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Nebraska Public Power Station - Certificate of Nuclear Energy Liability Insurance
	ML22326A017
Person / Time
Site:	Cooper
Issue date:	11/03/2022
From:	; Acord Corporation, Marsh USA
To:	; Office of Nuclear Reactor Regulation
References
	Download: ML22326A017 (1)
	v • d • e

AGENCY CUSTOMER ID: _C_N_1_0_1---'34_5_0_7_5_ _ _ _ _ _ _ _ _ _ __

LOC #: Kansas City ACORD . ADDITIONAL REMARKS SCHEDULE Page 2 of 2

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AGENCY NAMED INSURED

'Marsh US~, l~c. Nebraska Public Rower District POLICY NUMBER CARRIER I NAIC,CODE ,

I*

,141~ 15th St.

..Columbus; NE. 68601-5226

,, SD - 2 cy ~

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 Uability,lnsurance 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 lrisured's operations described herein. If such poli~y is cancelled or othe~ise terminated prior to the end of December '31st of the calendar year in which the Effective Date of this Certificate occurs, notice will be delive_red in accordance with the policy provisions. Otherwise this Certificate sh~II 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 & Tr_ansporters], FS- [Foreign Suppliers & Transporters], N-

[Secondary Financial Protection Certificate]

COVERAGE FOR NUCLEAR FACILITIES

1. SITE #1 - Cooper Nuclear Station LOCATION OF NUCLEAR FACILITY: Located on the west bank of the Missouri River at river mile 532.2 in Nemaha County, Nebraska which is approximately 2 1/4 miles south of Brownville, Nebraska NAMED INSURED [LISTED 9N POLICY]: Nebraska Public Power District POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:

NF- 0200 11/01/1971 $450 Million NW-0583 11/01/1971 $450 Million N-0041 08/01/1977 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 it is issued shall ~mend, 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 bf payment of claims or claims expen_ses.

"'Secondary Financial Protection Certificate - Financial protection available under an industf\' retrospective rating plan.

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~

I DATE (MM/DD/YYYY)

ACORD CERTIFICATE OF LIABILITY INSURANCE 11/03/2022

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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 NAME:

.. *Marsh USA, Inc.

2405 Grand Boulevard, #900

PHONE IA/C No Extl:

I /A/C FAX Nol:

.. Kansas City, MO 64108 E-MAIL ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC#

CN101345075--Nucl-22-23 INSURER A : American Nuclear Insurers INSURED INSURERS:

Nebraska Public Power District 141415th St. INSURERC:

Columbus, NE 68601-5226 INSURER D:

INSURER E:

INSURERF:

COVERAGES CERTIFICATE NUMBER: CHl-009957689-02 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

'"'"" WVD POLICY NUMBER CMM/DD/YYYYl /MM/DD/YYYYl LIMITS r--

COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR EACH OCCURRENCE DAMAGE TO RENTED PREMISES /Ea occurrence\

r--

MED EXP (Any one person)

PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

~ POLICY JECT PRO- DLoc PRODUCTS - COMP/OP AGG $.

OTHER: $

AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $

r-- /Ea accidentl ANY AUTO BODILY INJURY (Per person) $

- OWNED - SCHEDULED BQDILY INJURY (Per accident) $

r - - AUTOS ONLY - AUTOS HIRED NON-OWNED PROPERTY DAMAGE $

- AUTOS ONLY - AUTOS ONLY I Per accident)

H UMBRELLA LIAB EACH OCCURRENCE $

I- OCCUR EXCESS LIAB CLAIMS-MADE AGGREGATE $

ED I I RETENTION $ $

WORKERS COMPENSATION AND EMPLOYERS' LIABILITY I STATUTE PER I I EROTH-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 01/01/2023 01/01/2024 LIMIT SEE ATTACHED DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Add!!ional 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 I ~ us~ eJt>U!-.

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

0003825 SP 0439 -C01-P03826-I Document Control Desk U.8- Nuclear Regulatory Commission Washington, DC 20555-0001 0439-01-00-0003825-0001-0009263

ML22326A017

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