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Certificate of Liability Insurance for Arizona Public Service Company
	ML17025A033
Person / Time
Site:	Palo Verde
Issue date:	01/05/2017
From:	; Acord Corporation, Marsh USA
To:	; Arizona Public Service Co, Document Control Desk, Office of Nuclear Reactor Regulation
References
	Download: ML17025A033 (4)
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ACORD

'--...-*-"' CERTIFICATE OF LIABILITY ~NSURANC!E THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION O~JlY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I DATE (MM/DD/YYYY) 01/05/2017 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIC~'.:~

BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTR".CT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

IMPORTANT: If the certificc:te holder os an ADDITIONAL INSURED, the policy(ies) must be c;,.dorsecl. If SUBROGATION IS WAIVED, subject to the terms and conditions o1 the policy, certain policies may require an endorsemer:t A statement on this certificate does not confer rights to ~he certificate holder in lieu of cuch eridorsement(s).

PRODUCER CONTACT NAME:

Marsh USA Inc.

500 Dallas Street, Suite 1500 PHONE IMC No i::rtl*

I IA/C FAX Nol:

Houston, TX 77002 E-MAIL ADDRESS:

INSURERCSI AFFORDING COVERAGE NAIC#

J03175-Sp-17-18 INSURER A : American Nuclear Insurers INSURED INSURERS:

Arizona Public Service Company, et a1*

Mail Station: 9618 PO Box 53999 INSURERC:

Phoenix, AZ. 85072-3999 :.~_~f~

INSURERD:

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INSURERE:

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INSURERF:

COVERAGES CERTIFICATE NUMBER: HOU-002668951-07 REVISION NUMBER:33 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIQD;:~.::.

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;~:**~:!

EXCLUSiOMS AMO COi'!DITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEErl REDUCED BY PAID CLAIMS. ..

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INSR LTR TYPE OF INSURANCE ......... SUBR

~.DDL lun.n POLICY tlUMBER (~~gg}:,~,

. '.ICY EXP

. . ;OD/YYYYl LIMITS

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cm;*.::ERCIAL GEN2:RAL LIABILITY EACH OCCURRENCE $

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D CLAIMS-MADE D OCCUR DAMAGE TO RENTED PREMISES <Ea occurrencel $

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MED EXP (Any one person) $ ~ '<£,.'"I'~

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PERSONAL & ADV INJURY $ 1;:>:.,

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GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

POLICY DPRO- JECT DLOC PRODUCTS - COMP/OP AGG $

OTHER: $

AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $

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<Ea accidentl ANY AUTO BODILY INJURY (Per person) $

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ALL OWNED SCHEDULED BODILY INJURY (Per accident) $

f-- AUTOS ~

AUTOS f--

HIRED AUTOS f--

NON-OWNED AUTOS rp~~~~~d"IJ,t?AMAGE $

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U~lBRELLA EXCESSLIAB LIAB H OCCUR CLAIMS-MADE EACH OCCURRENCE AGGREGATE DED I I RETENTION $ $

WORKERS COMPENSATION PJ<D EMPLOYERS' LIABILITY I PER STATUTE I I OTH-ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE

~ N/A E.l. EACH ACCIDENT $

OFFICER/MEMBER EXCLUDED?

(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 01/01/2017 01/01/2018 See Attached Acord 101 Insurance 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 l

Document Control Desk ~ .JLD ANY OF T:-IE ABOVE DESCRibED t"'OLICIES BE CANCELLED BEFORE U.S. Nuclear Regulatory Commission i.ti EXPIRATIO:*l DATE THEREOF, NOTICE WILL BE DELIVERED IN Washington, DC 20555-0001 .-CCORDANCE lf>lfrH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE of Marsh USA Inc.

Manashi Mukherjee ~'\.A.00!..A. ~:~

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

AGENCYCUSTOMERID:_J_0_3_17_5~~-'-~~~~~~~~~~~~

LOC #: Houston ADD~T~O~JAL REMARKS SCMEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. Arizona Public Service Company, et al' Mail Station: 9618 PO Box 53999 POLICY NUMBER Phoenix, AZ 85072-3999 ICARRIER I NAICCODE EFFECTIVE DATE:

THIS ADDITIONAL REM!\,*i.S FOR.~:ii IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FOh.,*. TITLE: Certificate of Liability Insurance ,

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,_,;J_i.; ~~ *.*** q; CERTIFICATE OF NUCLEAR ENERGY LIABILITY INSURANCE -~~~-;.~. ~~*

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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 Nuc!ear 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 lnsured'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], 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, et al POLICY N_U_MBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:

NF-0266 08/07/1981 $450 Million NW-0625 08/07/1981 $450 Million" N-0088 12/3111984 N-0107 12/09/1985 N-0114 03/25/1987 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.

The following are Named Insureds: Arizona Public Service Company, Southern California Edison Company, Salt River Project Agricultural Improvement and Power District, Public Service Company of New Mexico, El Paso Electric Company, Southern California Public Power Authority, and The Department of Water and Power of the City of Los Angeles.

The ACORD name and logo are registered marks o~ ACORD

ML17025A033

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