ML22333A266
| ML22333A266 | |
| Person / Time | |
|---|---|
| Site: | Cook  |
| Issue date: | 11/07/2022 |
| From: | Marsh USA |
| To: | Document Control Desk, Office of Nuclear Reactor Regulation |
| References | |
| Download: ML22333A266 (1) | |
Text
0000043 SP 0445,C01-P00043-I Document Control Desk U.S. Nuclear Regulatory CommissiGin Washington, DC 20555-0001
0445-01-00-0000043-0001-0000285 ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY)
\\i....------- 11/07/2022 I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE,_DOES NOT AFFIRMATIVELY 0~,NEGA TIV~LY ~J,11,E~D.,EXTEND 0~ ALTER T HE c;;ovERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANC ~ Do'ES ' NOT CClNSTITUTE A CONTRA CT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERT IFICATE HOL_DER.
- IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSU R ED p rovisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms an~ _conditions of the policy, certain policies may require an endorsement. A statement o n this certificate does not confer rights to the certificate hol~er in lieu of suc h endorsement(s).
PRODUCER CONTACT Marsh USA, Inc. NAME : fa~~N.t ;,,.,_'. : I FAX *"*
800 Market Street, Suite 1800.. ' !A/C Nol:
-.... -~ -- -*~t. Louis,. MO 63101 ' -,.1 1 "1: E-MAIL -.,.. ',_. - - ADDRESS : - -
... - -. -- - - ' - **-* ******- ** ' -* INSURER(S) AFFORDING COVERAGE. ~ < i;_ j._,, t ? > h NAIC#
CN102679986-Stda-Nuc.- 22-23 l~ORER Al: ' ArrieiiGan Nuqea r ln'surers- :.: *!.. **1,' ~ '. I ;' ! 1 ".,,:: i INSURED *INSURE R S : "" ' ',, I.. ~.,. *b I JI.,,, _,
American Electric flower. '
Attn: Cathy C. Hundley INSURERC :
1 Riverside Plaza INSURER D :
Columbus, OH 43215-2355 INSURER E: :
INSURERF :
COVERAGES CERT I FICATE NUM B ER :, CHl-008880087-06,, REVISION, NUM BE R : 5 THIS IS TO CERTIFY THAT THE POLIPES OF IN SURANCE LISTED BELOW HAV.E BE;EN ISS\\,JED,TO, WI;. INSURED NAMED ABOV E. FOR THE POL.I CY PER IOD i INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM dR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WIHICH THI S CERTIFICATE MAY BE ISSUED OR MAY
- PERTAIN, THE INSURA NC E AFFORDED ' BY THE POLICIES DESCRIBED HEREIN ' 1s SUBJEC T TO ALL THE TER MS, ;
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PI\\ID CLAIMS.' _,,
INSR ADDL SUBR POLICYEFF r::'LICY EXP., ' LTR TYPE OF INSURANCE,,.. c:n wvn PO LI CY NUMBER !MM/DD/YYYY l M/DD/YYYYl LIMITS
CO MM ERCIAL GEN ERAL LIABILITY EACH OCCl,/RRENCE $,,
t-- D UJ<MAGI:: I u Hl::N I c:u t-- PREMISES /Ea occurrene9l $ CLAIMS-MADE OCCUR
t-- MEO EXP (Any one person) $
t-- PERSONAL & ADV IN JURY $
GE N'L AGGREGATE LIMI T APPLIES PER GENERAL AGGREGATE $
Fl PRO - L OC PR OD U CTS - COMP / OP AGG $ POLICY JECT
OTHER $
AUTOMOBILE LIABILITY COM BINE D SINGLE LIMIT $ !Ea accident\\
t--
ANY AUTO BOOIL Y INJURY (Per person) $
t-- OWN ED - SC HED ULED BOOIL Y INJURY (Per accident) $
t-- AUTOS ONLY t-- AUTOS HIRED NON -OWNED PROPER TY DAMAGE $
- t--AUTOS ONLY AUTOS ONLY /Per accident\\
UMBRELLA LIAB H OCCUR EAC H OCC URR ENCE $
EXCESSLIAB CLAIMS-MADE A GGREGATE $
OED I I RETENT ION $ $
WORKERS COMPENSATION,, I,,, ' YER I I OTH-AND EMPLOYERS ' LIABILITY ' STATUTE ER Y/N ANYPROPRIETOR/PARTNER/ EXECUTIV E 0 N/A EL EACH ACC IDENT $
OFFICER/MEMBER EXCLUDE D?.,,.;,,..,, ' ',
(Man datory in NH) I..,,...EL DISEA SE - EA EMP,LOYEE $
If yes, descr ibe under E.L DISEASE - POLICY LIMIT I DESCRIPTION OF OPERATIONS below $
A Nuclear Energy Liability See Attached 01/01/2023 01/01/2024 See Attached
Insurance 'I
DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101; Add ltlonat Rem ar1<s 'Schedule, m iy be attac hed If more **pace Is required),,
,.*, i,;!*, I., ' '.. -.,, i'
I CERTIFICATE HOLDER CANCELLATION
Document Control De sk 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
I ~'\\A,QI0""4 ~
- © 1988-2016 ACORD CORPORATION. All rights reserved.
1 ACOR D 25 (2016/03) The ACORD name and logo are registered marks of ACORD *
' *,1 *.,...
- AGENCY CUSTO r,,ER ID : C N 102679 986
... A, * * -~-------- ----- --- --
LOC # : St. Loui s AQDITIONAL R.i;MA~K S SGHED U L E Page 2 of 2
AGENCY NA MED INSURED Marsh USA, Inc. Amencan,lilectric Power Attn: Catry C. Hundley PO LI CY NUMBER ' 1 ~iver ide Plaza
.. -Co !umbe!:.,' OH 4321&2355'..
CA RRIER \\ I, NAI' C cpot. ** i
,I,~ *) *. i, t-E_F_F_E _C_TI_V _E _D_A_T E-:-- ------- ------,-,,-,--,,,....--.-r.-- :_ -,,-._ -..,-,-,.-----,-1 I
' ADDITIONAL REM A RKS THIS ADDITIONAL REMARKS FO RM IS A S CHE DU L E TO A C OR!;) F.ORNI, FORM NUMBER : 2 5 FORM T!TL E: Ce rtific at e of L ia b ilit;y: Jr.1s1.1ranc e
CERTIFICATE OF NUCLEAR ENERGY LIABILITY INSURANCE
t *.,........ *-. *- - -. *,_;:,_**.2'.;.._
This is ~q certify that there isjA ~'3/4!tel.as of tt\\!l il!Le<iti~~ ~-~!e of this.~ _rtific~te a Ny _c le!l(.E1J.et9.j L.ia~jJity lnsur1mce Policy is~ueif by mel(lbers 9fi merican *Nu 9lear Insurers as
- ,. in~icated (Coml)anies1, lo lhe-tnsurtd named hetbin'iwith respect'.io thii Nuclea(Facility attheil.ocaf10n *s~own and /or with respecit to the lnsured's Oj)erations desc ribed herein.' If* *'*1*
' );i~c h _policy is,ca _~~e1ika or oihe~i~e* te~~ln.~teli ~i~r to 'me
- ena ~ ( cie~ ~ ber 31si'of the c~.~r<iar'y ~ar 'i,~' ~h_f<;h the Eff~t~i qa te'of this Certific~tr oc c ~rs,, noi ~~.- ~ 1-~ deliy~ie1.'
in accor dance with the policy provisions. Othe rw ise this Certi~ica)e shall l~rminat~ as qf \\he end o( suct);!?e_cember 31st., A, Certjficate.will NOT be ~sued for. any ~ubsequent,.,, *.
calenda r year unless rll<!~ested in writing. 'fol,,
- _I. J~.... * ** *'.:..
- wt * (.1:*.1,
- , *. 1, :. ~ c.,; *..,:;:\\i '. *-** i i.1!r Type s of Insurance : NF - [Facility_ F?frn]:_~'l\\1-[Master,'(\\lprker Certificate], NS - [US Domestic Supplier's & Transporters], FS - [Foreign Suppliers & Transporters], N - !Seco ndary Financial Protection Certificate],, ' "
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - D.C. Cook LOCATI ON OF NUC LEAR FACILITY: The Do n ald C. Cook Electric Plant In Lake Township, Berrien County, Michigan NAMED INSURED [LISTED ON POLICY ]: Ind iana Michigan Power Company ; American Electric Power Service Corporation agent POLICY NUMBER: POLICY EFFECTIVE : LIMIT OF LIABILITY:
NF- 0206 0;i/25/1972 $450 Million NW -0587 01/01/1998 $450 Million..
N-0045 08/01/1977 N-0064 12/23/1977
THIS CERTIFICATE IS ISSUED AS A MATTER OF iNFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
i
- ',, ' I ' I ' '
- 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 co ntract er other document with respect to which it is issued shall amend '. extend or alt~r the coverage afforded by the policy. The Limit of Liability shown above may have been r,educed by. payment of c laims or claims.expenses. I ' f f,, *, ~.
->-~* **,, ' ; ! \\r I I
COMMENTS/NOTES:
... Ma ster Worker Certificate - This limit is shared by
- all '(?lrjirX.;a l~s to !h_e M,aster_,Worker Ppl\\yY of whic h_ e;/~P CertiflCil~ i~ a _pilrt ~n\\1 is su _b ject to <)II of the pro¥jsions *of s.u~ h J:olicy'. _, :., ;.*,.J "
and Certificate having reference thereto. Such limit may have been reduced by payment of claims or claims expe n ses.
... Secondary Financial Protection Certificate - Financial protection avai lable under an industry retrospective rating plan.
~t -1:*~ '"' " J l:.i>:,t/ *... ~,, * *F-* - * *
.Jt,
ACORD. 101 (2008/01) © ~.008 ACORD CORPORATION. All rights 1 The ACORD name aild logo
- are reg istered marks of ACORD
0445-01-00-0000043-0002-0000286 Ii