Text

Certificate of Liability Insurance
	ML16074A186
Person / Time
Site:	Millstone, Kewaunee, Surry, North Anna
Issue date:	03/01/2016
From:	Moyer S; Marsh Risk & Insurance Services
To:	; Document Control Desk, Office of Nuclear Material Safety and Safeguards, Office of Nuclear Reactor Regulation
References
	Download: ML16074A186 (4)
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57)- *¢2 L 0 0 012 84 SP 0101 -C01-P01284-I Document Control Desk U.S. Nuclear Regulatory Commission Washington, DC 20555-0001 A2*

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ACRE CERTIFICATE OF LIABILITY INSURANCE 03012016 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 & insuranlce Services PHNAE:FA CA License #0437153 AC.o.E:(AIC, NoI:

777 South Flgueroa Street E-MAIL Los Angeles, CA 90017 ADES Atm: LosAngeles.CertRequest@marsh.com IF: 212-948-0535 INSURER S) AFFORDING COVERAGE NAIC #

08819 -DRI-AII-16-17 INSURER A: American Nuclear Insurers INSURED INSURER B :

Dominion Resources, Inc.

AflN: Leslie D.Gatber INSURER C: :____

Leslie.Garber~dom.com INSURER D::_____

701 East Cap/Street, 20th Floor Richmond, VA 23219 INSURER E:

INSURER F::_____

COVERAGES CERTIFICATE NUMBER: LOS-001839081-06 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, 4NS ADDL SUBER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INS WMD POUCY NUMBER (MM/DD/YYYYI 'MMIDD/YYYY) LIMITS COMMERCIAL GENERAL UABILITY EACH OCCURRENCE $

F1 DAMAGE TO RENTED CLAIMS-MADE LJOCCUR PREMISES (Ea occurrencel $

_________________________MED EXP (Any one person) $

___________________PERSONAL & ADV INJURY $

D GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

POLICY, ECOTD L PROOUCTS -COMPIOP AGG OTHER: _____ __________$

_AUTOMOBILE UABIUTY COMBINED(E acieSINGLE LIMIT $

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) $

__UMBRELLA LIAB --- OCCUR EACH OCCURRENCE $

EXCESS LIAB I ICLAIMS-MADE AGGREGATE $

__DED I I RETENTION $________________ $

WORKERS COMPENSATION PER 0H AND EMPLOYERS' LIABILITY YN ER ________

ANY PROPRETORIPARTNERJEEUTIVE OFFICER/MEMBER EXCLUDED? [

-- IEL.

N IA EACH ACCIDENT $

(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 01101/2016 01/01/2017 See Attached Acord Insurance 'Acord 101" 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 RIsk & Insurance Services Shannon Moyer *'~ "

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

AGENCY CUSTOMER ID: 08819 LOC #: Los Angeles AW~RD" ADDITIONAL REMARKS SCHEDULE Page 2 of3 AGENCY NAMED INSURED Marsh Risk & Insurance Services Dominion Resources, Inc.

POLICY NUMBER Leslie.Garber@dora.corn 701 East Gary Street, 20th Floor Richmond, VA 23219 CARRIER NAIC CODE EFCTVDAE ITHIS ADDITIONAL REMARKS 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 by members of American Nuclear Insurers as indicated (Companies), to the Insured named herein, with respect to the Nudlear 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 ot this Certificate occurs, notice willbe delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate as of the end of such December 31st. ACertificate willNOT be issued for any subsequent calendar year unless requested in writing.

Types of Insurance: NF - [Facility Form], NW- [Master Worker Certificate), NS - [USDomestic 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 MlNW of Richmond, VA NAMED INSURED [LISTED ON POLICY]: Virginia Electric &Power Company POLICY NUMBER: POLICY EFFECTIVE: LIMITOF LIABILITY:

NF-0240 03/26/1 976 $375 Million NW-0610 03/26/1976 $375 Million**

N-0063 11126/1977

N-0070 04/1111980 *

2. SITE #2 -SURRY LOCATION OF NUCLEAR FACILITY: Surry Nuclear Power Plant 17 MINW of Newport News, VA NAMED INSURED [LISTED ON POLICY]: Virginia Electric &Power Company POLICY NUMBER: POLICY EFFECTIVE: LIMITOF LIABILITY:

NF-0186 06/1 5/1 970 $375 Million NW-0571 06/15/1970 $375 Million" N-0027 08/01/1977**

N-0028 08/01/1977 *

3. SITE #3- MILLSTONE LOCATION OF NUCLEAR FACILITY: Millstone Nuclear Power Plantf 3.2 MIWSW of New London, CT NAMED INSURED [LISTED ON POLICY]: Dominion Nuclear Connecticut, Inc.

POLICY NUMBER: POLICY EFFECTIVE: LIMITOF LIABILITY:

NF-0173 0510111969 $375 Million NW-0563 05/01/1969 $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 Cartton, Kewaunee County, Wisconsin NAMED INSURED [LISTED ON POLICY]: Dominion Energy Kewaunee, Inc.

POLICY NUMBER: POLICY EFFECTIVE: LIMITOF LIABILITY:

NF-0204 01/01/1972 $375 Million NW-0586 01/01/1972 $375 Million**

The ACORD name and logo are registered marks of ACORD

AGENCY CUSTOMER ID: 08819 LOC #: Los Angeles AC~~RD ADDITIONAL REMARKS SCHEDULE Page 3 of 3 AGENCY NAMED INSURED Marsh Risk & Insurance Services Dominion Resources, Inc.

__________________________________________________ATTN: Leslie D. Garber POLICY NUMBER Leslie.Garberl~dom.com 701 East Cary Street, 20th Floor Richmond, VA 23219 CARRIER INAIC CODE 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 MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.

The insurance afforded by the policy(ies) is subject to the exclusions, conditions and other provisions of the policy(ies). Neither this Certificate nor any contract or other document with respect to which itis issued shall amend, extend or alter the coverage afforded by the policy. The Uimitof 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 1othe Master Worker Policy of which each Certificate is a part and ix subject to all of the provisions of such Policy and Certifcate having reference thereto. Such limit may have been reduced by payment of claims or claims expenses.

"*SecondaryFinancial Protection Certificate - Financial protection available under an industry retrospective rating plan.