ML19295D243
| ML19295D243 | |
| Person / Time | |
|---|---|
| Site: | Columbia  |
| Issue date: | 10/07/2019 |
| From: | Vong V Marsh USA |
| To: | Document Control Desk, Office of Nuclear Reactor Regulation |
| References | |
| CN102299757 | |
| Download: ML19295D243 (3) | |
Text
0 0 044 94 SP 0557 -C01-P04496-I Document Control Desk U.S. Nuclear Regulatory Commission Washington, DC 20555-0001
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ACORD CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATIER 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 I
DATE (MM/DDNYYY) 10/07/2019 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 have ADDITIONAL INSURED provisions or 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, Inc.
1301 5th Avenue, Suite 1900 PHONE IAlf' .,n Cvt\*
I IA/C FAX Nol:
Seattle, WA 98101 E-MAIL ADDRESS:
Attn: Jenelle May 206-214-3082 INSURERISl AFFORDING COVERAGE NAIC#
CN102299757-2D-21 INSURER A : American Nuclear Insurers INSURED ,,,
INSURERB:
Energy Northwest A Joint Operating Agency INSURERC:
PO Box968 INSURERD:
Richland, WA 99352-0968 INSURERE:
INSURERF:
~,.....
COVERAGES CERTIFICATE NUMBER: SEA-003217626-12 REVISION NUMBER: 16 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 SUBR
,.,~n un,n POLICY NUMBER ,&gM%~, POLICY EXP IMM/DDNYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ,:
,___ D CLAIMS-MADE D OCCUR DAMAGE 19i RENTED PREMISES Ea occurrencel $
..*"~,:*
MED EXP (Any one person) $
- ,* **: PERSONAL & ADV INJURY $
- .* **r*
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
~ POLICY DPRO- JECT DLOC PRODUCTS - COMP/OP AGG $
OTHER: $
- AUTOMOBILE LIABILITY
,___ ANY AUTO OWNED AUTOS ONLY
- SCHEDULED
,___ AUTOS COMBINED SINGLE LIMIT
/Ea accidentl BODILY INJURY (Per person)
BODILY INJURY (Per accident) $
- HIRED NON-OWNED fp~~~&:~~RAMAGE $
- AUTOS ONLY ,___ AUTOS ONLY H
UMBRELLA LIAB EACH OCCURRENCE $
- OCCUR EXCESSLIAB CLAIMS-MADE AGGREGATE $
DED I I RETENTION$ $
WORKERS COMPENSATION AND EMPLOYERS' LIABILITY I PER STATUTE I I EROTH-Y/N ANYPROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) D N/A EL EACH ACCIDENT EL DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached Acord 101 01/01/2020 01/01/2021 See Attached Acord 101 DESCRIPTION OF OPERATIONS/ 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.
Van H. Vorig 77=n .,re.vz:,>-V>-?-
I
© 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are re~istered marks of ACORD .
AGENCY CUSTOMER ID: CN102299757 LO C #: Seattle ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA, Inc. Energy Northwest A Joint Operating Agency POLICY NUMBER PO Box 968 Richland, WA 99352-0968 CARRIER I NAICCODE 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 lnsured's operations described herein. 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 - 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 but not limited to the reactors formerly known as WNP 1, WNP 2 and WNP located approximately 12 miles NW of Richland, Washington.
NAMED INSURED !LISTED ON POLICY]: Energy Northwest POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0270 08/01/1982 $450 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:
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD