ML19295D252

Certificate of Liability Insurance - Pacific Gas & Electric Company

ML19295D252
Person / Time
Site:	Diablo Canyon, Humboldt Bay
Issue date:	10/07/2019
From:	Kolstad E Marsh Risk & Insurance Services
To:	Document Control Desk, Office of Nuclear Material Safety and Safeguards, Office of Nuclear Reactor Regulation
References
Download: ML19295D252 (3)

Text

0004502 SP 0557

-C01-P04504-I Document Control Desk U.S. Nuclear Regulatory Commission Washington, DC 20555-0001

J/V/55b I fj!J!J/

Jt. R_

Vt,.f5S

ACORD CERTIFICATE OF LIABILITY INSURANCE

~

DATE (MM/DDNYYY)

~

10/07/2019 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 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 MARSH RISK & INSURANCE SERVICES NAME:

r4~gN,.ro <=xtl*

I FAX 345 CALIFORNIA STREET, SUITE 1300 (A/C Nol:

CALIFORNIA LICENSE NO. 0437153 E-MAIL SAN FRANCISCO, CA 94104 ADDRESS:

INSURERISl AFFORDING COVERAGE NAIC#

CN102994327-NUC-20-21 INSURER A : American Nuclear Insurers INSURED INSURERS:

PACIFIC GAS & ELECTRIC COMPANY ONE MARKET SPEAR TOWER INSURERC:

SUITE2400 INSURERD:

SAN FRANCISCO, CA 94105 INSURERE:

INSURERF:

COVERAGES CERTIFICATE NUMBER:

SEA-003349650-09 REVISION NUMBER: 19 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 TYPE OF INSURANCE ADDL SUBR

,&.gMiv,JVv, POLICY EXP LIMITS LTR

,,.,~n lun,n POLICY NUMBER IMM/DDNYYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE

.__ D CLAIMS-MADE D OCCUR

~~~~~~J9E~~~~encel MED EXP (Any one person)

PERSONAL & ADV INJURY GEN'LAGGREGATE LIMIT APPLIES PER:

GENERAL AGGREGATE Fl DPRO-Owe PRODUCTS - COMP/OP AGG POLICY JECT OTHER:

AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I Ea accident)

ANY AUTO BODILY INJURY (Per person)

OWNED SCHEDULED BODILY INJURY (Per accidenl) $

AUTOS ONLY

~

AUTOS HIRED NON-OWNED PROPERTY DAMAGE

.__ AUTOS ONLY AUTOS ONLY

( Per accident)

UMBRELLA LIAB H OCCUR EACH OCCURRENCE EXCESSLIAB CLAIMS-MADE AGGREGATE DED I I RETENTION$

WORKERS COMPENSATION I PER I I OTH-AND EMPLOYERS' LIABILITY STATUTE ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE D 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 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 Document Control Desk U.S. Nuclear Regulatory Commission Washington, DC 20555-0001 I

ACORD 25 (2016/03)

CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services Eric T Kolstad

© 1988-2016 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

AGENCY CUSTOMER ID: _C_N_1_0_2_9_9_43_2_7 ____________

LOC #:

San Francisco ACORD

~-

ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED MARSH RISK & INSURANCE SERVICES PACIFIC GAS & ELECTRIC COMPANY ONE MARKET SPEAR TOWER POLICY NUMBER SUITE2400 SAN FRANCISCO, CA 94105 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 lo 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. 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-IForeign Suppliers & Transporters]

COVERAGE FOR NUCLEAR FACILITIES:

1. SITE #1 - 0/ABLO CANYON LOCATION OF NUCLEAR FACILITY: Diablo Canyon Nuclear Power Plant 12 Ml WSW of San Luis Obispo, CA NAMED INSURED [LISTED ON POLICY]: Pacific Gas and Electric Company POLICY NUMBER:

POLICY EFFECTIVE:

LIMIT OF LIABILITY:

NF-0228 NW-0605

2. SITE #2 - HUMBOLDT BAY 07/05/1974 12/15/1997

$375 Million

$375 Million LOCATION OF NUCLEAR FACILITY: Humboldt Bay Nuclear Power Plant (Shutdown July 76) in Humboldt County, California NAMED INSURED [LISTED ON POLICY]: Pacific Gas and Electric Company POLICY NUMBER:

POLICY EFFECTIVE:

NF-0113 NW-0534 01/01/1962 12/15/1997 LIMIT OF LIABILITY:

$53.3 Million

$375 Million 50 -13 3 THIS CERTIFICATE IS ISSUED AS A MA TIER 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 th!l 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.

Page 2

of 2

ACORD 101 (2008/01)

© 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD