIETORJPARTNERJEXECUTIVE FTF E.L. EACH ACCIDENT OFFICERJMEMBER EXCLUDED?
[J N
A (Mandatory In NH)
EL. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below
______________________E.L.
DISEASE - POLICY LIMIT A
Nuclear Enargy See Attached Acord 101 01/01/2016 01/0112017 See Attached Acord 101 Liability Insurance DESCRIPTION OF OPERATIONS I LOCATIONS/IVEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more epace 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Manashi Mukherjee
.3
.,,.a*
t,.;
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 016265 LOC #: Chicago ACOIRD ADDITIONAL REMARKS SCHEDULE Page 2
of3 AGENCY NAMED INSURED MARSH USA INC.
FirstEnergy Corporation Attn: Pete Nadel POLICY NUMBER pnadel@firstenergycorp.com 76 South Main Street Akron, OH 44308 C:ARRIER
/NAIC CODE
/
EFFECTIVE DATE:
ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:
25 FORM TITLE: Certificate of: Liability InsuranceI CERTIFICATE OF NUCLEAR ENERGY LIABtUTY INSURANCE This is to certify that there is in force as of the effective date of this Certificate a Nuclear Energy Uability 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/sr with respect to the Insured's operations described hemein. 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 will be delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate as of the end of such December 31 st. 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 - BEAVER VALLEY LOCATION OF NUCLEAR FACILITY: Beaver Valley Nuclear Power Plant in Shippingport Borough, Beaver County, Pennsylvania NAMED iNSURED [USTED ON POLICY]: FirstEnergy Nuclear Generation, LLC, Ohio Edison Company, The Toledo Edison Company and FirstEnergy Nuclear Operafing Company POLICY NUMBER:
NF-0226 NW-0603 N-005B N-0110 POLICY EFFECTIVE:
08/01/1974 08/'01
/1974 08/01/1977 05/28/1 987 LIMIT OF LIABILITY:
$375 Million
$375 Million**
- 2. SITE #2 -DAVIS-BESSE LOCATION OF NUCLEAR FACILITY:
Davis-Reuse Nuclear Power Plant on Lake Erie approx 20 miles ESE of Toledo in Ottawa County, Ohio NAMED INSURED [LISTED ON POLICY]: FirstEnergy Nuclear Generation, LLC and FirstEnergy Nuclear Operating Company POLICY NUMBER:
POUCY EFFECTIVE:
LIMIT OF LIABILITY:
N F-0236 11/01/1975
$375 Million NW-0608 11/01/1975
$375 Million*
N-0061 08/01/1 977**
- 3. SiTE #3 -PERRY LOCATION OF NUCLEAR FACILITY: Perry Nuclear Power Plant on Lake Erie approx 35 miles NE of Cleveland, Ohio NAMED INSURED [LISTED ON POLICY]: FirstEnergy Nuclear Generation, LLC, Ohio Edison Company, and FirstEnergy Nuclear Operating Company POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0291 09/01/1984
$375 Million NW-0644 09/01/1984
$375 Million*
N-01 02 03/18/1986
- 4. SITE #4 - SAXTON LOCATION OF NUCLEAR FACILITY: Santon Nuclear Experimental Corporation Facility in Liberty Township, Bedford County, Pennsylvania NAMED INSURED [LISTED ON POLICY]: Saxten Nuclear Experimental Corporation POLICY NUMBER:
POUCY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0107 06/01/1961
$1 Million NW-0532 08/01/1961
$375 Million*
- 5. SITE #5 -THREE MILE ISLAND LOCATION OF NUCLEAR FACILITY: Three Mile Island Nuclear Power Plant in Londondenry Township, Dauphin County, Pennsylvania NAMED INSURED [LISTED ON POLICY]: MetropoLitan Edison Company, Jersey Central Power & Light Cowpany, Pennsylvania Electric Company and CPU Nuclear Inc.
ACORD 101 (2008/01)
©@2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 016265 LOC #:
Chicago ACO¶R.D ADDITIONAL REMARKS SCHEDULE Page 3
of3 AGENCY NAMED INSURED MARSH USA INC.
FirstEnergy Corporation Attn: Pete Nadet POLICY NUMBER pnadet@firstenergycorp.com 76 South Main Street Akron, OH 44308 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 InsuranceI NW-0599 12131/1973
$375 Million**
THIS CERTIFICATE IS ISSUED AS A MAiFER 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 policylies). 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 Uability shown above may have been reduced by payment of claims or claims expenses.
COMMENTS/NOTES:
Master Worker Certificate - This limit is shared by ati 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
ACR CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 0/07/2016 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 Inc.
NAME:
PHONE FAX 1717 Arch Street (A/c, No, Ext):
(A/C, No):
Philadelphia, PA 19103-2797 E-MAIL Attn: Philadelphia.Certs@marsh.com/ Fax - 212-948-0360 ADES INSURER(S) AFFORDING COVERAGE NAIC #
S27339-Exelo-NE-16117 INSURER A :American Nuclear Insurers INSURED INSURER B :
Exelon Corporation ATTN: michael~mee@exeloncorp.com INSURER C :
2301 Market Street, S21-1 INSURER D :
P.O. Box 8699 Philadelphia, PA 19101-8699 INSURER E :
INSURER F: :_____
COVERAGES CERTIFICATE NUMBER:
CLE-004728374-03 REVISION NUMBER:4 THIS IS TO CERTtFY 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 IN*Df WVP POLICY NUMBER I MM/DD/YYYYI IMM/DD/YYYY1 LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE
]
DAMAGE TO RENTED SCLAIMS-MADE L j OCCUR PREMISES lEa occurrence)
___________________________MED EXP (Any one person)
_____________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE POLICY D JPO-T LOC PRODUCTS - COMP/OP AGG OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT l_
Ea accident)_____________
ANY AUTO BODILY INJURY (Per person)
ALL OWNED SCHEDULED BODILY IN JURY (Per accident)
__AUTOS
__AUTOS NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS
__AUTOS (Per accident)$
-- UMBRELLA LIAB l*
OCCUR EACH OCCURRENCE EXCESS LIABR CLAIMS-MADE AGGREGATE EDDED RETENTION $
WORKERS COMPENSATION IESAUEI ITE AND EMPLOYERS' LIABILITY YN I N~J~5 ANY PROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
LI+/-N/ A (Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below
__E.L.
DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached 01/01/2016 01/01/2017 See Attached Acord 101 Insurance "Acord 101" DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mome 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Manashi Mukherjee
- .t kL,
,.;...ade.,
.c,}.L.
© 1988-2014 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: $27339 LOG #: Philadelphia ACO9RD ADDITIONAL REMARKS SCHEDULE Page 2
of 4
AGENCY NAMED INSURED Marsh USA Inc.
Exelon Corporation
__________________________________________________________ATTN:___mich__eATT:
meeca exeee oncorncopcco POLICY NUMBER 2301 Market Street, $21-1 P.O. Box 8699 Philadelphia, PA 19101-8699 CARRIER
/NAIC CODE L
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 Uability Insurance Policy issued by members of American Nuclear Insurers an indicated (Companies), to the Insured named herein, with respect to the Nuclear Facility at the Location shown and/sr with respect to the Insured's operations described herein. If such policy is cancelled or otherwise terminated prior to the end of December 31sat 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 ot such December 31st. A Certificate will NOT be iussed for any subsequent calendar year unless requested in writing.
Types of Insurance: NE - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's & Transporters], ES - [Eoreign Suppliers & Transporters], N- [Secondary Einancial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - BRAIDWOOD LOCATION OF NUCLEAR FACILITY: Braidwood Nuclear Power Plant in Reed Township ot Will County in Northeastern Illinois NAMED INSURED [LISTED ON POLICY]: Exelon Generation Company, LLC POLICY NUMBER:
POUCY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0294 08/21/1985
$375 Million NW-0645 08/21(1985
$375 Million*
N-0108 10/17/1986 N-0115 12118/1987
- 2. SITE #2 -BYRON LOCATION OF NUCLEAR FACILITY: Byron Nuclear Power Plant located south-south east of the City of Byron, Rockvale Township, Ogle County, Illinois NAMED INSURED [LISTED ON POLICY]: Exelon Generation Company, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0277 02/03/1983
$375 Million NW-0634 02/03/1983
$375 Million*
N-0093 10/31/1984 N-0101 11/06/1986
- 3. SITE #.3 - DRESDEN LOCATION OF NUCLEAR FACILITY: Dresden Nuclear Power Plant in Goose Lake Township, Grundy County, Illinois NAMED INSURED [LISTED ON POLICY]: Exelon Generation Company, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF UABILITY:
NF-0043 09/01/1958
$375 Million NW-0514 09/01/1958
$375 Million*
N-0002 08/01/1977 N-0003 08/01/1977
- 4. SITE #4 -LA SALLE LOCATION OF NUCLEAR FACILITY: La Salle Nuclear Power Plant in Brookfield Township, LaSalle County, Illinois NAMED iNSURED [LISTED ON POLICY]: Exelon Generation Company, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0253 08/1 0/1 978
$375 Million NW-0617 08/1 0/1 978
$375 Million**
N-0071 04/1 7/1 982**
N-0083 1 2/18/1983 ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: $27339 LOC #: Philadelphia ACO~RD ADDITIONAL REMARKS SCHEDULE Page 3
of4 AGENCY NAMED INSURED Marsh USA Inc.
Exelon Corporation
__________________________________________________________ATT__:___i____eATT:
eecae xeeeoex orncopcoo POLICY NUMBER 2301 Market Street, $21-1 P.O. Box 8699 Philadelphia, PA 19101-8699 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
- 5. SITE #5 - LIMERICK LOCATION OF NUCLEAR FACILITY:
Limerick Nuclear Power Plant in Southeastern PA on the Schuylkill River, 1.7 miles SE of horough of Pottstown NAMED INSURED [LISTED ON POLICY]: Exelon Generatisn Company, LLC POUCY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0284 03/19/1984
$375 Million NW-0640 03/19/1984
$375 Million" N-0098 10/26/1984 N-01 18 06/22/1989**
- 6. SITE #6 - PEACH BO'i-IOM LOCATION OF NUCLEAR FACILITY:
Peuch Bottom Nuclear Power Plant in Peach Bottom Township, York County, Pennsylvania NAMED INSURED [LISTED ON POLICY]: Exelon Generation Company, LLC and PSEG Nuclear LLC POUCY NUMBER:
POLICY EFFECTIVE:
LIMIT OF UABILITY:
NF-0140 10/05/1964
$375 Million NW-0544 10/05/1984
$375 Million**
N-0008 08/01/1977 N-0009 08/01/1 977
- 7. SITE #7 - OUAD-CITIES LOCATION OF NUCLEAR FACILITY:
0usd-Cities Nuclear Power Plant in Rock Island County, Illinois NAMED INSURED [LISTED ON POLICY]: Exelon Generation Company, LLC and MidAmerican Energy Company POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0187 10/0111970
$375 Million NW-0572 10/01/1970
$375 Million**
N-0029 08/01/I1977 N-0030 08/01/1977
- 8. SITE #8 - CLINTON LOCATION OF NUCLEAR FACILITY:
Clinton Nuclear Power Plant East of the city of Clinton in Dewitt County, Illinois NAMED INSURED [lISTED ON POLICY]: Enelon Generation Company, LLC POUCY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0261 09/05/1 980
$375 Million NW-0621 09/05/1 980
$375 Million" N-0085 09/29/1 988
- 9. SITE #9 - OYSTER CREEK LOCATION OF NUCLEAR FACILITY:
Oyster Creek Nuclear Power Plant in Lacey Township, Ocean County, New Jersey NAMED INSURED [LISTED ON POLICY]: Exelon Generation Company, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0164 10/03/1 967
$375 Million NW-0558 10/03/1967
$375 Million**
N-0013 08/01/1977
- 10. SITE #10 - THREE MILE ISLAND LOCATION OF NUCLEAR FACILITY:
Three Mile Island Nuclear Power Plant in Londonherry Township, Dauphin County, Pennsylvania NAMED INSURED [LISTED ON POLICY]: [FOR NF-0220] Exelon Generation Company, LLC, Metropolitan Edison Company, Jersey Central Power & Light Company, Pennsylvania Electric Company and GPU Nuclear Inc.; [FOR NW-0688[ Enelon Generation Company, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
V.
AGENCY CUSTOMER ID: $27339 LOC #: Philadelphia ACORD ADDITIONAL REMARKS SCHEDULE Page 4
of 4
AGENCY NAMED INSURED Marsh USA Inc.
Exelon Corporation
__________________________________________________________ATTN_____ic__aeATT:
eecae xeleonceonpopcco POLICY NUMBER 2301 Market Street, $21-1 P.O. Box 8699 Philadelphia, PA 19101-8699 CARRIER
/NAIC CODE L
EFFECTIVE DATE:
ADDITIONAL REMARKS
[THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
[FORM NUMBER:
25 FORM TITLE: Certificate of Liability Insurance NF-0220 NW-0688 N-0056 12/03/1973 12/03/1973 08/01/1 977
$375 Million
$375 Million**
- 11. SITE #11 - CALVERT CLIFFS LOCATION OF NUCLEAR FACILITY: Calvert Cliffs Nuclear Power Plant in Calvert County, Maryland NAMED INSURED [LISTED ON POLICY]: Calvert Cliffs Nuclear Power Plant, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0216 06/27/1 973
$375 Million NW-0595 06t27/1 973
$375 Million" N-0052 08/01/1 977 N-0053 08/01/1977
- 12. SITE #12 - NINE MILE POINT LOCATION OF NUCLEAR FACILITY: Nine Mile Point Nuclear Power Plant on Luke Ontario 8 miles NE of Oswego, Oswego County, New York NAMED INSURED [LISTED ON POLICY]: Nine Mile Point Nuclear Station, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
N F-0161 06/1 4/1 967
$375 Million NW-0557 06/14/1967
$375 Million**
N-0012 08/01/1977 N-0105 10/31/1986
- 13. SITE #13 -R. E. GINNA LOCATION OF NUCLEAR FACILITY: R. E. Ginna Nuclear Power Plant located in Ontario, New York.
NAMED INSURED [LISTED ON POLICY]: R.E. Ginna Nuclear Power Plant, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
N*F-0170 11/01/1968
$375 Million NW-0561 11/01 /1 968
$375 Million" N-0014 08/01/1977 THIS CERTIFICATE IS iSSUED AS A MATIER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policy~ies) is subject to the exclusions, condifions and other provisions of the policy~ies). 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 Uwit of Uiability shown above way have been reduced by payment of claims or claims expenses.
COMMENTS/NOTES:
- Maxter Worker Certificate - This limit is shamed 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 raUng plan.
ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 01/11/2016 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 Mars USAInc.NAME:
Mas S n.PHONE FAX 2405 Grand Boulevard, #900 IA/C, No, Ext:
(A/C, No):
Kansas City, MO 64108 E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #t B22759-OPPD-NRC-16-17 INSURER A : American Nuclear Insurers INSURED INSURERS :
Omaha Public Power District Attn: Uisa Hough INSURER C :
444 S 16th Street INSURER D :
Mall BE/EP1 Omaha, NE 68102 INSURER E2:
_________________________________________________________INSURER F: :_____
COVERAGES CERTIFICATE NUMBER:
CHI-005941393-02 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBSR POLICY 2FF POLICY EXP LTR TYPE OF INSURANCE IN*
WyP POLICY NUMBER (MMIDD/YYYYI IMM/DDIYYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACI-OCCURRENCE m
DAMAGE TO RENTED CLAIMS-MADE ~JOCCUR PREMISES (Ea occurrence)
__________________MED EXP (Any one peraon)
S
_____________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE FiIPRO-m--
POLICY LiJECT LOC PRODUCTS - COM P/OP AGG
___OTHER:
AUTOMBILELIABLITYCOMBINED SINGLE LIMIT AUTOMBILELIABIITYtEa 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 LIAR OCCUR EACH OCCURRENCE EXCESS LIAR I
CLAIMS-MADE AGGREGATE DEDDED RETENTION $
WORKERS COMPENSATION STuTPER 0 TH-R AND EMPLOYERS' LIABILITY iYIII N~f ANY PRDPRIETORIPARTNER/EXECUTIVE FTF E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
[jN
/ A (Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE $
If yea, deacribe under DESCRIPTION OF OPERATIONS below
_E.L.
DISEASE - POLICY LIMIT A
NUCLEAR ENERGY LIABILITY SEE ATTACHED ACORD 101 01/01/2016 01/01/2017 SEE ATTACHED ACORD 101 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarka Schedule, may be attached if more apace 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.
AUTHORIZED REPRESENTATIVE of Mersth USA Inc.
Manashi Mukherjee
.3'.,ttaiet
- .2tacis.c+/-
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014101)
AGENCY CUSTOMER ID:" B22759 LOC #: Kansas City
.0*
A CORD
'4.-.
ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED Marsh USA Inc.
Omaha Public Power District
___________________________________________________________________Attn: Usa Hough POLICY NUMBER 444 S316th Street Mall 8EJEP1 Omaha, NE 68102 CARRIER
/NAIC CODE L
EFFECTIVE DATE:
ADDITIONAL REMARKS rTHIS 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 certity that there is is force as of the effective date of this Certificate a Nuclear Energy Uability Insurance Policy issued by members ot Aeericen Nacteer 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 soch policy is cancelled or otherwise terminated prior to the end of December 31sat ot the calendar year is 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 ot such December 31st. A Certificate will NOT be issued for any sobsequent 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 & Travsporters], N -[Secondary Financial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - FORT CALHOUN LOCATION OF NUCLEAR FACILITY: The Fort Calhoun Station is situated on the southwest bank of the Mississippi River in Washington Cosnty, Nebraska.
NAMED INSURED [LISTED ON POLICY]: Omaha Public Power District POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
N F- 0207 12/15/1972
$375 Millio n
NW-0588 12/15/1972
$375 Million**
N-0046 08/01/1977**
THIS CERTIFICATE IS ISSUED AS A MAT-IER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policy(ies) is subject to the exclusions, conditions sod other provisions of the policy(ies). 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 Uability shown above may have been reduced by payment of claims or claims espenses.
COMMENTS/NOTES:
- Master Worker Certifi cute - This limit is shared by all Certificates to the Master Worker Policy of which each Certiti cats is a part and is subject to all ot the provisions of such Policy and Certificate having reference thereto. Such limit may have bees redsced by paymant of claims or claims expenses.
- Secondary Financial Protection Certificafe - Financial protection available under an industry retrospective rating plan.
ACORD 101 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACO~RD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 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 endorsement(s).
PRODUCER CONTACT Marsh USA Inc.
NAME:
PHONE FAX 600 Dallas St, Suite 1500 AIC.No.Ext):
AIC, No):
Houston, TX 77002 E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
377089-Wolf-Nucle-16-17 INSURER A : American Nuclear Insurers INSUREDINUEB:
Wolf Creek Nuclear Operating Corporation ISRRB Attn: Angela Cool INSURER C :
Angela.Cool@westarenergy.com INSURER D :
818 Kansas Avenue P.O. Box 889 INSURER B Topeka, KS 66601 INSURER F:
COVERAGES CERTIFICATE NUMBER:
HOU-002496763-02 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
~TYPE OF INSURANCE NSD WVD POLICY NUMBER MMDYYY(MDDYY)LIMITS COMMERCIAL GENERAL LIABlUTY EAC-H OCCURRENCE F1 DAMAGE TO RENTED CLAIMS-MADE
[]
OCCUR PREMISES tEa occurrence)
___________________________MED EXP (Any one person)
______________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE POLICY Li PROCT [
LOC PRODUCTS -COMP/OP AGO
__OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I
(_ ea accident)
ANY AUTO BODILY INJURY (Per person)
ALL OWVNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS
__AUTOS (Per accident)
__UMBRELLA LIAB
- JOCCUR EACH OCCURRENCE EXCESS LIABR ICLAIMS-MADE AGGREGATE
__DEDI RETENTIONS WORKERS COMPENSATION PER 0H STATUTE ERITH AND EMPLOYERS' LIABILITY Y I N E
ANY PROPRIETORJPARTN ER/EXECUTIVE u-E.L. EACH ACCIDENT OFFICERIMEMBER EXCLUDED?
1
_ N I A (Mandatory In NH)
E.L DISEASE - BA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below
______E.L 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 ILOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mome apace 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Manashi Mukherjee
-..,SY 4.,
- ,-,*o5-~ A-eua~-
0 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD A CORD 25 (2014101)
AGENCY CUSTOMER ID: 377089 LOC #: Houston ACOIRD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED Marsh USA Inc.
Wolf Creek Nuclear Operating Corporation
______________________________________________________________Attn: Angela Cool POLICY NUMBER Angela.Cool~westarenergy.comn 818 Kansas Avenue P.O. Box 889 CARRIER NAIC CODE Topeka, KS 66601 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 is 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 in cancelled or otherwise terminated prior to the end of December 31sf of the calendar year in which the Effective Date ot this Certificate occurn, notice will be delivered in accordance with the policy provisions. Otherwise this Certificete shall terminate as of the end of each December 31sf. A Certificate will NOT be issued for any subsequent calendar year unless requested in writing.
Types of Insurance: NE - [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 - WOLF CREEK LOCATION OF NUCLEAR FACILITY:
Wolf Creek Generating Station in Burlington, Kansas NAMED INSURED [LISTED ON POLICY]: Wolf Creek Nuclear Operating Corporation; Kansas Gas and Electric Company (formerly KCA Corporation); Kansas City Power & Light Company; Kansas Electric Power Cooperative, Inc.; Westemn Resources, Inc.
POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0283 02/17/198i4
$375 Million NW-0639 02/17/198i4
$375 Million*
N-0099 03/11/1985**
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS ND RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policylies) is subject to the esclusionu, conditions and other provisions of the policylies). 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 ot Uability 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 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
AGENCY CUSTOMER ID: J361 05 LOG #: Salt Lake City A*RD ADDITIONAL REMARKS SCHEDULE Page 2
of2 SAGENCY NAMED INSURED Marsh USA Risk & Insurance Services ZionSolutions, LLC and Exelon Generation Company, LLC POLICY NUMBER Attn: Layne Ashton 423 West 300 South, Suite 200 Salt Lake City, UT 84101 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 01 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 of1December 31sat 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[
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:
LIMIT OF LIABILITY:
NF-0201 12/16/1971
$100 Million NW-0584 12./'611971
$375 Miiiion*
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 policy(Jes). 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:
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, accept 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 all of the provisions ofi such Policy and Certificate having reference thereto. Such limit may have been reduced by payment of claims or claims expenses.
ACORD 101 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 01107/2016 THIS CERTIFICATE IS ISSUED AS A MA'ITER 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 NAME:
Marsh USA Risk & Insurance Services PHONE FAX 15 West South Temple, Suite 700 fA/C. No, Ext):
A/C, No):
Salt Lake City, UT 84101 E-MAIL Attn: SsltLakeCity.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 :
ZionSolutions, LLC and Exelon Generation Company, LLC INSURER C :
Attn: Layne Ashton INSURERD :
423 West 300 South, Suite 200 Salt Lake City, UT 84101 INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER:
SEA-002671181-03 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVfl POLICY NUMBER IMM/DD/YYYYI IMMIDDIYYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE m
DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence)
SMED EXP (Any one person)
_____________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
[*
PRO-F7 POLICY JECT L2LOC PRODUCTS - COMP/OP AGG
__OTHER:
AUTOMBILELIABLITYCOMBINED SINGLE LIMIT AUTOMBILELIABLITY(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 LIAR OCCUR EACH OCCURRENCE EXCESS LIABR ICLAIMS-MADFE AGGREGATE DEDDED RETENTION $
WORKERS COMPENSATION PER OH ERTATUTE_____OTH'E__
AND EMPLOYERS' LIABILITY Y IN ANY PROPRI ETORJPARTNERJEXECUTIVE r1 E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
[*
N I A_________
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below
______E.L DISEASE - POLICY LIMIT $
A Nuclear Energy Liability NJF-0201 01101/2016 01/01/2017 See attached Acord 101 Insurance See Attached Acord 101' DESCRIPTION OF OPERATIONS I 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 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 Risk & Insurance Services Monica Poulsen i:'e/,:.Z,7<2=-,-
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
ACv R
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/14/2016 THIS CERTIFICATE IS ISSUED AS A MATT-ER 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 MARSHUSAINC.NAME:
MRHUAIN.PHONE FAX 99 HIGH STREET IAIC.No.EXt}:
AIC, No):
BOSTON, MA 02110 E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
024880-AII-NucI-16-17 INSURER A : American Nuclear Insurers INSURED INSURER B :
General Electric Company Attn: Scott McCurdy INSURER C :
scott~mccurdy@ge.com
]NSURER D :
3135 Easton Turnpike - W3F Fairfield, CT 06828 INSURER E :
INSURER F: :_____
COVERAGES CERTIFICATE NUMBER:
NYC-007487487-03 REVISION NUMBER: 12 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWAITHSTANDING 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 gN*p WVjD POLICY NUMBER IMM/DD/YyyyI
'MMIDDIYyyy1 LIMITS COMMERCIAL GENERAL LIABILITY EAC-H OCCURRENCE m
DAMAGE TO RENTED CLAIMS-MADE L.JOCCUR PREMISES (Ea occurrence)
___________________________MED EXP (Any one person)
______________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE IIPRO-II]
POLICY LJ JECT LJLOC PRODUCTS -COMP/OP AGG
__OTI-ER:
AUTOMBILELIABLITYCOMBINED SINGLE LIMIT AUTOMBILELIABLITY(Ca 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*
OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DEDDED RETENTIONS WORKERS COMPENSATIONSTA TPER 0 RTH-AND EMPLOYERS' LIABILITY YIN N~AUJL&
ANY PROPRIETORIPARTNERIEXECUTIVE F7F EL. EACH ACCIDENT OFFICERJMEMBER EXCLUDED?
j N I A (Mandatory in NH)
E.L. DISEASE - CA EMPLOYEE $
If yes, describe under D)ESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Uability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101 Insurance DESCRIPTION OF OPERATIONS I LOCATIONS ( 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 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.
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 024880 LOC #: Boston ACO~RD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED MARSH USA, INC.
General Electric Company
___________________________________________________________Attn: Scott McCurdy POLICY NUMBER scott.mccurdy@ge.com 3135 Easton Turnpike - W3F Fairfield, CT 06828 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 ot this Certificate a Nuclear Energy Uahility 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 descnibed herein, If ouch policy is cancelled or otherwise terminated prior to the end of Decemher 3lstoftthe calendar year in which the Eftective Date of this Certificate occurs, notice will he delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate assof the end of such December 31st. A Certificate will NOT be issued for any subsequent calendar year unless requested in writing.
Types of Insurance: NE--
[Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's & Transporters], ES - [Foreign Suppliers & Transporters]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - VALLECITOS, CA MANUEACTURING EACILITY LOCATION OF NUCLEAR FACILITY: The GE-Hitachi Vallecitos Nuclear Center Facility 6705 Vallecitos Road, Sunol, California NAMED INSURED [LISTED ON POLICY]: GE-Hitachi Nuclear Energy Americas LLC [NOTE 1]
POLICY NUMBER:
POLICY EFEECTIVE:
LIMIT OF LIABILITY:
NF-0001 03/22/1957
$25 Million NW-0500 03/22/1957
$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 policylies) in 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 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:
- 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.
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)
ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Dan Evans t4MARSH Marsh USA Inc.
Three Logan Square 1717 Arch Street, Suite 1100 Philadelphia, PA 19103
+1 215 246 1463 Danie.R.Evans@marsh.com www.marsh.com U.S. Nuclear Regulatory Commission ATTN: Document Control Desk Washington, DC 20555-0001 February 19, 2016
Subject:
2016 Nuclear Liability Certificates of Insurance Enclosed, please find the 2016 Nuclear Liability Certificates Marsh for insurance' brokerage services. The Certificate financial protection.
of Insurance for licensees that utilize of Insurance provides evidence of If you have any questions, please do not hesitate to contact me.
Best regards,............
Dan Evans Nuclear Client Advisor, U.S. Nuclear Energy Practice Enclosure Copy:
T. Farward, C. Hardie i* MARSH &McLENNAN g
~PCOMPANIES SOLUTIONS...DEFINED, DESIGNED, AND DELIVERED.
6o-.867 2~I
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47 L/:,
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ACO9RD CERTIFICATE OF LIABILITY INSURANCE SDATE (MMIDD/YYYY) 02/12/2016 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 ANOC No, Ext :
(A/C, No:
HARTFORD, CT 06103 E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
282248-NUC-16-17 INSURER A : American Nuclear Insurers INUEConnectfcut Yankee Atomic Power Company INSURER B :
362 Injun Hollow Road INSURER C :
East" Hampton, CT 06424 INSURER D :
INSURER E :
_________________________________________________________INSURER F:
COVERAGES CERTIFICATE NUMBER:
NYC-007079786-02 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 HAVEF BEEN REDUCED RY PAID CLAIMS.
INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE 5NP V
POLICY NUMBER IMMIDD/YYYYI (MMIDD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CIMSMD I[
CU DAMAGE TO RENTED CLAMSMAD L
OCURPREMISES (Ea occurrence)
___________________________MED EXP (Any one person)
_____________________PERSONAL
& ADV INJURY GENtL AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE POLICY LJ JECT
[J LOC PRODUCTS -COMP/OP AGG
__OTHER:
_AUTOMOBILE LIABILITY COMBINED(E cietSINGLE LIMIT ANY AUTO BODILY INJURY (Per person)
ALL OWNED SCHEDULED BODILY INJURY (Per accident)
__AUTOS
__AUTOS NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS
__AUTOS IPer accident)$
__UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB ICLAIMS-MADE AGGREGATE DEDI RETENTIONS$
WORKERS COMPENSATION
]PERsTTT 0 THER AND EMPLOYERS' LIABILITY Y I NL.L&
ANY PROPRIETORJPARTNEPJE.XECUTIVE E.L. EACH ACCIDENT OFFICERJMEMBER EXCLUDED?
N 1 NI A (Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below E.L. 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 /LOCATIONS/IVEHICLES (ACORD I01, Additional Remarks Schedule, may be attached if more apace Is requiredl 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Craig A. Parrow
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 282248 LOC #: Hartford ACOIRD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED MARSH USA, INC.
Connecticut Yankee Atomic Power Company
___________________________________________________________362 Injun Hollow Road POLICY NUMBER East Hampton, CT 06424 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 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 operafions 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 will he delivered is accordance with the policy provisions. Otherwise this Certificate shall terminate as of the end of such December 31st. A Certificate will NOT be lossed for any subsequent calendar year unless requested in mritfing.
Types of Insurance: NE - [Facility Form], NW-
[Master Worker Certificate], NS - [US Domestic Supplier's & Transporters], FS - [Foreign Suppliers & Transporters]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 -CONNECTICUT YANKEE LOCATION OF NUCLEAR FACILITY: Connecticut Yankee Plant located in Middlesex County, State of Connecticut NAMED INSURED [LISTED ON POLICY]: Connecticut Yankee Atomic Power Company POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0151 09/15/1 966
$100 Million NW-0552 09/1 5/1 966
$375 Million**
THIS CERTIFICATE IS ISSUED AS A MArIER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policy(ies) is subject to the exclusions, condifions and other provisions of the policy(ies). 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 Uimit of Liability shown above may have been reduced by payment ot 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 sublect 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.
ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
A CORD*
CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 02/12/2016 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 AIc. No, Ext)
(A/C, No:
HARTFORD, CT 06103 EMI INSURER(S) AFFORDING COVERAGE NAIC U J44032-NUC-15-16 INSURER A : American Nuclear Insurers INSU RED INSURER B :
Maine Yankee Atomic Power Company 321 Old Ferry Road INSURER C :
Wiscasset, ME 04578 INSURER D :
INSURER E :
INSURER F: :_____
COVERAGES CERTIFICATE NUMBER:
NYC-007316427-02 REVISION NUMBER: 5 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 REOUIREMENT, 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.
INSR ADDL SUBRc POLICY EFF POLICY EXP LTR TYPE OP INSURANCE Img WVP POLICY NUMBER (MMIDD/YYYYI IMMIDD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE m
DAMAGE TO RENTED CLAIMS-MADE
[jOCCUR PREMISES (Es occurrence)
___________________________MED EXP (Any one personl
__________________PERSONAL
&ADV INJURY GENtL AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE POLICY JECT LI LOC PRODUCTS - COMPIOP AGO OTHER:
AUTOMBILELIABLITYCOMBINED SINGLE LIMIT AUTOMBILELIABLITY(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 t*
OCCUR EACH OCCURRENCE
,EXCESS LIAR CLAIMS-MADE AGGREGATE
_ EDDED RETENTIONS$
WORKERS COMPENSATION
!PERSTTT 0 TH-E AND EMPLOYERS' LIABILITY ERN ANY P ROPRI ETOR/PARTN ER/EXECUTIVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?_jjjN I A (Mandatory in NH)
E.L. DISEASE - BA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below
_E.L.
DISEASE - POLICY LIMIT A
Nuclear Energy Liability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101 Insurance DESCRIPTION OP OPERATIONSI LOCATIONS IVEHICLES (ACORD 1O1, 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Manashi Mukherjee J.a"*wswokL
.t*M[a,*
e4-t,.*
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014101)
AGENCY CUSTOMER ID: J44032 LOC #: Hartford
.0*
ACO9RD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED MARSH USA, INC.
Maine Yankee Atomic Power Company
___________________________________________________________321 Old Ferry Road POLICY NUMBER Wiscasset, ME 04578 CARRIER
/NAIC CODE l
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 LIABIUTY INSURANCE Thin is to certify that there is in force as of the effective date of this Certificate a Nuclear Energy Uability 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 31sat of the calendar year in which the Effective Date of this Ceritifcate 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]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - MAINE YANKEE LOCATION OF NUCLEAR FACILITY: TOWN OF WISCASSET, LINCOLN COUNTY, STATE OF MAINE NAMED INSURED [LISTED ON POLICY]: Maine Yankee Atomic Power Company POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY3:
NF-0194 08/0111971
$100 Million NW-0578 08101/1971
$375 Million" THIS CERTIFICATE IS ISSUED AS A MATI'ER 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 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 paywent of claims or claims expenses.
COMMENTS/NOTES:
Muster 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 sand 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
ACORD CERTIFICATE OF LIABILITY INSURANCE SDATE (MM/DDIYYYY) 021122016 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 MARSHUSAINC.NAME:
MRHUAIN.PHONE FAX TWO ALLIANCE CENTER AIC.No.Exth (A/C No):
3560 LEN OX ROAD, SUITE 2400 E-MAIL ATLANTA, GA 30326 ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
J21970-4-Nuke.-16-17 INSUJRER A: American Nuclear Insurers INUESouthern Company Services, Inc.INUEB:
Attn: Deborah Ga~frney INSURER C :
dsgaffne~southemco.com INSURER D :
30 Ivan Allen Jr. Boulevard NW Bin SC1 404 INSURER E :
Atlanta, GA 30308 INSURER F:
COVERAGES CERTIFICATE NUMBER:
ATL-003946656-02 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, FXCI ISI(ONS ANfl CONDITIONS OF SUICH P0OLICIFS. LIMITS SHOWN MAY HAVF RFFN REflIJCED RY PAIfl Cl AIMS INS ADL SUB~R POLICY EFF POLICY EXP LTR TYPE OF INSURANCE
- NSD *VI0g POLICY NUMBER (MMIDD/YYYYI IMM/DD/YYYYI LIMITS
.* COMMERCIAL GNRLIALIYEACH OCCURRENCE
-FCAMSMD 1
CU DAMAGE TO RENTED CLAMSMAD K
OCURPREMISES (Ea occurrence)
____________________MED EXP (Any one person)
_____________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE D
PRO-° POLICY JECT LOC PRODUCTS - COMP/OP AGG
__OTHER:
AUTOMBILELIABLITYCOMBINED SINGLE LIMIT BODILY INJURY (Prpro)$
ALL WNED
__]
U~osCHEDLEDBODILY INJURY (Per accident) $
AUOSNN-WNDPROPERTY DAMAGE
[_.*
IRED UTOS UTOS(Per accident)$
UMRELALIB
.*OCUREACH OCCURRENCE EXESLA CAM-AEAGGREGATE AND EMPLOYERS' LIABILITY ERI I__________
ANY PROPRIETORJPARTNERIEXECUTIVE E.L. EACH ACCIDENT OFFICERJMEMEER EXCLUDED?
[jN I A
'(Mandatory in NH)
EL. DISEASE - EA EMPLOYEE $
If yes, describe under SDESCRIPTION OF OPERATIONS below
_____E.L DISEASE - POLICY LIMIT A
Nuclear Energy Liability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101 see addi page text Insurance DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If mome apace 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Manashi Mukherjee 3 4
-O.'L9,.*,..i dAL,JJ.
a.LL-.*
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: J21970 LOC #: Atlanta ACORD ADDITIONAL REMARKS SCHEDULE Page 2
of 3
AGENCY NAMED INSURED MARSH USA, INC.
Southern Company Services, Inc.
_______________________________________________________________Attn: Deborah Gaiffney POLICY NUMBER dsgaffne@southernco.com 30 Ivan Allen Jr. Boulevard NW Bin SC1404 CARRIER NAIC CODE Atlanta, GA 30308 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 ot the etfective date ot this Certificate a Nuclear Energy Uiability Insurance Policy issued by members ot 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 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 & Tranuporters], FS - [Foreign Suppliers & Transporters], N -[Secondary Financial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - JOSEPH M. FARLEY LOCATION OF NUCLEAR FACILITY: Joseph M. Fardey Nuclear Power Plant 16.5 MI E of Dothan, AL NAMED INSURED [LISTED ON POLICY]: Alabama Power Company and Southern Nuclear Operating Company POUiCY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0238 02/01/1976
$375 Million NW-0609 02101/1976
$375 Million" N-0052 08/01/1977 N-0073 10/23/11980**
- 2. SITE #2 -HATCH LOCATION OF NUCLEAR FACILITY: Hatch Nuclear Power Plant 11 MI N of Basley, GA NAMED INSURED [LISTED ON POLICY]: Georgia Power Company, Southemn Nuclear Operating Company, Oglethorpe Power Corporation, Municipal Electric Authority of Georgia, City of Dalton, Georgia POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0215 06/26/1973
$375 Million NW-0594 06/26/1 973
$375 Million*
N-0051 08/01/1 977 N-0067 06/1 3/1 978**
- 3. SITE #3 - ALVIN W. VOGTLE LOCATION OF NUCLEAR FACILITY:
Alvin W. Vogtie Nuclear Power Plant 26 Ml SSE of Augusta, GA NAMED INSURED [lISTED ON POLICY]: Georgia Power Company, Southern Nuclear Operating Company, Oglethorpe Power Corporation, Municipal Electric Authority of Georgia, MEAG Power SPVM, LLC, MEAG Power SPVJ, LLC, MEAG Power SPVP, LLC and City of Dalton, Georgia POLICY NUMBER:
POUiCY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0302 06/01/11986
$375 Million NW-0653 06/01/1986
$375 Million" N-0111 01/16/1987 N-01 17 02/09/1 989 THIS CERTIFICATE IS ISSUED AS A MAtTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policylies) 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 it is issued shall amend, estend or alter the coverage afforded by the policy. The Limit of Liability shown shove 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
AGENCY CUSTOMER ID: J21 970 LOC #: Atlanta AWORD ADDITIONAL REMARKS SCHEDULE Page 3
of3 AGENCY NAMED INSURED MARSH USA, INC.
Southern Company Servces, Inc.
__________________________________________________________Attn: Deborah Gaffney POLICY NUMBER dsgaffne@southernco.com 30 Ivan Allen Jr. Boulevard NW Bin 601404 CARRIER NAIC CODE Atlanta, GA 30308 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 sublect 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 Certiticate - 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
AGENCY CUSTOMER ID: 798153 LOC #: Hartford ACO~RD ADDITIONAL REMARKS SCHEDULE Page 2
of 2
AGENCY NAMED INSURED MARSH USA, INC.
Yankee Atomic Electric Company
______________________________________________________________49 Yankee Road POLICY NUMBER Rowe, MA 01367 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 CERTIFICATE OF NUCLEAR ENERGY LIABILITY INSURANCE This is to certify that there is is force as of the effective date st this Certificate a Nuclear Energy Uability 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 shows and/or with respect to the Issured's operations described herein, It such policy is cancelled or otherwise terminated prior to the end of December 31st of the calender year in which the Effective Date of this Certifi cafe occurs, notice will be delivered in accordance with the policy pruvinions. Otherwise this Certificate shall terminate as of the end of such December 31st. A Certifcate 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]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - YANKEE ROWE LOCATION OF NUCLEAR FACILITY:
Town of Rowe, State of Massachusetts NAMED INSURED [USTED ON POLICY]: Yankee Atomic Electric Company POLICY NUMBER:
POLICY EFFECTIVE:
NF-0076 10/23/1959 LIMIT OF LIABILITY:
$100 Million
$375 Miilion**
NW-0522 10/23/1959 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 Certifi cafe 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 Uiability 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 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.
ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/ODDYYYY) 01/1912016 w
I 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(sl.
PRODUCER CONTACT MARSHUSAINC.NAME:
MRHUAIC.PHONE IFAX 20 CHURCH STREET, 8TH FLOOR (AC, No, Eat:
I(CO NO):
HARTFORD, CT 06103 E-MAIL Attn: Hartford certrequest~marsh com I Fax: 212-948-01866ADES INSURER(SI AFFORDING COVERAGE NAIC #
7981 53--NUC-16-17 INSURER A : American Nuclear Insurers INSUREDINUEB:
Yankee Atomic Electric Company ISRRB 49 Yankee Road INSURER C :
Rowe, MA 01367 INSURER 0:
INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER:
NYC-007330493-03 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.
NOTIWITHSTANDING 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.
INSR ADDL SUiBR POLICY EFF POLICY EXP
-T TYPE OF INSURANCE
!NSD WVIM POLICY NUMBER (M(DDYyy 9{MiD/Yyy LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE II DAMAGE TO RENTED SCLAIMS-MADE KJ OCCUR PREMISES lEa occurence)
____________________________MED EXP (Any one person)
_______________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE D
PRO-[
POLICY JECT LOC PRODUCTS-COMP/OP AGO
__OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea 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) i I $
__UMBRELLA LIAB
[*
OCCUR EACH OCCURRENCE EXCESS LIAB I ICLAIMS-MADE AGGREGATE DED!
RETENTION S WORKERS COMPENSATION STATUERE AND EMPLOYERS' LIABILITY Y/NIR ANY PROPRIETORIPARTNERJEXECUTIVE FTF E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
[JN1 A
A_________
(Mandatory In NH)
EL. DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below
___________E.L.
DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached Acoid 101 01/01/2016 01/01/2017 See Attached Acord 101 Insurance DESCRIPTION OF OPERATIONS I LOCATIONS)I VEHICLES (ACORD 1 01, Additional Remarks Schedule, may be attached If mome space Is required)
CERTIFICATE HOLDER CANCELLATION Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE U.S. Nuclear Regu~latory 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
..,* ~
~
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AwD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 12/08/2015 I
THIS CERTIFICATE IS ISSUED AS A MA'n'ER 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 500 Dallas St, Suite 1500 nc. No. Ext; (AC, No):
Houston, TX 77002 EMI INSURER(S) AFFORDING COVERAGE NAIC #
897592-Energ-Nucle-16-17 INSURER A : American Nuclear Insurers INSURED INSURERB :
Energy Future Holdings Corp.
1601 Bryan Street INSURER C :
Dallas, TX 75201 INSURER D :
INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER:
HOU-002497200-03 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 IS SUBJECT TO ALL THE TERMS, I:Y I IQI~l(kIO Akflr ('IMflTICIFI t(l C1 I(PW Dfl Ir'II=
I IIWllTO QWr~lA/el I~AlV WA'.I= DFI*I= iOflIr ifltrl IV DAIR t' AIIUIO INSR ADDL SUBR~
POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INp WVw POLICY NUMBER IMMIDD/YYYY I (MMIDD/YYYY)
LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1
DAMAGE TO RENTED JCLAIMS-MADE OCCUR PREMISES (Ea occurrence)
____________________MED EXP (Any one person)
_____________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
[m PRO-II POLICY LiJECT LOC PRODUCTS -COMPIOPAGG
__OTHER:
AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT
{lEa 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 LUAB OCCUR EACH OCCURRENCE EXCESS LIABR CLAIMS-MADE AGGREGATE
_ EDDED RETENTIONS$
WORKERS COMPENSATION IPER 0H AND EMPLOYERS' LIABILITY YIN ER ANY PROPRI ETORIPARTNERJEXECUTiVE FF E.L. EACH ACCIDENT OFFICERIMEMBER EXCLUDED?
[JN I A (Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OP OPERATIONS below E.L 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 iai, Addit~onal Remarks Schedule, may be attached If more apace 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
I
~ ~~Jessie Guerrero ACORD 25 (2014101)
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 897592 LOC #: Houston A CORD ADDITIONAL REMARKS SCHEDULE Page 2
of 2
AGENCY NAMED INSURED Marsh USA Inc.
Energy Future Holdings Corp.
-1601 Bryan Street POLICY NUMBER Dallas, TX 75201 CARRIER NAIC CODE L
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 theme is in force as of the effective date of fhis Certificate a Nuclear Energy Uabilify 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 Insumeds 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 mill he 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 unleus requested in writing.
Types of Insurance: NE - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's & Transporters], ES
- [Eoreign Suppliers & Transporters], N- [Secondary Financial Protect ion Certificate]
COVERAGE EOR NUCLEAR FACILITIES:
- 1. SITE #1 - COMANCHE PEAK LOCATION OF NUCLEAR FACILITY: Comanche Peek Nuclear Power Plant is located on the south hunk of Squaw Creek Reservoir near the town of Glen Rose in Somervell County, Texas approximately 35 miles southwest of Fort Worth and 67 miles southwest of Dallas, Texas.
NAMED INSURED [LISTED ON POLICY]: Luminant Generation Company LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0274 01101/1983
$375 Million NW-0631 01/01/1983
$375 Million" N-0090 02/08o990 N-OilS 02102/1993 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS ND 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 Uability 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 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 Proftaction 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
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 02/10/2016 THIS CERTIFICATE IS ISSUED AS A MATT'ER 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(lest 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 Mars USAInc.NAME:
Mas S n.PHONE FAX 100 North Tryon Street, Suite 3600 A/c, No, Extt:
A/C, No):
Charlotte, NC 28202 E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
22830 -ONE-1/1-16-17 INSURER A : American Nuclear Insurers INSURED INSURER B :
Duke Energy Corporation ATTN: Ed Adams IINSURER C :
ed.adams@duke-energy.com INSURER D :
550 S. Tryon Street DEC40-C INSURER E :
Charlotte, NC 28202 INSURER F :
COVERAGES CERTIFICATE NUMBER:
ATL-003526555-06 REVISION NUMBER: 19 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, INSR ADDL S5UBR-POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INS WVD POLICY NUMBER IMMIDD/YYYY'
'MM/DD/YYYY)
LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE II DAMAGE TO RENTED
]CLAIMS-MADE I
OCCUR PREMISES tEa occurrence)
___________________________MED EXP (Any one person)
_____________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE 7 PRO-7 POLICY I JECT LOC PRODUCTS - COMP/OP AGG
__OTHER:
AUTOMBILELIABLITYCOMBINED SINGLE LIMIT AUTOMBILELIABIITYtEa accident)
ANY AUTO BODILY IN JURY (Per person)
ALL OWNED SCHEDULED BODILY iNJURY tPer accident)
__AUTOS
__AUTOS NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS
__AUTOS (Per accident)
__UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAB I
CLAI MS-MADE AGGREGATE DEDDED RETENTIONS WORKERS COMPENSATION
{PER OH AND EMPLOYERS' LIABILITY Y I N ER ANY PROPRIETORJPARTNERJEXECUTIVE flf E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
[ 2 N
A (Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below EL. DISEASE - POLICY LIMIT $
A Nuclear Energy Uiability SEE ATTACHED 01/01/2016 01/01/2017 SEE ATTACHED 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 Commnission THE EXPIRATION DATE
- THEREOF, NOTICE WILL BE DELIVERED IN Washington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Karen A. Burke Kd-J.*-
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
V AGENCY CUSTOMER ID: 22830 LOC #: Charlotte ACO9RD ADDITIONAL REMARKS SCHEDULE Page 2of 4
AGENCY NAMED INSURED Marsh USA Inc.
Duke Energy Corporation
_________________________________________________ATTN: Ed Adams POLICY NUMBER ed.adams@duke-energy.com 550 S. Tryon Street DEC40-C CARRIER
/NAIC CODE Charlotte, NC 28202 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 theme is in force as of the effective date of this Certificate a Nuclear Energy Uability Insurance Policy issued hy members of American Nuclear Insurers as indicated (Companies), to the Insured named herein, mith respect to the Nuclear Facility at the Location shown sod/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 ot the end of such December 31st. A Certificate will NOT be issued for any subsequent calendar year unless requested is writing.
Types of Insurance: NP - [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 - CATA WBA LOCATION OF NUCLEAR FACILITY: Catawba Nuclear Power Plant in the NE portion of York County, SC NAMED INSURED [LISTED ON POLICY]: Duke Energy Carolinas, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0281 12/01/1983
$375 Million NW-0637 12/01/1983
$375 Million" N-0097 07/18/1 984 N-0106 12/01/1983
- 2. SITE #2-MCGUIRE LOCATION OF NUCLEAR FACILITY: McGuire Nuclear Power Plant located 17 ml N/NW of Chariotte, NC NAMED INSURED [USTED ON POLICY]: Duke Energy Carolinas, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF UABIUITY:
NF-0248 05/01/1977
$375 Million NW-0615 05/01/1977
$375 Million**
N-0069 01/23/1981 N-0092 03/03/11983
- 3. SITE #3 - OCONEE LOCATION OF NUCLEAR FACILITY: Oconee Nuclear Power Plant in Oconee County, South Carolina NAMED INSURED [LISTED ON POLICY]: Duke Energy Carolinas, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0182 03/01 /1 970
$375 Million NW-0569 03/01/1970
$375 Million**
N-0022 08/01/11977 N-0023 08/01/11977 N-0024 08/01/1 977**
- 4. SITE # BRUNSWICK LOCATION OF NUCLEAR FACILITY: Brunswick Nuclear Power Plant 2.5 MI N of Sosthport, NC NAMED INSURED [LISTED ON POLICY]: Duke Energy Progress, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0218 10/25/11973
$375 Million NW-0597 10/25/1973
$375 Million**
N-0054 08/01/1977 N-0055 08/01/1977 ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 22830 LOC #: Charlotte ACO9RD ADDITIONAL REMARKS SCHEDULE Page 3
of 4
AGENCY NAMED INSURED Marsh USA Inc.
Duke Energy Corporation
________________________________________________ATTN: Ed Adams POLICY NUMBER ed.adams@duke-energy.com 550 S. Tryon Street DEC40-C CARRIER
/NAIC CODE Charlotte, NC 28202 EFFECTIVE DATE:
ADDITIONAL REMARKS
[THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:
25 FORM TITLE: Certificate of Liability Insurance
- 5. SITE #5 - CRYSTAL RIVER LOCATION OF NUCLEAR FACILITY:
Crystal River Nuclear Power Plant 7.5 MI NW of Crystal River, Citros County, FL NAMED INSURED [LISTED ON POLICY]:
Duke Energy Floride, inc.; Seminole Electric Cooperative, Inc.; Orlando Utilities Commission and City of Odando; City of Gainesville, Florida; City of Ocala; City of Leesbarg, Florida; City of Kissimmee, Florida, A Municipal Corporation; City of New Smymna Beach, Florida and Utilities Commission of New Smymna Beach, Florfda; City of Alachua, Florida; The City of Bushnell; Florida Progress Corporation POLICY NUMBER:
PDUCY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0195 07/01/1971
$375 Million NW-0579 07/01/1971
$375 Million**
- 6. SITE #6 - SHEARON HARRIS LOCATION OF NUCLEAR FACILITY:
Shearon Heelis Nuclear Power Plant 20 MI SW of Raleigh, NC NAMED INSURED [LISTED ON POLICY]; Duke Energy Progress, Inc.
POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
N F-0288 06101/1984
$375 Million NW-0642 06101/1984
$375 Million**
N-0112 10/24/1986
- 7. SITE #7-H. B. ROBINSON LOCATION OF NUCLEAR FACILITY:
H.B. Robinnon Nuclear Power PlantS5 MI WNW from Hertsville, SC NAMED INSURED [LISTED ON POLICY]: Duke Energy Progress, Inc.
POLICY NUMBER:
POUCY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0180 10/1 5/1 969
$375 Million NW-0567 10/15/1969
$375 Million**
N-0021 08/01/11977**
- 8. SITE #8 -LEVY LOCATION OF NUCLEAR FACILITY:
Levy Nuclear Plant 39 MI SW of Gainsville, FL NAMED INSURED [LISTED ON POLICY]: Duke Energy Florida, Inc.
POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF -0354 01/01/2015
$1 Million
- 9. SITE #9 - LEE LOCATION OF NUCLEAR FACILITY:
Lee Nuclear Site 6 Ml S of Blacksburg, SC NAMED INSURED [USTED ON POLICY]: Duke Energy Carolinas, LLC POUCY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0355 1/1/2016
$1 Million THIS CERTIFICATE IS ISSUED AS A MATIER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policylies) is subject to the encluoions, conditions and other provisions of the pelicylies). 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 Uimit of Uability shown above may have been reduced by payment of claims or claims expenses.
COMMENTS/NOTES:
ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 22830 LOC #: Charlotte A CORD ADDITIONAL REMARKS SCHEDULE Page 4
of 4
AGENCY NAMED INSURED Marsh USA Inc.
Duke Energy Corporation
_______________________________________________________ATTN: Ed Adams POLICY NUMBER ed.adams~duke-energy.com 550 S. Tryon Street DEC4O-C CARRIER
/NAIC CODE Charlotte, NC 28202 EFFECTIVE DATE:
ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:
25 FORM TITLE: Certificate of Liability InsuranceI
- Master Worker Certificate - This limit is shared by all Certificates to the Master Worker Policy of which each Certificate is a part and is sabject to all of the provisions of such Policy and Certificate having reference thereto. Sach limit may have been reduced by payment of claims or claims enpenses.
- Secondary Financial Protection Certificate - Financial protection available ander an industry retrospective rating plan.
ACORD 101 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACO~RD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 02/10/2016 THIS CERTIFICATE IS ISSUED AS A MATT-ER 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 100 North Tryon Street, Suite 3600 A/c. No. Extl:
(A/C, No):
Chadotte, NC 28202 E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
070250-SCAN-NUKE-16-17 INSURER A : American Nuclear Insurers INUESCANA CorporationINUEB:
ATTN: John Mellette INSURER C :
JMELLETTE@scana.com INSURER D :
100 SCANA Parkway Cayce, SC 29033 INSURER E :
_________________________________________________________INSURER F: :_____
COVERAGES CERTIFICATE NUMBER:
ATL-003396433-02 REVISION NUMBER:3 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWIMTHSTANDING 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.
INSR ADDL SUB~R POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN*;u *V'"
POLICY NUMBER (MMIDD/YYYY1 IMMIDD/YYYY)
LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE II DAMAGE TO RENTED CLAIMS-MADE KJOCCUR PREMISES (Ea occurrence)
___________________________MED EXP (Any one person)
PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
- O ICYI PRO-m-
PLCLJJECT LiLOC PRODUCTS - COMPIOP AGG OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accidenlt 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 l
OCCUR EACH OCCURRENCE EXCESS LIAB I ICLAIMS-MADE AGGREGATE DEDBED RETENTIONS 5
WORKERS COMPENSATION IPERTAT TE I°TH-E AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORJPARTNERJEXECUTIVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
N 1 N A (Mandatory In NH)
E.L. DISEASE - RA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below E.L. 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 / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If mome space Ia 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 070250 LOG #: Charlotte ACORD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED Marsh USA Inc.
SCANA Corporation
_______________________________________________________________ATTN: John Mellette POLICY NUMBER JMELLETTE@scana.com 100 SCANA Parkway Cayce, SC 29033 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 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 Uability Insurance Policy issued hy 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, It such policy is cancelled or otherwise terminated pdor to the end of December 3lst of the calendar year in which the Effective Date of this Certificate occurs, notice will he 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 wdting.
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 - VIRGIL C. SUMMER NUCLEAR STATION LOCATION OF NUCLEAR FACILITY: Virgil C. Summer Nuclear Station 2.5 miles N of Purr, Fairfield County, South Carolina NAMED INSURED [LISTED ON POLICY]: South Carolina Electric & Gas Company and South Carolina Public Service Authority POUCY NUMBER:
POLICY EFFECTIVE:
LIMIT OF UABILITY:
NF-0252 03/21/1978
$375 Million NW-0616 03/21/1978
$375 Million" N-0078 08/05/1 982 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policylies) 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 in issued shall amend, extend or alter the coverage afforded by the policy. The Umit of Liability ahown above may have been reduced by payment of claims or claims expenses.
COMMENTS/NOTES:
"Master Worker Certificate - This limit is shared by all Certiticates to the Master Worker Policy of which each Certificate is a part and is subject to nil of the provisions of ouch 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
ACOIRD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 02/10/2016 THIS CERTIFICATE IS ISSUED AS A MA'I-ER 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 Mars USAinc.NAME:
Mas S n.PHONE FAX 100 North Tryon Street, Suite 3600 A/C.No.Extl:
A/C, No):
Charlotte, NC 28202 E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #t 936236-*..-FinPr-16-17 INSURER A : American Nuclear Insurers INSURED INSURERSB:
BWXT Nuclear Operations Group, Inc.
2016 Mt. Athos Road INSURER C :
Lynchburg, VA 24504 INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER:
ATL-003416213-02 REVISION NUMBER:7 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, aALI f OlaJIlNO flNlr' a,a"JI"aLITI r".,In tsrou r
r'1
.JU
'lIPISICQ LtII I,'I * *.J "CAl IJU' h,
fltVU
\\IZ: DC:IZ=IN Df::rl IJU EL DV rtarL, t.,LI IVAO.
INRADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INsla
- p POLICY NUMBER IMM/DD/YYYYI IMM/DD/VYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED
]CLAIMS-MADE Li OCCUR PREMISES (Ea occurrencel
___________________________MED EXP (Any one person)
___________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE POLICY LJ PEOT LJ LOC PRODUCTS -COMP/OP AGG
__OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident)
ANY ATOEDGILY INJURY (Per person)
ALL WNED SCHEULEDBODILY INJURY (Per accident)
NNONDPROPERTY DAMAGE HIEDAUTS UTOS(Per accident)
__UMRELALIB
-* OCUREACH OCCURRENCE EXESLAB LIM-AEAGGREGATE AND EMPLOYERS' LIABILITY ERIN ANY PROPRIETORIPARTNER(EXECUTIVE r---
E.L. EACH ACCIDENT OFFICERJMEMBER EXCLUDED?
L2NI/
A (Mandatory In NH)
EL. DISEASE - CA EMPLOYEE $
If yes, describe under DE:SCRIPTION OF OPERATIONS below
______E.L.
DISEASE - POLICY LIMIT A Nuclear Energy Uability See Attached 01/01/2016 01/01/2017 See Attached Insurance "Acord 101' Acord 101 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1011, Additional Remarks Schedule, may be attached If more apace 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 936236 LOC #: Charlotte ACO~RD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED Marsh USA Inc.
BWXT Nuclear Operations Group, Inc.
___________________________________________________________2016 Mt. Athos Road POLICY NUMBER Lynchburg, VA 24504 CARRIER NAIC CODE L
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 Uability 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 31sat of the calendar year in which the Effective Date of this Certificate occars, 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 reqaested in wrilting.
Types of Insurance: NF - [Facility Form], NW-
[Master Worker Certificate], NS - [US Domestic Suppliers & Transporters], FS - [Foreign Suppliers & Transporters]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - LYNCHBURG FUEL FABRICATION FACILITY LOCATION OF NUCLEAR FACILITY: Lynchburg Fuel Fabrication Facility 550 acre plant site, approx 7mi east of Lynchburg, VA NAMED INSURED [LISTED ON POLICY): BWXT Nuclear Operations Group, Inc. and AREVA Inc.
POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0111 10/01/1961
$200 Million NW-0533 10/01/1961
$375 MIllion" THIS CERTIFICATE IS ISSUED AS A MATIER 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 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.
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 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.
ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 02/09/2016 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 Risk & Insurance Services NAME:FA PHONEFA 4445 Eastgate Mall
{AIC, No, Ext):
A/C, No):
San Diego, CA 92121 E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC 1/
03434B-NRC-GA-16-17 INSURER A : American Nuclear Insurers INSURED ISRRB General AtomicsINUEB:
P0 Box 85608 INSURER C :
San Diego, CA 92138 INSURER D :
INSURER EB:
INSURER F :
COVERAGES CERTIFICATE NUMBER:
LOS-001836936-03 REVISION NUMBER:3 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 INp V
POLICY NUMBER IMM/DD/YYYYI IMM/DD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE II DAMAGE TO RENTED CLAIMS-MADE LiOCCUR PREMISES (Ea occurrence)
__________________________MED EXP (Any one person)
___________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE II PRO-7--
POLICY ~jJECT LOC PRODUCTS-COM P/OPAGO OTHER:$
AUTOMBILELIABLITYCOMBINED SINGLE LIMIT AUTOMBILELIABIITYlEa accident)
ANY AUTO BODILY INJURY (Per person)
ALL OWNED SCHEDULED BODILY INJURY (Per accident)
__AUTOS
__AUTOS NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS
__AUTOS (Per accidentl 5
UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE
__ flED RETENTIONS WORKERS COMPENSATIONST TPER 0 ITH-E AND EMPLOYERS' LIABILITY ERY________N_
ANY PROPRIETORJPARTNER/EXECUTIVE r1 E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
IJ NA (Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached 01/01/2016 01/01/2017 See Attached DESCRIPTION OF OPERATIONS I LOCATIONS/IVEHICLES IACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION Document Centro[ 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.
AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 034348 LOC #: San Diego A CORD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED Marsh Risk & Insurance Services General Atomics PG Box 85608 POLICY NUMBER San Diego, CA 92138 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 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 hy members of American Nuclear Insurers as indicated (Companies), In the Insured named herein, with respect to the Nuclear Facility at the Location shown and/or with respect to the Insured's operations descrtbed 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 Certiti cafe occurs, notice will be delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate us 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 Certficate), NS - [US Domestic Supplier's & Transporters], PS
- [Foreign Suppliers & Transoporters]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - GENERAL ATOMICS LOCATION OF NUCLEAR FACIUITY:
Sun Diego, CA NAMED INSURED [LISTED ON POLICY]: General Atomics POLICY NUMBER:
POLICY EFFECTIVE:
NF-0034 0313111958 NW-051 2 03/31/1958 LIMIT OF UIABIUITY:
$40 Million
$375 Million" THIS CERTIFICATE IS ISSUED AS A MATTFER 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 contruct or other document with respect to which it is issued shall amend, estend 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.
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 all of the provisions of such Policy and CertiJficate having reference thereto. Ssch limit may have been reduced by payment of claims or claims expenses.
ACORO 101 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 02109/2016 THIS CERTIFICATE IS ISSUED AS A MATT'ER 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 1717 Arch Street AC, NoExt):
(AC, No):
Philadelphia, PA 19103-2797 E-MAIL Attn: Philadelphia.Certs@marsh.com/ fax - 212-948-0360 ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #I S27324-NUC-ENR-16-17 INSURER A : American Nuclear Insurers INSURED INSURER B :
Susquehanna Nuclear, LLC and Allegheny Electric Cooperative, Inc.
INSURER C :
Corporate Risk & Insurance INSURER D :
835 Hamilton Street, Suite 150, GENPL7N Allentown, PA 18101 INSURER B :
_________________________________________________________INSURER F:
COVERAGES CERTIFICATE NUMBER:
CLE-004443748-05 REVISION NUMBER:9 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 CONflITIONS OF SI ICH P0OLICIES L IMITS SHOWN MAY HAVF RFFN R~FlIIJCI:: RY PAIDi CI AIMS INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE yN*D WVD' POLICY NUMBER (MMIDD/YYYYI IMMIDD/YYYY1 LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 77 DAMAGE TO RENTED CLAIMS-MADE LiOCCUR PREMISES (Ea occurrence)
__________________________MED EXP (Any one person)
______________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE D
PRO-° POLICY JECT LOC PRODUCTS - COMP/OP AGG S
__OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 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 OCCUR EACH OCCURRENCE EXCESS LIAR ICLAIMS-MADE AGGREGATE
__DED RETENTIONS$
WORKERS COMPENSATION IPER 0H AND EMPLOYERS' LIABILITY Y I NIJL~
ANY PROPRIETORJPARTNERIEXECUTIVE F1 E.L. EACH ACCIDENT OFFICERJMEMBER EXCLUDED?
[hNt A
A________
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE $
If yen, describe under DESCRIPTION OP OPERATIONS below E.L. DISEASE - POLICY LIMIT $
ANuclear Energy Liability See Attached 01/01/2016 01/01/2017 See Attached Acord 101 Insurance Acord 101 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Manashi Mukherjee
..3"i4.e.*.J Ltc..CJt
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: S27324 LOC #t: Philadelphia A CORD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED Marsh USA Inc.
Susquehanna Nuclear, LLC and Allegheny
-Electric Cooperative, Inc.
POLICY NUMBER Corporate Risk & Insurance 835 Hamilton Street, Suite 150, GENPL7N
-Allentown, PA 18101 CARRIER NAIC CODE L
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 American Nuclear Insurers as indicated (Companies), to the insured named herein, with inspect to the Nuclear Facility at the Location shown and/or with respect to the Insredas 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 Etfective 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 issaued for any sabsequent 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]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - SUSOUEH-ANNA LOCATION OF NUCLEAR FACILITY: Sasquehanna Naclear Power Plant is Salem Township, Luzeme Coanty, Pennsylvania NAMED INSURED [LISTED ON POLICY]: Susquehanna Nuclear, LLC & Allegheny Electric Cooperative, Inc.
POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0262 01/01/1981
$375 Million NW-0622 0110111981
$375 Million's N-0084 07/17/1982 N-0096 03/23/1 984 THIS CERTIFICATE IS ISSUED AS A MATTFER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policy(ies) is sabject to the euclasions, conditions and other provisions of the policy(ies). Neither this Certificate nor any contract or other docament with respect to which it is issued shall amend, extend or alter the coverage afforded by mhe policy. The Limit of 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 Cerfif cafes 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 espouses.
NOTE 1 -NS-0422: Suppliers & Transporters Coverage - Additional Named Insured - Restricted Coverage Such insarance as is afforded by the policy shall also apply to Allegheny Electric Cooperative, Inc. and Tales Energy Corporation, but solely with respect to liability for bodily injury, property damage or environmental damage which arises oat of naclear material which has been sused or is to be used, or baa been irradiated in the course of the operation of a meactor in which it has an ownership interest, located at the Sasqaehanna Steam Electric Station.
ACORD 101 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACO~RD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 01/0812016 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 NAME:FA PHONEFA CA License #0437153 inc.NoExt):
(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-16-17 INSURER A : American Nuclear Insurers EDISON INTERNATIONAL ISRRB 2244 WALNUT GROVE AVENUE INSURER C :
ROSEMEAD, CA 91770 INSURER D0:
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 CI AIMS.
INSR
- .D SUBS POLICY EFF POLICY EXP LTR TYPE OF INSURANCE rNp raVjp POLICY NUMBER (MM/DD/YYYYI)
MMIDD/YYYY)
LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE m
DAMAGE TO RENTED SCLAIMS-MADE LJ OCCUR PREMISESlEa.... urre..e )
__________________________M ED EXP (Any one person)
___________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
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[*
LOC PRODUCTS -COMPIOP AGO OTHER:
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__AUTOS
__AUTOS NON-OWNED PROPERTY DAMAGE
__HI RED AUTOS
__AUTOS (Per accident)
__UMBRELLA LIABR
- OCCUR EACH OCCURRENCE S
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__DED!
RETENTION $
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~
AND EMPLOYERS' LIABILITY Y I NIE ANY PROPRIETORJPARTNER/EXCCUTIVE F*1 EL. EACH ACCIDENT OFFICERJMEMBER EXCLUDED?
Li N I A (Mandatory 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 mome space is requiredl 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.
AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services Cynthia Guist
- o.,lr,,*.
.1
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 53370 LOC #: Los Angeles ACORD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED Marsh Risk & Insurance Services EDISON INTERNATIONAL 2244 WALNUT GROVE AVENUE POLICY NUMBER ROSEMEAD, CA 91770 CARRIER NAIC CODE
.L 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 torce as of the effective dale 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, It sach policy is cancelled or otherwise terminated prior to the end of December 31 st of the calendar year in which the Effectiye 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 suhsequent calender year unless requested in writing.
Types of Insurance: NE - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's & Transporters], ES
- [Foreign Suppliers & Transporters], N - [Secondary Financial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 -SAN ONOFRE LOCATION OF NUCLEAR FACILITY:
San Onotre Nuclear Generating Station 3 miles S of City of San Clemente in San Diego County, California NAMED INSURED [USTED ON POLICY]: Southern Califomnia Edison Company, San Diego Gas & Electric Company, The City of Anaheim, The City of Riverside POLICY NUMBER:
POUCY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0146 04/06/1966
$375 Million NW-0549 01/01/1998
$375 Million" N-008l1 02/16t/1 982 N-00fl7 11/15/1982**
THIS CERTIFICATE IS ISSUED AS A MAlT-ER 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 it is issued shall amend, extend or alter the coverage afforded by the policy. The Uimit of Liability shown shove 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 all ot 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 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACO2RD CERTIFICATE OF LIABILITY INSURANCE SDATE (MM/DD/YYYY) 02109/2016 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 500 Dallas St, Suite 1500 (A/C, No, Ext):
(A/C, No):
Houston, TX 77002 E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIc #
J03175-Sp-16-17 INSURER A : American Nuclear Insurers INSURED INSURER E :
Arizona Public Service Company, et al Mail Station: 9618 PO Box 53999 INSURER C :
Phoenix, AZ 85072-3999 INSURER D :
INSURER E :
_________________________________________________________INSURER F: :_____
COVERAGES CERTIFICATE NUMBER:
HOU-002668951-05 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 TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE I*p VVV POLICY NUMBER (MID/YY (MMID/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE II 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 POLICY D PRO-D---
LOC PRODUCTS-COMP/OP AGG
__OTHER:
AUTOMOBILE LIABILITY COMEINED 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 OCCUR EACH OCCURRENCE EXCESS LIAB i
CLAIMS-MADE AGGREGATE
__DEDI RETENTIONS WORKERS COMPENSATIONST~TPR I
ITE AND EMPLOYERS' LIABILITY Y I NJ~L~
ANY PROPRIETOR/PARTNER/EXECUTIVE r1 E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
N 1 N A___________
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYES If yes, describe under D)ESCRIPTION OP OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Uability See Attached 01/01/2016 01/01/2017 See Attached Acord 101 Insurance Acord 101 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mome 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Manashi Mukherjee
.. t"4,kj; L,-
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: J03 175 LOC #: Houston ACORD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED Marsh USA Inc.
Arizona Public Service Company, et al
______________________________________________________________Mail Station: 9618 P0 Box 53999 POLICY NUMBER Phoenix, AZ 85072-3999 CARRIER NAIC CODE
.L 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 American Nuclear Insurers us indicated (Companies), to the Insured named herein, with respect to the Nucleer 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 will be delivered is accordance with the policy provisions. Otherwise this Certificate shall terminate as ot 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 - PALO VERDE LOCATION OF NUCLEAR FACILITY: Palo Verde Nuclear Generating Station located in Wintersburg, Arizona NAMED INSURED [LISTED ON POLICY]: Arizona Public Service Company, at al POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0266 08/07/1 981
$375 Million NW-0625 08/07/1 981
$375 Million' N-0088 12131/1984 N-0107 12109/1985 N-01 14 03/25/1987**
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 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.
COMMENTS/NOTES:
- Muster 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 nil of 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
AC1R CERTIFICATE OF LIABILITY INSURANCE
[/DAE(MDD/YYY THIS CERTIFICATE IS ISSUED AS A MATT-ER 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 1301 5th Avenue, Suite 1900 A/C. No. Ext-;
(A/C, No):
Seattle, WA 98101 E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
J26976-NUC2-16-17 INSURER A : American Nuclear Insurers INSURED INSURER B:
Energy Northwest Attn: Marie Thomas INSURER C :
P.O. Box 968 INSURER D0:
Richland, WA 99352 INSURER E :
INSURER F: :______
COVERAGES CERTIFICATE NUMBER:
SEA-002714992-02 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.
INSR ADDL SUBR~
POLICY EFF POLICY EXP LTR TYPE OF INSURANCE ffl@
WV POLICY NUMBER IMM/DD/YYYY)
IMM/DD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE II DAMAGE TO RENTED
. CLAIMS-MADE L..... OCCUR PREMISES lEa occurrence)
___________________________MED EXP (Any one person)
_____________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE POLICY D JPRO LOC PRODUCTS -COMP/OPAGG
__OTHER:$
_AUTOMOBILE LIAEILITY (ECOMBINEDacietSINGLE LIMIT ANY AUTO BODILY INJURY (Per person)
ALL OWNE*D SCHEDULED BDL NUY(e ciet
__AUTOS
__AUTOS BDL NUYle ciet NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS
__AUTOS (Per accident)$
__UMBRELLA LIABR [
OCCUR EACH OCCURRENCE EXCESS LIAB I
CLAIMS-MADE AGGREGATE
__DED RETENTIONS $______$__
WORKERS COMPENSATION IPERSTTT 0 TH-R AND EMPLOYERS' LIABILITY YN ER ANY PROPRIETOR/PARTNER/EXECUTIVE r7F EL. BACH ACCIDENT OFFICER/MEMBER EXCLUDED?
2 j I A (Mandatory In NH)
EL. DISEASE - BA EMPLOYEE $
If yes. describe under DESCRIPTION OF OPERATIONS below
_______________E.L.
DISEASE - POLICY LIMIT $
A Nuclear Energy Uabilty See Attached Acord 101 01/01(2016 01/01/2017 See Attached Acord 101 Insurance DESCRIPTION OF OPERATIONS I LOCATIONS/IVEHICLES (ACORD l01, Additional Remarks Schedule, may be attached if more space is requlredi 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
I
~ ~~Van H. Vong"7'z
© 1988-2014 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD ACORD 25 (2014101)
AGENCY CUSTOMER ID: J26976 LOC #: Seattle
ACO~RD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED Marsh USA, Inc.
Energy Northwest
_________________________________________________________________tn:__MaArie Mrieohoma POLICY NUMBER P.O. Box 968 Richiand, WA 99352 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 torce as of the effective date of this Certificate a Nuclear Energy Uability 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 will be delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate as of the end of such December 31sat A Certificate will NOT be lossed 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]
CDVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - COLUMBIA GENERATING STATION LOCATION OF NUCLEAR FACILITY:
All of the premises including the land and all building and structures of Energy Northwest Columbia Generating Station including bat not limited to the reactors formerly knlown as WNP 1, WNP 2 and WNP located approximately 12 miles NW of Richiand, Washington.
NAMED iNSURED [LISTED ON POLICY]: Energy Northwest POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0270 08/01/1982
$375 Million NW-0628 08/01/1982
$375 Million**
N-0091 12120/1983 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 conhract or other document with respect to which it is issued shall amend, extend or alter the coverage afforded by the policy. The Uimit of 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 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 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACO9RD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 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 RISK & INSURANCE SERVICES PHNAE:A 345 CALIFORNIA STREET, SUITE 1300 IA/C. No. Extt:
(A/C, Nol:
CALIFORNIA LICENSE NO. 0437153 E-MAIL SAN FRANCISCO, CA 94104 ADES INSURER(S) AFFORDING COVERAGE NAIC #
021716-NUC2-16-17 INSURER A : American Nuclear Insurers INSURED INSURER B :
PACIFIC GAS & ELECTRIC COMPANY ONE MARKET SPEAR TOWER INSURER C :
SUITE 2400 INSURER D :
SAN FRANCISCO, CA 94105 INSURER EB:
INSURER F COVERAGES CERTIFICATE NUMBER:
SEA-002937975-03 REVISION NUMBER: 3 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 INj*p W3*
POLICY NUMBER IMMIDD/YYYYI IMM/DD/YY'YYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE m
DAMAGE TO RENTED CLAIMS-MADE U OCCUR PREMISES lEa occurrence)
S
___________________________MED EXP (Any one person)
S
_____________________PERSONAL
& ADV INJURY S
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE POLICY [j PRO-
[j LOC PRODUCTS-COMP/OPAGG OTHER:
AUTOMBILELIABLITYCOMBINED SINGLE LIMIT AUTOMBILELIABIITY Ea accident)$
ANY AUTO BODILY IN JURY (Per person)
ALL OWNED SCHEDULED BODILY INJURY IPer accident) $
__AUTOS
__AUTOS NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS
__AUTOS (Per accident)$
__UMBRELLA LIAB OCCUR EACH OCCURRENCE S
EXCESS LIAB CLAIMS-MADE AGGREGATE DEDDED RETENTIONS$
WORKERS COMPENSATION IPER OH AND EMPLOYERS' LIABILITY Y'
ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
[ 2 JN/ A A__________
(Mandatory 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 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 apace 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.
AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services Eric t Kolstad E
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 021716 LOC #: San Francisco ACORD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED MARSH RISK & INSURANCE SERVICES PACIFIC GAS & ELECTRIC COMPANY
__________________________________________________ONE MARKET SPEAR TOWER POLICY NUMBER SUITE 2400 SAN FRANCISCO, CA 94105 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 LIABIUITY INSURANCE This is to certify that there is in force as of the effective date of this Certificate a Nuclear Energy Uiability Insursance 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 pdior to the end of December 31 st of the calender year in which the Effective Date of this Certificate occurs, notice mill be delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate an of the end of such December 31st. A Certificate mill 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 FACILUTIES:
- 1. SITE #1 - DIABLO CANYON LOCATION OF NUCLEAR FACILITY: Diablo Canyon Nuclear Power Plant 12 MI WSW of San Luis Obispo, CA NAMED INSURED [LISTED ON POLICY]: Pacific Gas and Electric Company POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
N F-0228 07/05/1 974
$376 Million NW-0605 07/05/1 974
$375 Million**
N-0074 09/22/1981 N-0076 04/26/1 985
- 2. SITE #2 - HUMBOLDT BAY LOCATION OF NUCLEAR FACILITY: Humboldt Bay Nuclear Power Plant (Shutdown July 76) in Humboldt County, Californie NAMED INSURED [LISTED ON POLICY]: Pacific Gas and Electric Company POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0113 01/01/1962
$53.3 Million NW-0534 01/01/1 998
$375 Million**
THIS CERTIFICATE IS ISSUED AS A MATIER 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 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 Uability shown above may have been reduced by payment of claims or claims expenoes.
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 all of the provisions of such Policy and Certificate having reference thereto. Such limit may have been reduced by payment of claims or cinims 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
ACO1RD CERTIFICATE OF LIABILITY INSURANCE S DATE (MMIODDYYYY) 01/11/12016 THIS CERTIFICATE IS ISSUED AS A MATTrER 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 MARSHUSAINC.NAME:
MRHUA N.PHONE FAX TWO ALUIANCE CENTER ANCNoExt):
(A/C No):
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 INSU RED INSURER B:
Tennessee Valley Authority Attention: Kirk Kelley INSURER C :
400 W. Summit Hill Drive, WT 4C INSURER D0:
Knoxville, TN 37919 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 TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADOL. SUBIt POLICY EFF POLICY EXP LTR TYPE OF INSURANCE gR*p WVp POLICY NUMBER IMMIDDIYYYYI
{MMIDD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE II DAMAGE TO RENTED CLAIMS-MADE Lj OCCUR PREMISES lEa occurrence)
____________________________MED EXP (Any one person)
_________________PERSONAL
&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE SPOLICY JEC PRO
[
LOC PRODUCTS -COMP/OPAGG OTHER:$
_AUTOMOBILE LIABILITY COMBINED(E acetSINGLE LIMIT ANY AUTO BODILY INJURY (Per person)
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS
__AUTOS (Per accidenlt)
-- UMBRELLA LIAB
[*
OCCUR EACH OCCURRENCE EXCESS LIABR CLAIMS-MADE AGGREGATE S
DEDDED RETENTIONS $______________$_____
WORKERS COMPENSATION PER 0H AND EMPLOYERS' LIABILITY YIN' EA~IJR ________
ANY PRO PRIETOR/PARTNERJEXECUTIVE F1 E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
[+/-N/
A (Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below
___E.L.
DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101 see addl page text Insurance DESCRIPTION OF OPERATIONS ( LOCATIONS ( VEHICLES (ACORD l01, 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Ronald A. Santaniello.
_*¢,,.J
© 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 AWORD ADDITIONAL REMARKS SCHEDULE Page 2
of3 AGENCY NAMED INSURED MARSH USA, INC.
Tennessee Valley Autthonty Attention: Kirk Kelley POLICY NUMBER 400 W. Summit Hill Drive, WVT 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 CERTIFICATE OP NUCLEAR ENERGY LIABIUTY INSURANCE This is to certify that there is in force as of the effective date of this Certificate a Nuclear Energy Uability Insurance Policy issued by members of American Nuclear Insurers as indicated (Companies), to the Innured named herein, with raspect to the Nuclear Facility at the Location shown and/or with respect to the Insured's operations described herein, if such policy in cancelled or otherwise terminated prior to the end of December 31st of the calendar year in which the Effective Date ot this Certificate occurs, notice will be delivered in accordance with the policy provisions. Dtheawse this Certificate shall terminate as of the end of such December 31st. A Certifcate 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 Supplieris & Transporters], ES - [Foreign Suppliers & Transporters], N - [Secondary Financial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - BROWNS FERRY LOCATION OF NUCLEAR FACILITY:
Browss 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-01g8 09122/1971
$375 Million NW-0581 09/22/1971
$375 Million**
N-0038 08101/1977 N-003g 08/01/1977 N-0040 08101/1977
- 2. SITE #2 - SEOUOYAH LOCATION OF NUCLEAR FACILITY:
Sequsyati 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-06514 03/11/1977
$375 Million**
N-0066 02/29/1980 N-0075 0812511981
- 3. SITE #3 - WATTS BAR LOCATION OF NUCLEAR FACILITY:
Watts Bar Nuclear Power Plant 10 MI S of Spring City, TN NAMED INSURED [USTED ON POLICY]: Tennessee Valley Authority POUCY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0256 09/04/1979
$375 Million NW-0618 09/04/1979
$375 Million" N-0080 11/09/11995**
N-0120 10/22/2015 THIS CERTIFICATE IS ISSUED AS A MATrER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the poilcylies) 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 it is issued shall amesnd, extend or alter the coverage afforded by the policy. The Umit of Uability shown above may have been reduced by payment of claims or claims enpenses.
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 ACORD ADDITIONAL REMARKs scHEDULE Page 3
of3 AGENCY NAMED INSURED MARSH USA, INC.
Tennessee Valley Authority Attention: Kirk Keiley POLICY NUMBER 400 W. Summit Hill Drive, WT 40
~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 Master Worker Certificate - This limint 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 reterence 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
ACORD CERTIFICATE OF LIABILITY INSURANCE SDATE (MMIDD/YYYY) 0110812016 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 NAME:FA PHONEFA CA Ucense #0437153 AIc. No, Extl:
AC, No):
777 South Figuerea Street E-MAIL Los Angeles, CA 90017 ADDRESS:
Attn: LosAngeles.CertRequest~marsh.com IF: 212-948-0535 INSURER(SI AFFORDING COVERAGE NAIC #
08819 -DRI-AII-16-17 INSURER A :American Nuclear Insurers INUEDominion Resources, Inc.INUEB ATTN: Leslie D. Garber INSURER C :
Leslie.Garber@dom.com INSURER D :
701 East Cary Street, 20th Floor Richmond, VA 23219 INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER:
LOS-001839081-05 REVISION NUMBER:8 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWIWTHSTANDING 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.
INSR ADDL SUBH POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INB p V
POLICY NUMBER IMMIDD/YYYY1 IMMIDD/YYYY)
LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE m
DAMAGE TO RENTED CLAIMS-MADE KJOCCUR PREMISES (Ea occurrence)
___________________________MED EXP (Any one personi
_____________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE POLICY LJPJCT :OHR[
LaOC PRODUCTS -OOMP/OP AGO AUTOMOBILE LIABILITY COMEINED 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
- _*OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DEDDED RETENTION $
WORKERS COMPENSATION FI PERH AND EMPLOYERS' LIABILITY Y I NI ELR ANY PROP RIETORIPARTNER/EXECUTrIVE m
E.L. EACH ACCIDENT OFFICERIMEMBER EXCLUDED?
[IjN A
/______A__
tMandatory in NH)
E.L. DISEASE - BA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Liability Sue Attached 01/01/2016 01/01/2017 See Attached Acord Insurance
'Acord 101" 101 DESCRIPTION OF OPERATIONS ILOCATIONS 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.
AUTHORIZED REPRESENTATIVE of March Rick & insurance Services Shannon Moyer
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 08819 LOC #: Los Angeies
.T ACO~RD ADDITIONAL REMARKS SCHEDULE Page 2
of3 AGENCY NAMED INSURED Marsh Risk & Insurance Services Dominion Resources, Inc.
___________________________________________________________ATTN: Leslie D. Garber POLICY NUMBER Leslie.Garber@dom.com 701 East Cary Street, 20th Floor Richmond, VA 23219 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 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 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 termilnated pdior to the end of December 31sat of the calendar year in which the Effective Date of this Certificate occurs, nofice will be delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate as of the end of such December 31sat. A Certificate will NOT be issued for any subsequent calendar year unless requested in writing.
Types of Insurance: NF - [Facility Fermi, NW- [Master Worker Certificate], NS - [US Dowestic Supplier's & Transporters], FS - [Foreign Suppliers & Transporters], N - [Secondary Financial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - NORTH ANNA LOCATION OF NUCLEAR FACILITY: North Anna Nuclear Power Plant 40 MI NW of Richmond, VA NAMED INSURED [LISTED ON POLICY]: Virginia Electric & Power Company POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0240 03/26/1976
$375 Million NW-O610 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 POLICY]: Virginia Electric & Power Company POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0186 06/15/1970
$375 Million NW-0571 06/15/1970
$375 Million" N-0027 08/01/1977 N-0028 06/01/1977
- 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:
NF-0173 05/01/1 969
$375 Million NW-0563 05/01 /1 969
$375 Million**
N-0016 08/01/1977**
N-0103 11/25/1985
- 4. SITE #4 - KEWAUNEE LOCATION OF NUCLEAR FACILITY: Kewaunee Nuclear Power Plant in the Town of Caditon, Kewaunee County, Wisconsin NAMED INSURED [LISTED ON POLICY]: Dominion Energy Kewaunee, Inc.
POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0204 01 /01/1 972
$375 Million NW-0586 01/01/1972
$375 Million**
ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 08819 LOC #: Los Angeles ACORD ADDITIONAL REMARKS SCHEDULE Page 3
of3 AGENCY NAMED INSURED Marsh Risk & Insurance Services Dominion Resources, Inc.
POLICY NUMBER Leslie.Garber@dom.com 701 East Cary Street, 20th Floor CARRIER
/NAIC CODE RcmnV 31 I
EFFECTIVE DATE:
ADDITIONAL REMARKS
[THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:
25 FORM TITLE: Certificate of Liability InsuranceI THIS CERTIFICATE IS ISSUED AS A MATTqER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policylies) is subject to the exclusions, conditions and other provisions of the policylies). 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:
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 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACO2RD CERTIFICATE OF LIABILITY INSURANCE S DATE (MMIDD/YYYY) 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, INC.
NAME:
PHONE FAX TWO ALLIANCE CENTER (A/C, No, Eat):
(A/C, Nol:
3560 LENOX ROAD, SUITE 2400 E-MAIL ATLANTA, GA 30326 ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
713170-NUCLE-*16-17 INSURER A : American Nuclear Insurers INSURED INSURER B :
NextEra Energy, Inc.
A~tn: Erica McNabb INSURER C :
'Edca.A.McNabb@FPL.com INSURER D :
700 Universe Blvd P.O. Box 14000 INSURER E :
Juno Beach, FL 33408 INSURER F: :______
COVERAGES CERTIFICATE NUMBER:
ATL-003533264-06 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE INSD yWV3(
POLICY NUMBER (MMIDDIYYYYI IMMIDDIYYYY)
LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE m
DAMAGE TO RENTED CLAIMS-MADE U OCCUR PREMISES (Ea occurrence)
SMED EXP (Any one person)
SPERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE POLICY D JPO-T LOC PRODUCTS-COMP/OP AGO OTHER:
AUTOOBIL LIAIUTYCOMBINED SINGLE LIMIT AUOOIELlBLT 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 LIABR~
OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DEDBED RETENTION $
WORKERS COMPENSATION FI FF5ER AND EMPLOYERS' LIABILITY Y I NJ~
ANY PROPRIETOR/PARTNER/EXECUTIVE r1 E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
)
N/ A (Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below
______E.L.
DISEASE - POLICY LIMIT A
NUCLEAR ENERGY LIABILITY (see attached) 01/01/2016 01/01/2017 SEE ATTACHED ACORD 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 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
,,,4--",.*,,..o,,L
- ,]u
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 713170 LOC #: Atlanta ACORD ADDITIONAL REMARKS SCHEDULE Page 2
of 3
AGENCY NAMED INSURED MARSH USA, INC.
NextEra Energy, Inc.
___________________________________________________________________Attn:
Erica McNabb POLICY NUMBER Erica.A.McNabb@FPL~com 700 Universe Blvd P.O. Box 14000 CARRIER
/NAIC CODE Juno Beach, FL 33408 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 Thin is to certify that there is in force as of the effective date of this Certificate a Nuclear Energy Uability Inaurance Policy issued by members of American Nuclear Insurers as indicated (Companies), to the Insured named herein, with respect to fhe Nuclear Facility at the Location shown and/or with respect fo the Insured's operations described herein. If such policy is cancelled or otherwise terminated prior to the end ot December 31sat of the calender year in which the Effective Date of this Certificate occurs, notice will be delivered in accordance with the policy provisions. Otherwse this Certificate shall terminate as of the end of such December 31st. A Certificate will NOT be issued for any subsequent caiendar 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 -ST. LUCIE LOCATION OF NUCLEAR FACILITY: St. Lucie Nuclear Power Plant on Hutchinson Island, St Lacde County, Ftorida NAMED INSURED [LISTED ON POLICY]: Florida Power & Ught Company, Ftorida Municipal Power Agency, and Orlando Utilities Commission of the City of Orlando POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0227 06/01/1974
$375 Million NW-0604 06/01 /1 974
$375 Million*
N-0059 08/01/1977 N-0089 04/06/1 983**
- 2. SITE #2 - TURKEY POINT LOCATION OF NUCLEAR FACILITY: Turkey Point Nuclear Power Plant in the Southeast part of Dade County, Florida NAMED INSURED [LISTED ON POLICY]: Florida Power & Ught Company POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
N F-0185 06/01/1970
$375 Million NW-0570 06/01/1970
$375 Million*
N-0025 08/01/1977 N-0026 08/01/1977**
- 3. SITE #3 - SEABROOK LOCATION OF NUCLEAR FACILITY: Seabmook Nuclear Power Plant in Seabreok Township, Rockingham County, New Hampshire NAMED INSURED [LISTED ON POLICY]: NeutEra Energy Seabrook, LLC; Massachusetts Municipal Wholesale Electric Company; Taunton Municipal Light Plant; and Hudson Light and Power Department POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABiLITY:
NF-0296 12/15/1985
$375 Million NW-0647 12115/1985
$375 Million**
N-0109 10/17/1986**
- 4. SITE #4-DUANE ARNOLD LOCATION OF NUCLEAR FACILITY: Duane Arnold Nuclear Power Plant on the Cedar River approx 2 and 1/3 Miles NNE of Palo, Iowa NAMED INSURED [LISTED ON POLICY]: NextEra Energy Duane Arnold, LLC, Central Iowa Power Cooperative and Corn Belt Power Cooperative POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF.0214 05/1 5/1 973
$375 Million NW-0593 05/1 5/1 973
$375 Million" N-0050 08/01/1977**
ACORD 101 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 713170 LOC #: Atlanta ACORD ADDITIONAL REMARKS SCHEDULE Page 3
of3 AGENCY NAMED INSURED MARSH USA, INC.
NextEra Energy, Inc.
_______________________________________________________________Attn:
Erica McNabb POLICY NUMBER Erica.A.McNabb@FPL~com 700 Universe Blvd P.O. Box 14000 CARRIER NAIC CODE Juno Beach, FL 3340B EFFECTIVE DATE:
ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:
25 FORM TITLE: CertifiCate of Liability Insurance
- 5. SITE #5-POINT BEACH LOCATION OF NUCLEAR FACILITY:
Point Beach Nuclear Power Plant in the Town of Two Creeks, Manitowoc County, Wisconsin NAMED INSURED [LISTED ON POLICY]: NextEra Energy Point Beach, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0178 0811211969
$375 Million NW-0565 08/1211969
$375 Million*
N-0018 08/01/1977**
N-0019 08/01/1977**
THIS CERTIFICATE IS ISSUED AS A MATITER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policyyies) is subject to the exclusions, conditions end other provisions of the policyjies). Neither this Certificate nor any contract or other document with inspect to which it is issued shall amend, extend or alter the coverage afforded by the policy. The Umit of Usbility shown above may hnve 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 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
ACcORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 01122/2016 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 445 SOUTH STREET AiCNoExt):
AIC, No}:
MORRISTOWN, NJ 07960-6454 E-MAIL Attn: Morristown.CertRequest@mrnash.corn ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #t 074725-OTU-NUCLE-16-17 INSURER A : American Nuclear Insurers INSURED INSURER B :
PSEG NUCLEAR LLC ATTN: ROBERT GREEN INSURER C :
ROBERT.GREEN2@PSEG.COM INSURER D :
80 PARK PLAZA, MAIL CODE T-6B NEWARK, NJ 07101 INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER:
NYC-007087875-03 REVISION NUMBER: 11 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 IN;D*
POLICY NUMBER IMalDD/Yyyy)'~'
(MMIDD/YyyyI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE II DAMAGE TO RENTED SCLAIMS-MADE U* OCCUR PREMISES (Ea occurrence)
___________________________MED EXP (Any one person)
_____________________PERSONAL
& ADV INJURY GENtL AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE POLICY J ~ECTr LOC PRODUCTS - COMPIOP AGO
__OTHER:
AUTOMOBILE LIABILITY (Ea accident)
ANY AUTO BODILY INJURY (Per person)
ALL OWSNED SCHEDULED BODILY IN JURY (Per accident) $
__AUTOS
__AUTOS NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS
__AUTOS (Per accident)
__UMBRELLA LIAB
[*
OCCUR EACH OCCURRENCE EXCESS LIAB
!CLAIMS-MADE AGGREGATE EDDED RETENTIONS$_____________
WORKERS COMPENSATION IPERSTTT 0 TH-R AND EMPLOYERS' LIABILITY YIN ERN_______
ANY PROPRIETOR/PARTNERIEXECUTIVE r--
E.L. EACH ACCIDENT OFFRCERJMEMBER EXCLUDED?
L iN A
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under D)ESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A NUCLEAR ENERGY LIABILITY SEE ATTACHED ACORD 101 01/0112016 01/0112017 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 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.
AUTHORIZED REPRESENTATIVE of Marsh USA (no.
Manashi Mukherjee
..S"4c.u*,
k.t *Ae*;.AJ-L
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 074725 LOC #: Morristown ACORD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED MARSH USA, INC.
____________________________________________________ATTN: ROBERT GREEN POLICY NUMBER ROBERT. GREEN2@PSEG.C0M 80 PARK PLAZA, MAIL CODE T-6B NEWARK, NJ 07101 CARRIER
/NAIC CODE L
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 Uability 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 31st 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], ES- [Foreign Suppliers & Transporters], N - [Secondary Financial Protection Certficate]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - SALEM NUCLEAR POWER STATIONS AND HOPE CREEK NUCLEAR POWER STATION LOCATION OF NUCLEAR FACILITY: Salem Nuclear Power Plant and Hope Creek Nuclear Power Plant in Lower Alloways Creek Township, Salem County, New Jersey NAMED INSURED [LISTED ON POLICY]: PSEG Nuclear LLC and Exelon Generation Company, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF UABILITY:
NF-0230 10/15/1974
$375 Million NW-0606 10/15/1974
$375 Million*
N-0060 08/01/1977 N-0072 04/1 8/1 980 N-0104 04/1 4/1 986 THIS CERTIFICATE IS ISSUED AS A MATI'ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policy(ies) is subject to the eoclusions, conditions end other provisions of the policy(ies). 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 Uability shown above may have been reduced by payment of claims or claims expenses.
COMMENTS/NOTES:
- Master Worker Certificate - This limit is shared by all Certiticates to the Master Worker Policy ot 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 expeases.
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
AGENCY CUSTOMER ID: ____________________
LeoC #: Minneapolis ACORD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED Marsh USA Inc.
Xcel Energy, Inc.
______________________________________________________________Attn: Robert L. Miller POLICY NUMBER Robert.L.Miller@xcelenergy.com 414 Nicollet Mall, 4th Floor Minneapolis, MN 55401 CARRIER JNAIC CODE L
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 theme is is 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 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 unles;s mequesfed 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 Certitcate]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - PRAIRIE ISLAND LOCATION OF NUCLEAR FACILITY:
Prairie Island Nuclear Power Pleant on the Mississippi River in Goodhue County, Minnesota NAMED INSURED [LISTED ON POLICY]: Northern States Power Company POUCY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0197 09/0f/1 971
$375 Million NW-0580 09/01/1971
$375 Million**
N-0036 08/01/1977**
N-0037 08/01/1977**
- 2. SITE #2 - MONTICELLO LOCATION OF NUCLEAR FACILITY:
Monticello Nuclear Power Plant on the Mississippi River in Wright County, Minnesota NAMED INSURED [LISTED ON POLICY]: Northern States Power Compasy POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0174 06/09/1969
$375 Million NW-0564 06/09/1969
$375 Million" N-0017 08/01/1977 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 policy(ies). Neither this Certificate nor any contract or other document with respect to whigh it is issued shall amend, extend or alter the coverage afforded by the policy. The Umit of Uability 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 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
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 01/12/2016 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 FA 333 South 7th Street, Suite 1400 tAC. No. Ext):
(A/C No):
Minneapolis, MN 55402-2400 E-MAIL ADDRESS:
INSURERtS) AFFORDING COVERAGE NAIC #
-..-NUCLR-15--16 INSURER A : American Nuclear insurers INSURED INSURER B :
Xcel Energy, Inc.
Attn: Robert L. Miller INSURER C :
RobertL.Mi~ler@xcelenergy.com INSURER D :
414 Nicollet Mali, 4th Floor Minneapolis, MN 55401 INSURER B :
INSURER F :
COVERAGES CERTIFICATE NUMBER:
CHI-006140703-03 REVISION NUMBER:9 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWIA'THSTANDING 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.
INSRADOUR POLICY EFF POLICY EXP LTR "FTYPE OF INSURANCE N
V POLICY NUMBER
'MM/DD/YYYY)
(M/DyYYYl LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE m
DAMAGE TO RENTED CLAIMS-MADE [JOCCUR PREMISES lEa occurrencel
____________________________MED EXP (Any one person)
_______________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE D--PRO-I POLICY JECT LOC PRODUCTS -COMP/OP AGO
__OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
~lEa 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*
OCCUR
__ACHOCCURRENCE_
EXCESS LIAB I ICLAIMS-MADE AGGREGATE DEDDED RETENTION $
I$
WORKERS COMPENSATION IPERSTTT 0 TH-E AND EMPLOYERS' LIABILITY Y IN N~AhJS ANY PROPRIETORIPARTNERJEXECUTIVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
L*
N I A_________
(Mandatory In NH)
E.L DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below E.L. 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 Remartrs 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Manashi Mukherjee
..3#o,*.=
© 1988-2014 ACORD CORPORATION. All rights reserved.
The A CORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 01107/2016 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(lest 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 MARS USAINC.NAME:
MAS S N.PHONE FAX 540 W. MADISON tA/C, No, Extt (A/C, No):
CHICAGO, IL 60661 E-MAIL Attn: chicago.CertRequest@marsh.com ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
01 6265-Nucle-Nucle-16-17 INSURER A : American Nuclear Insurers INSURED INSURER B :
FirstEnergy Corporation Attn: Pete Nadel INSURER C :
pnadel@ftrntenergycorp.com INSURER D :
76 South Main Street Akron, OH 44308 INSURER E :
_________________________________________________________INSURER F: :_____
COVERAGES CERTIFICATE NUMBER:
CHI-005417270-04 REVISION NUMBER:7 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 INP V
POLICY NUMBER iMMiDD/YyyyI IMMiDD/Yyyy1 LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE m[
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 m--
PRO-II POLICY LiJECT LOC PRODUCTS-COMP/OP AGO
__OTHER:
AUTOMBILELIABLITYCOMBINED SINGLE LIMIT AUTOMBILELIABIITY Ea accidentt ANY AUTO BODILY INJURY (Per person)
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS
__AUTOS NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS
__AUTOS (Per accidenlt
__UMBRELLA LIAB I-*OCCUR EACH OCCURRENCE EXCESS LIABR
]CLAIMS-MADE AGGREGATE DEDDED RETENTION $
WORKERS COMPENSATION PER 0H AND EMPLOYERS' LIABILITY Y IN ERI_______
ANY PROPRIETORJPARTNERJEXECUTIVE FTF E.L. EACH ACCIDENT OFFICERJMEMBER EXCLUDED?
[J N
A (Mandatory In NH)
EL. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below
______________________E.L.
DISEASE - POLICY LIMIT A
Nuclear Enargy See Attached Acord 101 01/01/2016 01/0112017 See Attached Acord 101 Liability Insurance DESCRIPTION OF OPERATIONS I LOCATIONS/IVEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more epace 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Manashi Mukherjee
.3
.,,.a*
t,.;
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 016265 LOC #: Chicago ACOIRD ADDITIONAL REMARKS SCHEDULE Page 2
of3 AGENCY NAMED INSURED MARSH USA INC.
FirstEnergy Corporation Attn: Pete Nadel POLICY NUMBER pnadel@firstenergycorp.com 76 South Main Street Akron, OH 44308 C:ARRIER
/NAIC CODE
/
EFFECTIVE DATE:
ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:
25 FORM TITLE: Certificate of: Liability InsuranceI CERTIFICATE OF NUCLEAR ENERGY LIABtUTY INSURANCE This is to certify that there is in force as of the effective date of this Certificate a Nuclear Energy Uability 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/sr with respect to the Insured's operations described hemein. 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 will be delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate as of the end of such December 31 st. 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 - BEAVER VALLEY LOCATION OF NUCLEAR FACILITY: Beaver Valley Nuclear Power Plant in Shippingport Borough, Beaver County, Pennsylvania NAMED iNSURED [USTED ON POLICY]: FirstEnergy Nuclear Generation, LLC, Ohio Edison Company, The Toledo Edison Company and FirstEnergy Nuclear Operafing Company POLICY NUMBER:
NF-0226 NW-0603 N-005B N-0110 POLICY EFFECTIVE:
08/01/1974 08/'01
/1974 08/01/1977 05/28/1 987 LIMIT OF LIABILITY:
$375 Million
$375 Million**
- 2. SITE #2 -DAVIS-BESSE LOCATION OF NUCLEAR FACILITY:
Davis-Reuse Nuclear Power Plant on Lake Erie approx 20 miles ESE of Toledo in Ottawa County, Ohio NAMED INSURED [LISTED ON POLICY]: FirstEnergy Nuclear Generation, LLC and FirstEnergy Nuclear Operating Company POLICY NUMBER:
POUCY EFFECTIVE:
LIMIT OF LIABILITY:
N F-0236 11/01/1975
$375 Million NW-0608 11/01/1975
$375 Million*
N-0061 08/01/1 977**
- 3. SiTE #3 -PERRY LOCATION OF NUCLEAR FACILITY: Perry Nuclear Power Plant on Lake Erie approx 35 miles NE of Cleveland, Ohio NAMED INSURED [LISTED ON POLICY]: FirstEnergy Nuclear Generation, LLC, Ohio Edison Company, and FirstEnergy Nuclear Operating Company POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0291 09/01/1984
$375 Million NW-0644 09/01/1984
$375 Million*
N-01 02 03/18/1986
- 4. SITE #4 - SAXTON LOCATION OF NUCLEAR FACILITY: Santon Nuclear Experimental Corporation Facility in Liberty Township, Bedford County, Pennsylvania NAMED INSURED [LISTED ON POLICY]: Saxten Nuclear Experimental Corporation POLICY NUMBER:
POUCY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0107 06/01/1961
$1 Million NW-0532 08/01/1961
$375 Million*
- 5. SITE #5 -THREE MILE ISLAND LOCATION OF NUCLEAR FACILITY: Three Mile Island Nuclear Power Plant in Londondenry Township, Dauphin County, Pennsylvania NAMED INSURED [LISTED ON POLICY]: MetropoLitan Edison Company, Jersey Central Power & Light Cowpany, Pennsylvania Electric Company and CPU Nuclear Inc.
ACORD 101 (2008/01)
©@2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 016265 LOC #:
Chicago ACO¶R.D ADDITIONAL REMARKS SCHEDULE Page 3
of3 AGENCY NAMED INSURED MARSH USA INC.
FirstEnergy Corporation Attn: Pete Nadet POLICY NUMBER pnadet@firstenergycorp.com 76 South Main Street Akron, OH 44308 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 InsuranceI NW-0599 12131/1973
$375 Million**
THIS CERTIFICATE IS ISSUED AS A MAiFER 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 policylies). 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 Uability shown above may have been reduced by payment of claims or claims expenses.
COMMENTS/NOTES:
Master Worker Certificate - This limit is shared by ati 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
ACR CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 0/07/2016 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 Inc.
NAME:
PHONE FAX 1717 Arch Street (A/c, No, Ext):
(A/C, No):
Philadelphia, PA 19103-2797 E-MAIL Attn: Philadelphia.Certs@marsh.com/ Fax - 212-948-0360 ADES INSURER(S) AFFORDING COVERAGE NAIC #
S27339-Exelo-NE-16117 INSURER A :American Nuclear Insurers INSURED INSURER B :
Exelon Corporation ATTN: michael~mee@exeloncorp.com INSURER C :
2301 Market Street, S21-1 INSURER D :
P.O. Box 8699 Philadelphia, PA 19101-8699 INSURER E :
INSURER F: :_____
COVERAGES CERTIFICATE NUMBER:
CLE-004728374-03 REVISION NUMBER:4 THIS IS TO CERTtFY 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 IN*Df WVP POLICY NUMBER I MM/DD/YYYYI IMM/DD/YYYY1 LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE
]
DAMAGE TO RENTED SCLAIMS-MADE L j OCCUR PREMISES lEa occurrence)
___________________________MED EXP (Any one person)
_____________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE POLICY D JPO-T LOC PRODUCTS - COMP/OP AGG OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT l_
Ea accident)_____________
ANY AUTO BODILY INJURY (Per person)
ALL OWNED SCHEDULED BODILY IN JURY (Per accident)
__AUTOS
__AUTOS NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS
__AUTOS (Per accident)$
-- UMBRELLA LIAB l*
OCCUR EACH OCCURRENCE EXCESS LIABR CLAIMS-MADE AGGREGATE EDDED RETENTION $
WORKERS COMPENSATION IESAUEI ITE AND EMPLOYERS' LIABILITY YN I N~J~5 ANY PROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
LI+/-N/ A (Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below
__E.L.
DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached 01/01/2016 01/01/2017 See Attached Acord 101 Insurance "Acord 101" DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mome 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Manashi Mukherjee
- .t kL,
,.;...ade.,
.c,}.L.
© 1988-2014 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: $27339 LOG #: Philadelphia ACO9RD ADDITIONAL REMARKS SCHEDULE Page 2
of 4
AGENCY NAMED INSURED Marsh USA Inc.
Exelon Corporation
__________________________________________________________ATTN:___mich__eATT:
meeca exeee oncorncopcco POLICY NUMBER 2301 Market Street, $21-1 P.O. Box 8699 Philadelphia, PA 19101-8699 CARRIER
/NAIC CODE L
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 Uability Insurance Policy issued by members of American Nuclear Insurers an indicated (Companies), to the Insured named herein, with respect to the Nuclear Facility at the Location shown and/sr with respect to the Insured's operations described herein. If such policy is cancelled or otherwise terminated prior to the end of December 31sat 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 ot such December 31st. A Certificate will NOT be iussed for any subsequent calendar year unless requested in writing.
Types of Insurance: NE - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's & Transporters], ES - [Eoreign Suppliers & Transporters], N- [Secondary Einancial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - BRAIDWOOD LOCATION OF NUCLEAR FACILITY: Braidwood Nuclear Power Plant in Reed Township ot Will County in Northeastern Illinois NAMED INSURED [LISTED ON POLICY]: Exelon Generation Company, LLC POLICY NUMBER:
POUCY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0294 08/21/1985
$375 Million NW-0645 08/21(1985
$375 Million*
N-0108 10/17/1986 N-0115 12118/1987
- 2. SITE #2 -BYRON LOCATION OF NUCLEAR FACILITY: Byron Nuclear Power Plant located south-south east of the City of Byron, Rockvale Township, Ogle County, Illinois NAMED INSURED [LISTED ON POLICY]: Exelon Generation Company, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0277 02/03/1983
$375 Million NW-0634 02/03/1983
$375 Million*
N-0093 10/31/1984 N-0101 11/06/1986
- 3. SITE #.3 - DRESDEN LOCATION OF NUCLEAR FACILITY: Dresden Nuclear Power Plant in Goose Lake Township, Grundy County, Illinois NAMED INSURED [LISTED ON POLICY]: Exelon Generation Company, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF UABILITY:
NF-0043 09/01/1958
$375 Million NW-0514 09/01/1958
$375 Million*
N-0002 08/01/1977 N-0003 08/01/1977
- 4. SITE #4 -LA SALLE LOCATION OF NUCLEAR FACILITY: La Salle Nuclear Power Plant in Brookfield Township, LaSalle County, Illinois NAMED iNSURED [LISTED ON POLICY]: Exelon Generation Company, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0253 08/1 0/1 978
$375 Million NW-0617 08/1 0/1 978
$375 Million**
N-0071 04/1 7/1 982**
N-0083 1 2/18/1983 ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: $27339 LOC #: Philadelphia ACO~RD ADDITIONAL REMARKS SCHEDULE Page 3
of4 AGENCY NAMED INSURED Marsh USA Inc.
Exelon Corporation
__________________________________________________________ATT__:___i____eATT:
eecae xeeeoex orncopcoo POLICY NUMBER 2301 Market Street, $21-1 P.O. Box 8699 Philadelphia, PA 19101-8699 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
- 5. SITE #5 - LIMERICK LOCATION OF NUCLEAR FACILITY:
Limerick Nuclear Power Plant in Southeastern PA on the Schuylkill River, 1.7 miles SE of horough of Pottstown NAMED INSURED [LISTED ON POLICY]: Exelon Generatisn Company, LLC POUCY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0284 03/19/1984
$375 Million NW-0640 03/19/1984
$375 Million" N-0098 10/26/1984 N-01 18 06/22/1989**
- 6. SITE #6 - PEACH BO'i-IOM LOCATION OF NUCLEAR FACILITY:
Peuch Bottom Nuclear Power Plant in Peach Bottom Township, York County, Pennsylvania NAMED INSURED [LISTED ON POLICY]: Exelon Generation Company, LLC and PSEG Nuclear LLC POUCY NUMBER:
POLICY EFFECTIVE:
LIMIT OF UABILITY:
NF-0140 10/05/1964
$375 Million NW-0544 10/05/1984
$375 Million**
N-0008 08/01/1977 N-0009 08/01/1 977
- 7. SITE #7 - OUAD-CITIES LOCATION OF NUCLEAR FACILITY:
0usd-Cities Nuclear Power Plant in Rock Island County, Illinois NAMED INSURED [LISTED ON POLICY]: Exelon Generation Company, LLC and MidAmerican Energy Company POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0187 10/0111970
$375 Million NW-0572 10/01/1970
$375 Million**
N-0029 08/01/I1977 N-0030 08/01/1977
- 8. SITE #8 - CLINTON LOCATION OF NUCLEAR FACILITY:
Clinton Nuclear Power Plant East of the city of Clinton in Dewitt County, Illinois NAMED INSURED [lISTED ON POLICY]: Enelon Generation Company, LLC POUCY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0261 09/05/1 980
$375 Million NW-0621 09/05/1 980
$375 Million" N-0085 09/29/1 988
- 9. SITE #9 - OYSTER CREEK LOCATION OF NUCLEAR FACILITY:
Oyster Creek Nuclear Power Plant in Lacey Township, Ocean County, New Jersey NAMED INSURED [LISTED ON POLICY]: Exelon Generation Company, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0164 10/03/1 967
$375 Million NW-0558 10/03/1967
$375 Million**
N-0013 08/01/1977
- 10. SITE #10 - THREE MILE ISLAND LOCATION OF NUCLEAR FACILITY:
Three Mile Island Nuclear Power Plant in Londonherry Township, Dauphin County, Pennsylvania NAMED INSURED [LISTED ON POLICY]: [FOR NF-0220] Exelon Generation Company, LLC, Metropolitan Edison Company, Jersey Central Power & Light Company, Pennsylvania Electric Company and GPU Nuclear Inc.; [FOR NW-0688[ Enelon Generation Company, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
V.
AGENCY CUSTOMER ID: $27339 LOC #: Philadelphia ACORD ADDITIONAL REMARKS SCHEDULE Page 4
of 4
AGENCY NAMED INSURED Marsh USA Inc.
Exelon Corporation
__________________________________________________________ATTN_____ic__aeATT:
eecae xeleonceonpopcco POLICY NUMBER 2301 Market Street, $21-1 P.O. Box 8699 Philadelphia, PA 19101-8699 CARRIER
/NAIC CODE L
EFFECTIVE DATE:
ADDITIONAL REMARKS
[THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
[FORM NUMBER:
25 FORM TITLE: Certificate of Liability Insurance NF-0220 NW-0688 N-0056 12/03/1973 12/03/1973 08/01/1 977
$375 Million
$375 Million**
- 11. SITE #11 - CALVERT CLIFFS LOCATION OF NUCLEAR FACILITY: Calvert Cliffs Nuclear Power Plant in Calvert County, Maryland NAMED INSURED [LISTED ON POLICY]: Calvert Cliffs Nuclear Power Plant, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0216 06/27/1 973
$375 Million NW-0595 06t27/1 973
$375 Million" N-0052 08/01/1 977 N-0053 08/01/1977
- 12. SITE #12 - NINE MILE POINT LOCATION OF NUCLEAR FACILITY: Nine Mile Point Nuclear Power Plant on Luke Ontario 8 miles NE of Oswego, Oswego County, New York NAMED INSURED [LISTED ON POLICY]: Nine Mile Point Nuclear Station, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
N F-0161 06/1 4/1 967
$375 Million NW-0557 06/14/1967
$375 Million**
N-0012 08/01/1977 N-0105 10/31/1986
- 13. SITE #13 -R. E. GINNA LOCATION OF NUCLEAR FACILITY: R. E. Ginna Nuclear Power Plant located in Ontario, New York.
NAMED INSURED [LISTED ON POLICY]: R.E. Ginna Nuclear Power Plant, LLC POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
N*F-0170 11/01/1968
$375 Million NW-0561 11/01 /1 968
$375 Million" N-0014 08/01/1977 THIS CERTIFICATE IS iSSUED AS A MATIER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policy~ies) is subject to the exclusions, condifions and other provisions of the policy~ies). 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 Uwit of Uiability shown above way have been reduced by payment of claims or claims expenses.
COMMENTS/NOTES:
- Maxter Worker Certificate - This limit is shamed 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 raUng plan.
ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 01/11/2016 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 Mars USAInc.NAME:
Mas S n.PHONE FAX 2405 Grand Boulevard, #900 IA/C, No, Ext:
(A/C, No):
Kansas City, MO 64108 E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #t B22759-OPPD-NRC-16-17 INSURER A : American Nuclear Insurers INSURED INSURERS :
Omaha Public Power District Attn: Uisa Hough INSURER C :
444 S 16th Street INSURER D :
Mall BE/EP1 Omaha, NE 68102 INSURER E2:
_________________________________________________________INSURER F: :_____
COVERAGES CERTIFICATE NUMBER:
CHI-005941393-02 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBSR POLICY 2FF POLICY EXP LTR TYPE OF INSURANCE IN*
WyP POLICY NUMBER (MMIDD/YYYYI IMM/DDIYYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACI-OCCURRENCE m
DAMAGE TO RENTED CLAIMS-MADE ~JOCCUR PREMISES (Ea occurrence)
__________________MED EXP (Any one peraon)
S
_____________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE FiIPRO-m--
POLICY LiJECT LOC PRODUCTS - COM P/OP AGG
___OTHER:
AUTOMBILELIABLITYCOMBINED SINGLE LIMIT AUTOMBILELIABIITYtEa 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 LIAR OCCUR EACH OCCURRENCE EXCESS LIAR I
CLAIMS-MADE AGGREGATE DEDDED RETENTION $
WORKERS COMPENSATION STuTPER 0 TH-R AND EMPLOYERS' LIABILITY iYIII N~f ANY PRDPRIETORIPARTNER/EXECUTIVE FTF E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
[jN
/ A (Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE $
If yea, deacribe under DESCRIPTION OF OPERATIONS below
_E.L.
DISEASE - POLICY LIMIT A
NUCLEAR ENERGY LIABILITY SEE ATTACHED ACORD 101 01/01/2016 01/01/2017 SEE ATTACHED ACORD 101 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarka Schedule, may be attached if more apace 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.
AUTHORIZED REPRESENTATIVE of Mersth USA Inc.
Manashi Mukherjee
.3'.,ttaiet
- .2tacis.c+/-
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014101)
AGENCY CUSTOMER ID:" B22759 LOC #: Kansas City
.0*
A CORD
'4.-.
ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED Marsh USA Inc.
Omaha Public Power District
___________________________________________________________________Attn: Usa Hough POLICY NUMBER 444 S316th Street Mall 8EJEP1 Omaha, NE 68102 CARRIER
/NAIC CODE L
EFFECTIVE DATE:
ADDITIONAL REMARKS rTHIS 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 certity that there is is force as of the effective date of this Certificate a Nuclear Energy Uability Insurance Policy issued by members ot Aeericen Nacteer 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 soch policy is cancelled or otherwise terminated prior to the end of December 31sat ot the calendar year is 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 ot such December 31st. A Certificate will NOT be issued for any sobsequent 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 & Travsporters], N -[Secondary Financial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - FORT CALHOUN LOCATION OF NUCLEAR FACILITY: The Fort Calhoun Station is situated on the southwest bank of the Mississippi River in Washington Cosnty, Nebraska.
NAMED INSURED [LISTED ON POLICY]: Omaha Public Power District POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
N F- 0207 12/15/1972
$375 Millio n
NW-0588 12/15/1972
$375 Million**
N-0046 08/01/1977**
THIS CERTIFICATE IS ISSUED AS A MAT-IER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policy(ies) is subject to the exclusions, conditions sod other provisions of the policy(ies). 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 Uability shown above may have been reduced by payment of claims or claims espenses.
COMMENTS/NOTES:
- Master Worker Certifi cute - This limit is shared by all Certificates to the Master Worker Policy of which each Certiti cats is a part and is subject to all ot the provisions of such Policy and Certificate having reference thereto. Such limit may have bees redsced by paymant of claims or claims expenses.
- Secondary Financial Protection Certificafe - Financial protection available under an industry retrospective rating plan.
ACORD 101 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACO~RD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 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 endorsement(s).
PRODUCER CONTACT Marsh USA Inc.
NAME:
PHONE FAX 600 Dallas St, Suite 1500 AIC.No.Ext):
AIC, No):
Houston, TX 77002 E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
377089-Wolf-Nucle-16-17 INSURER A : American Nuclear Insurers INSUREDINUEB:
Wolf Creek Nuclear Operating Corporation ISRRB Attn: Angela Cool INSURER C :
Angela.Cool@westarenergy.com INSURER D :
818 Kansas Avenue P.O. Box 889 INSURER B Topeka, KS 66601 INSURER F:
COVERAGES CERTIFICATE NUMBER:
HOU-002496763-02 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
~TYPE OF INSURANCE NSD WVD POLICY NUMBER MMDYYY(MDDYY)LIMITS COMMERCIAL GENERAL LIABlUTY EAC-H OCCURRENCE F1 DAMAGE TO RENTED CLAIMS-MADE
[]
OCCUR PREMISES tEa occurrence)
___________________________MED EXP (Any one person)
______________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE POLICY Li PROCT [
LOC PRODUCTS -COMP/OP AGO
__OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I
(_ ea accident)
ANY AUTO BODILY INJURY (Per person)
ALL OWVNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS
__AUTOS (Per accident)
__UMBRELLA LIAB
- JOCCUR EACH OCCURRENCE EXCESS LIABR ICLAIMS-MADE AGGREGATE
__DEDI RETENTIONS WORKERS COMPENSATION PER 0H STATUTE ERITH AND EMPLOYERS' LIABILITY Y I N E
ANY PROPRIETORJPARTN ER/EXECUTIVE u-E.L. EACH ACCIDENT OFFICERIMEMBER EXCLUDED?
1
_ N I A (Mandatory In NH)
E.L DISEASE - BA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below
______E.L 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 ILOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mome apace 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.
AUTHORIZED REPRESENTATIVE of Marsh USA Inc.
Manashi Mukherjee
-..,SY 4.,
- ,-,*o5-~ A-eua~-
0 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD A CORD 25 (2014101)
AGENCY CUSTOMER ID: 377089 LOC #: Houston ACOIRD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED Marsh USA Inc.
Wolf Creek Nuclear Operating Corporation
______________________________________________________________Attn: Angela Cool POLICY NUMBER Angela.Cool~westarenergy.comn 818 Kansas Avenue P.O. Box 889 CARRIER NAIC CODE Topeka, KS 66601 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 is 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 in cancelled or otherwise terminated prior to the end of December 31sf of the calendar year in which the Effective Date ot this Certificate occurn, notice will be delivered in accordance with the policy provisions. Otherwise this Certificete shall terminate as of the end of each December 31sf. A Certificate will NOT be issued for any subsequent calendar year unless requested in writing.
Types of Insurance: NE - [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 - WOLF CREEK LOCATION OF NUCLEAR FACILITY:
Wolf Creek Generating Station in Burlington, Kansas NAMED INSURED [LISTED ON POLICY]: Wolf Creek Nuclear Operating Corporation; Kansas Gas and Electric Company (formerly KCA Corporation); Kansas City Power & Light Company; Kansas Electric Power Cooperative, Inc.; Westemn Resources, Inc.
POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0283 02/17/198i4
$375 Million NW-0639 02/17/198i4
$375 Million*
N-0099 03/11/1985**
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS ND RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policylies) is subject to the esclusionu, conditions and other provisions of the policylies). 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 ot Uability 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 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
AGENCY CUSTOMER ID: J361 05 LOG #: Salt Lake City A*RD ADDITIONAL REMARKS SCHEDULE Page 2
of2 SAGENCY NAMED INSURED Marsh USA Risk & Insurance Services ZionSolutions, LLC and Exelon Generation Company, LLC POLICY NUMBER Attn: Layne Ashton 423 West 300 South, Suite 200 Salt Lake City, UT 84101 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 01 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 of1December 31sat 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[
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:
LIMIT OF LIABILITY:
NF-0201 12/16/1971
$100 Million NW-0584 12./'611971
$375 Miiiion*
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 policy(Jes). 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:
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, accept 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 all of the provisions ofi such Policy and Certificate having reference thereto. Such limit may have been reduced by payment of claims or claims expenses.
ACORD 101 (2008101)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 01107/2016 THIS CERTIFICATE IS ISSUED AS A MA'ITER 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 NAME:
Marsh USA Risk & Insurance Services PHONE FAX 15 West South Temple, Suite 700 fA/C. No, Ext):
A/C, No):
Salt Lake City, UT 84101 E-MAIL Attn: SsltLakeCity.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 :
ZionSolutions, LLC and Exelon Generation Company, LLC INSURER C :
Attn: Layne Ashton INSURERD :
423 West 300 South, Suite 200 Salt Lake City, UT 84101 INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER:
SEA-002671181-03 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVfl POLICY NUMBER IMM/DD/YYYYI IMMIDDIYYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE m
DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence)
SMED EXP (Any one person)
_____________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
[*
PRO-F7 POLICY JECT L2LOC PRODUCTS - COMP/OP AGG
__OTHER:
AUTOMBILELIABLITYCOMBINED SINGLE LIMIT AUTOMBILELIABLITY(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 LIAR OCCUR EACH OCCURRENCE EXCESS LIABR ICLAIMS-MADFE AGGREGATE DEDDED RETENTION $
WORKERS COMPENSATION PER OH ERTATUTE_____OTH'E__
AND EMPLOYERS' LIABILITY Y IN ANY PROPRI ETORJPARTNERJEXECUTIVE r1 E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
[*
N I A_________
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below
______E.L DISEASE - POLICY LIMIT $
A Nuclear Energy Liability NJF-0201 01101/2016 01/01/2017 See attached Acord 101 Insurance See Attached Acord 101' DESCRIPTION OF OPERATIONS I 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 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 Risk & Insurance Services Monica Poulsen i:'e/,:.Z,7<2=-,-
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
ACv R
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/14/2016 THIS CERTIFICATE IS ISSUED AS A MATT-ER 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 MARSHUSAINC.NAME:
MRHUAIN.PHONE FAX 99 HIGH STREET IAIC.No.EXt}:
AIC, No):
BOSTON, MA 02110 E-MAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
024880-AII-NucI-16-17 INSURER A : American Nuclear Insurers INSURED INSURER B :
General Electric Company Attn: Scott McCurdy INSURER C :
scott~mccurdy@ge.com
]NSURER D :
3135 Easton Turnpike - W3F Fairfield, CT 06828 INSURER E :
INSURER F: :_____
COVERAGES CERTIFICATE NUMBER:
NYC-007487487-03 REVISION NUMBER: 12 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWAITHSTANDING 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 gN*p WVjD POLICY NUMBER IMM/DD/YyyyI
'MMIDDIYyyy1 LIMITS COMMERCIAL GENERAL LIABILITY EAC-H OCCURRENCE m
DAMAGE TO RENTED CLAIMS-MADE L.JOCCUR PREMISES (Ea occurrence)
___________________________MED EXP (Any one person)
______________________PERSONAL
& ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE IIPRO-II]
POLICY LJ JECT LJLOC PRODUCTS -COMP/OP AGG
__OTI-ER:
AUTOMBILELIABLITYCOMBINED SINGLE LIMIT AUTOMBILELIABLITY(Ca 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*
OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DEDDED RETENTIONS WORKERS COMPENSATIONSTA TPER 0 RTH-AND EMPLOYERS' LIABILITY YIN N~AUJL&
ANY PROPRIETORIPARTNERIEXECUTIVE F7F EL. EACH ACCIDENT OFFICERJMEMBER EXCLUDED?
j N I A (Mandatory in NH)
E.L. DISEASE - CA EMPLOYEE $
If yes, describe under D)ESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Uability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101 Insurance DESCRIPTION OF OPERATIONS I LOCATIONS ( 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 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.
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 024880 LOC #: Boston ACO~RD ADDITIONAL REMARKS SCHEDULE Page 2
of2 AGENCY NAMED INSURED MARSH USA, INC.
General Electric Company
___________________________________________________________Attn: Scott McCurdy POLICY NUMBER scott.mccurdy@ge.com 3135 Easton Turnpike - W3F Fairfield, CT 06828 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 ot this Certificate a Nuclear Energy Uahility 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 descnibed herein, If ouch policy is cancelled or otherwise terminated prior to the end of Decemher 3lstoftthe calendar year in which the Eftective Date of this Certificate occurs, notice will he delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate assof the end of such December 31st. A Certificate will NOT be issued for any subsequent calendar year unless requested in writing.
Types of Insurance: NE--
[Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's & Transporters], ES - [Foreign Suppliers & Transporters]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - VALLECITOS, CA MANUEACTURING EACILITY LOCATION OF NUCLEAR FACILITY: The GE-Hitachi Vallecitos Nuclear Center Facility 6705 Vallecitos Road, Sunol, California NAMED INSURED [LISTED ON POLICY]: GE-Hitachi Nuclear Energy Americas LLC [NOTE 1]
POLICY NUMBER:
POLICY EFEECTIVE:
LIMIT OF LIABILITY:
NF-0001 03/22/1957
$25 Million NW-0500 03/22/1957
$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 policylies) in 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 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:
- 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.
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)
ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD