ML19295D246

Marsh USA, Inc., Certificate of Liability Insurance

ML19295D246
Person / Time
Site:	Columbia
Issue date:	10/07/2019
From:	Vong V Marsh USA
To:	Document Control Desk, Office of Nuclear Reactor Regulation
References
Download: ML19295D246 (3)

Text

0004491 SP 0557 -C01-P04493-I Document Control Desk U;S. Nuclear Regulatory Commission Washington, DC 20555-0001

ACORD DATE (MM/DDNYYY)

~- CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MA TIER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I 10/07/2019 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 PROOUCER, 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 IA/C No Extl:

I IA/C FAX Nol:

Seattle, WA 98101 E-MAIL ADDRESS:

Attn: Jenelle May 206-214-3082 INSURER(Sl AFFORDING COVERAGE NAIC#

CN 102299757-20-21 INSURER A : American Nuclear Insurers INSURED INSURERB:

Energy Northwest A Joint Operating Agency INSURERC:

PO Box 968 INSURERD:

Richland, WA 99352-0968 INSURERE:

INSURERF: .,.....

COVERAGES CERTIFICATE NUMBER: SEA-003289099-06 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.

INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE 1,.,.,n lun,n POLICY NUMBER IMM/DDNYYYI IMM/DD/YYYYI

• LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $

I CLAIMS-MADE D OCCUR ~~~~~~J9E~~:~~ence' $

~

MED EXP (Any one person) $

.__ PERSONAL & ADV INJURY $

R GEN'LAGGREGATE LIMIT APPLIES PER:

POLICY DPRO-OTHER:

JECT DLoc GENERAL AGGREGATE PRODUCTS - COMP/OP AGG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $

~ (Ea accident)

ANY AUTO BODILY INJURY (Per person) $

OWNED SCHEDULED BODILY INJURY (Per accident) $

~ AUTOS ONLY .__ AUTOS HIRED NON-OWNED PROPERTY DAMAGE IPer accident\ $

~ 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 OTH-ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) 0 N/A 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 01/01/2020 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. Vong ~,.,~...-.--;;,-

I

© 1988-2016 ACORD CORPORATION. All rights reserved.

ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD

AGENCY CUSTOMER ID: CN102299757 LO C #: Seattle

-~

ACORD 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 (Compan!es), 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 - 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 NW-0628 N-0091 08/01/1982 12/20/1983

$450 Million" S-o-3q7 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 ii 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.

'" 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