Text

Certificate of Liability Insurance
	ML16067A084
Person / Time
Site:	Fort Calhoun
Issue date:	01/11/2016
From:	Mukherjee M; Marsh USA
To:	; Document Control Desk, Office of Nuclear Reactor Regulation
References
	Download: ML16067A084 (3)
	v • d • e

0O0016 9 SP )0027 -O01 -P01669-1 Document.C~ntrol Desk, .

U.S.*Nuclear Regulatory Cornlrnissiorn Washington,D.;2*05*5,-OO01* ,.

1) (.

04.

A L DATE (MMIDD/YYYY)

ACORE]I CERTIFICATE OF LIABILITY INSURANCE 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 requi.re an endore=3ment. A statement on this certificate does not confer rights to the certificate holder in lieu oV such endorsement(s).

PRODUCER CONT"ACT Mars USAInc.NAME:

Mas S n.PHONE FAX 2405 Grand Boulevard, #900 (AICNo, EA (C,*o):

Kansas City, MO 64108 E-MAIL ADDRESS:

INSURER(S) AFFORDING COVERA*GE NAIC #

B22759-OPPD-NRC-16-17 INSURER A : American Nuclear Insurers INSURED Omaha Public Power DistrictI 1INSURER E :

Attn: Lisa Hough INSURER C :

444 S 16th Street INSURER D :

Mall 8E/EP1I Omaha, NE 68102 INSURER E :

________________________________________________________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 LTR __ TYPE OF INSURANCE ADDL IN.P .WSUER POLICY NUMBER POLICY EFF I (MM~cIEYYYY)

(MJIDD/fl'~y) POLICY EXP I LMT LIMITS________

COMMERCIAL GENERAL UABILITY EACH OCCURRENCE I$

fl7 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence) 4$

_____________________________MED EXP (Any one person) $

______________________PERSONAL & ADV INJURY $_______

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

POLICY JE T [* LOC PRODUCTS - COMP/OP AGG $

OTHER: $

AUTOOBIL UABLITYCOMBINED SINGLE LIMIT $

AUOOIEUBLTlEa accident) $___________

ANY AUTO BODILY INJURY (Per person) $

ALL OWNED l SCHEDULED BDL NUY(e ciet

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

__HIRED AUTOS __AUTOS (Per accident) $

IUMBRELLA L!'AB OCCUR EACH OCCURRENCE $

EXCESS LIAB CLAIMS-MADE AGGREGATE ,

DEDI RETENTIONS ___________________ $

WORKERS COMPENSATION, PER 0 ITH-AND EMPLOYERS' LIABILITY YIH TTUE E ANY PROPRIETOR/PARTNER/EXECUTIVE FW E.L. EACH ACCIDENT $

OFFICER/MEMBER EXCLUDED? [Lj_ N /A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $

If yes, describe underI DESCRIPTION OP OPERATIONS below __ 1.____ E.L. DISEASE - POLICY LIMIT $

A UCLEAR ENERGY LIABILITY - jEE ATTACHED ACORD 101 101/01/2016 01/01/2017 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 Inc.

4 Manashi Mukherjee ,I.'*' .. oi,*.ie, t.

The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)

AGENCY CUSTOMER ID: B22759 LOC #: Kansas City

-'---Itt, ~

ACORO ADDITIONAL REMARKS SCHEDULE Page 2 of2 C-AGENCY NAMED INSURED Marsh USA Inc. Omaha Public Power.District

________________________________________________________________Attn: Uisa Hough P'OLICY NUMBER 444 S 16th Street Mall8E/EPI Omaha, NE 68102 CARRIER NAIC CODE EFFECTIVE DATE=:

ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS ASCHEDULETO ACORD FORM, 'I FORM NUMBER: 25 FORM TITLE: Certificate of, Liability Insurance CERTIFICATE OF NUCLEAR ENERGY LIABILITY INSURANCE This is to cerlifythat there is in force as of the effective date of this Certificate a Nuclear Energy Liability Insurance Policy issued by members of American Nuclear Insurers as indicated (Companies), to the Insured named herein, with respect to the Nuclear Facility at the Location shown and/or with respect to the Insured's operations described herein. If such policy is cancelled or otherwise terminated prior to the end of December 31st of the calendar year in which the Effective Date~of this Certificate occurs, notice willbe delivered in acconiance 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 Certiflcatej, NS - [US Domestic Supplier's &Transporters], FS - [Foreign Suppliers &Transporters], 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 County, Nebraska.

NAMED INSURED [LISTED ON POLICY]: Omaha Public Power District POLICY NUMBER: POLICY EFFECTIVE: LIMITOF LIABILITY:

NF- 0207 12/1 5/1972 $375 Million NW-0588 12/15/1972 $375 Million**

N-0046 08/01/1977

THIS CERTIFICATE IS ISSUED AS AMATTER 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 illis issued shall amend, extend or alter the coverage afforded by the policy. The Uimitof Liability shown above may have been reduced by payment ot claims or claims expenses.

COM.,MENTS/NOTES:

- Master Worker Certificate - This limit is shared by allCertificates to the Master Worker Policy of which each Certificate is a part and issubject to allof the provisions of such Policy and Certificate having reference tir.ereto. Such limit may have been reduced by payment of claims or claims expenses.

- Secondary Financial Protection Certificate - Financial protection available under an industry retrospective rating plan.

The ACORD name and logo are registered marks of ACORD

0O0016 9 SP )0027 -O01 -P01669-1 Document.C~ntrol Desk, .

U.S.*Nuclear Regulatory Cornlrnissiorn Washington,D.;2*05*5,-OO01* ,.

1) (.

04.

A L DATE (MMIDD/YYYY)

ACORE]I CERTIFICATE OF LIABILITY INSURANCE 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 requi.re an endore=3ment. A statement on this certificate does not confer rights to the certificate holder in lieu oV such endorsement(s).

PRODUCER CONT"ACT Mars USAInc.NAME:

Mas S n.PHONE FAX 2405 Grand Boulevard, #900 (AICNo, EA (C,*o):

Kansas City, MO 64108 E-MAIL ADDRESS:

INSURER(S) AFFORDING COVERA*GE NAIC #

B22759-OPPD-NRC-16-17 INSURER A : American Nuclear Insurers INSURED Omaha Public Power DistrictI 1INSURER E :

Attn: Lisa Hough INSURER C :

444 S 16th Street INSURER D :

Mall 8E/EP1I Omaha, NE 68102 INSURER E :

________________________________________________________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 LTR __ TYPE OF INSURANCE ADDL IN.P .WSUER POLICY NUMBER POLICY EFF I (MM~cIEYYYY)

(MJIDD/fl'~y) POLICY EXP I LMT LIMITS________

COMMERCIAL GENERAL UABILITY EACH OCCURRENCE I$

fl7 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence) 4$

_____________________________MED EXP (Any one person) $

______________________PERSONAL & ADV INJURY $_______

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

POLICY JE T [* LOC PRODUCTS - COMP/OP AGG $

OTHER: $

AUTOOBIL UABLITYCOMBINED SINGLE LIMIT $

AUOOIEUBLTlEa accident) $___________

ANY AUTO BODILY INJURY (Per person) $

ALL OWNED l SCHEDULED BDL NUY(e ciet

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

__HIRED AUTOS __AUTOS (Per accident) $

IUMBRELLA L!'AB OCCUR EACH OCCURRENCE $

EXCESS LIAB CLAIMS-MADE AGGREGATE ,

DEDI RETENTIONS ___________________ $

WORKERS COMPENSATION, PER 0 ITH-AND EMPLOYERS' LIABILITY YIH TTUE E ANY PROPRIETOR/PARTNER/EXECUTIVE FW E.L. EACH ACCIDENT $

OFFICER/MEMBER EXCLUDED? [Lj_ N /A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $

If yes, describe underI DESCRIPTION OP OPERATIONS below __ 1.____ E.L. DISEASE - POLICY LIMIT $

A UCLEAR ENERGY LIABILITY - jEE ATTACHED ACORD 101 101/01/2016 01/01/2017 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 Inc.

4 Manashi Mukherjee ,I.'*' .. oi,*.ie, t.

The ACORD name and logo are registered marks of ACORD ACORD 25 (2014/01)

AGENCY CUSTOMER ID: B22759 LOC #: Kansas City

-'---Itt, ~

ACORO ADDITIONAL REMARKS SCHEDULE Page 2 of2 C-AGENCY NAMED INSURED Marsh USA Inc. Omaha Public Power.District

________________________________________________________________Attn: Uisa Hough P'OLICY NUMBER 444 S 16th Street Mall8E/EPI Omaha, NE 68102 CARRIER NAIC CODE EFFECTIVE DATE=:

ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS ASCHEDULETO ACORD FORM, 'I FORM NUMBER: 25 FORM TITLE: Certificate of, Liability Insurance CERTIFICATE OF NUCLEAR ENERGY LIABILITY INSURANCE This is to cerlifythat there is in force as of the effective date of this Certificate a Nuclear Energy Liability Insurance Policy issued by members of American Nuclear Insurers as indicated (Companies), to the Insured named herein, with respect to the Nuclear Facility at the Location shown and/or with respect to the Insured's operations described herein. If such policy is cancelled or otherwise terminated prior to the end of December 31st of the calendar year in which the Effective Date~of this Certificate occurs, notice willbe delivered in acconiance 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 Certiflcatej, NS - [US Domestic Supplier's &Transporters], FS - [Foreign Suppliers &Transporters], 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 County, Nebraska.

NAMED INSURED [LISTED ON POLICY]: Omaha Public Power District POLICY NUMBER: POLICY EFFECTIVE: LIMITOF LIABILITY:

NF- 0207 12/1 5/1972 $375 Million NW-0588 12/15/1972 $375 Million**

N-0046 08/01/1977

THIS CERTIFICATE IS ISSUED AS AMATTER 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 illis issued shall amend, extend or alter the coverage afforded by the policy. The Uimitof Liability shown above may have been reduced by payment ot claims or claims expenses.

COM.,MENTS/NOTES:

- Master Worker Certificate - This limit is shared by allCertificates to the Master Worker Policy of which each Certificate is a part and issubject to allof the provisions of such Policy and Certificate having reference tir.ereto. Such limit may have been reduced by payment of claims or claims expenses.

- Secondary Financial Protection Certificate - Financial protection available under an industry retrospective rating plan.

The ACORD name and logo are registered marks of ACORD

ML16067A084

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