ML21340A029
| ML21340A029 | |
| Person / Time | |
|---|---|
| Site: | Beaver Valley, Davis Besse, Perry, 05000314 |
| Issue date: | 11/01/2021 |
| From: | Marsh USA |
| To: | Office of Nuclear Reactor Regulation |
| References | |
| Download: ML21340A029 (4) | |
Text
0006906 SP 0481
-C01-P06909-I Document Control Desk U.S. Nuclear Regulatory Commission Washington, DC 20555-0001 0481-01-00-0006906-0001-0014396 S-o-33'-/
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ACORD CERTIFICATE OF LIABILITY INSURANCE I
DATE (MMIDD/YYYY)
~
11/01/2021 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 USA, INC.
NAME:
rA~~N,t Fri\\
- I FAX TWO ALLIANCE CENTER IAJC Nol:
3560 LENOX ROAD, SUITE 2400 E-MAIL ATLANTA, GA 30326 ADDRESS:
INSURER(Sl AFFORDING COVERAGE NAIC#
CN101587077-NRC-22-23 INSURER A : American Nuclear Insurers INSURED INSURERB:
Energy Harbor Corp.
168 E. Marilet Street INSURERC :
Akron, OH 44308 INSURER D:
INSURER E :
INSURERF :
COVF.RAGES CERTIFICA lE NUMBER:
A TL-005038755-06 REVISION NUMBER: 1 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
,ucn lwvn POLICY NUMBER IMMIDD/YYYYI IMM/DO/YYYYl LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE u CLAIMS-MADE OCCUR UAMAl.>t: TU REN I t:U PREMISES IEa occurrence\\
MED EXP (Any one person)
PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE Fl PRO-OLoc PRODUCTS - COMP/OP AGG POLICY JECT OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT IEa accident\\
ANY AUTO BODILY INJ°URY (Per person)
OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY
/Per accident\\
UMBRELLA LIAB H OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED I I RETENTION $
WORKERS COMPENSATION I PER I I OTH-AND EMPLOYERS' LIABILITY STATUTE ER YIN ANYPROPRIETOR/PARTNERIEXECUTIVE 0 N/A E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE $
gtst~ftfi3~ ~1~PERATIONS below E.L. DISEASE - POLICY LIMIT A
Nuclear Energy Liability See Attached Acord 101 01/01/2022 01/01/2023 See Attached Acord 101 Insurance DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Addltlonal Remarl<s 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 I
~
USA 'JHe,
© 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03)
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID:....:..C::..:N....:..1....:..0::...:1-=-5-=-8.:....70::..:7....:..7 ____________
LOC #: Atlanta ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED MARSH USA, INC.
Energy Harbor Corp.
168 E. Market Street POLICY NUMBER Akron, OH 44308 CARRIER I
NAICCODE EFFECTIVE DATE:
ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE lO 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 forca as of !he effective dale of this Certificate a Nuclear Energy Liability Insurance PQlicy issued by members of Arr.irican 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 d~scribed herein. If such policy is cancelled or otherwise terminated prior to the end of December 31st of the calendar year in which the Effective Dale of t~is 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 Formj, NW- [Master Worker Certificatej, NS. (US Domestic Supplier's & Transportersj, FS. [Foreign Suppliers & Transportersj, N. (Secondary Financial Protection Certificate!
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1
- Beaver Valley LOCATION OF NUCLEAR FACILITY: Beaver Valley Nuclear Power Plant in Shippingport Borough, Beaver County, Pennsylvania NAMED INSURED [LISTED ON POLICYJ: Energy Harbor Nuclear Generation LLC and Energy Harbor Nuclear Corp POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0226 8/1/1974
$450 Million NW-0603 N-0058 N-0110
- 2. SITE #2. Davis-Besse 8/1/1974 8/1/1977 5/28/1987
$450 Million..
LOCATION OF NUCLEAR FACILITY: Davis-Besse-Nuclear Power Plant on Lake Erie approx. 20 miles ESE of Toledo in Ottowa County, Ohio NAMED INSURED [LISTED ON POLICYJ: Energy Harbor Nuclear Generation LLC and Energy Harbor Nuclear Corp POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0236 11/1/1975
$450 Million NW-0608 11/1/1975
$450 Million" N-0061 8/1/1977
- 3. SITE #3. Perry LOCATION OF NUCLEAR FACILITY: Perry Nuclear Power Plant on Lake Erie approx. 35 miles NE of Cleveland, Ohio NAMED INSURED [LISTED ON POLICY]: Energy Harbor Nuclear Generation LLC and Energy Harbor Nuclear Corp POLICY NUMBER:
POLICY EFFECTIVE:
LIMIT OF LIABILITY:
NF-0291 NW-0644 N-0102 9/1/1984 9/1/1984 3/18/1986
$450 Million
$450 Million" 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, condilio.ns and other provisions of the policy(les). 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:
Page 2
of 3
ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights 1 The ACORD name and logo are registered marks of ACORD 0481 *01 *00*0006906-0002-0014397
AGENCY CUSTOMER ID: _C_N_1_0_1_5_87_0_7_7 _
LOC #: Atlanta ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED MARSH USA, INC.
Energy Harbor Corp.
168 E. Market Street POLICY NUMBER Akron, OH 44308 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
" 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 induslly retrospective rating plan Page 3
of 3
ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD