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Marsh USA, Inc., Certificate of Liability Insurance
	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)
	v • d • e

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 I

DATE (MM/DD/YYYY)

\i....------- CERTIFICATE OF LIABILITY INSURANCE I

11/07/2022 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 THE c;;ovERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANC~ Do'ES ' NOT CClNSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOL_DER.

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 an~ _conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate hol~er in lieu of such endorsement(s).

PRODUCER CONTACT NAME:

Marsh USA, Inc.

800 Market Street, Suite 1800 ..

' fa~~N.t ;,,.,_'. : I !A/C FAX Nol:

- . ~t. Louis,. MO 63101 . . -~

-,_ . ,.1 1"1:

-- E-MAIL ADDRESS: - - i;_ j._,,

... - - . -- - - ' - ** -* ***** *- ** ' -

INSURER(S) AFFORDING COVERAGE

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>h NAIC#

CN102679986-Stda-Nuc.-22-23 l~ORER Al: 'ArrieiiGan Nuqear ln'surers-:.: *! . . **1 ,' ~ ' . I ;' ! 1

" . ,,:: i INSURED American Electric flower *INSURER S : "" ' ' ,, I. . ~

. ,. *b I JI Attn: Cathy C. Hundley INSURERC :

1 Riverside Plaza INSURER D :

Columbus, OH 43215-2355 INSURER E:

INSURERF :

COVERAGES CERTIFICATE NUMBER: , CHl-008880087-06

,, REVISION, NUMBER: 5 THIS IS TO CERTIFY THAT THE POLIPES OF INSURANCE LISTED BELOW HAV.E BE;EN ISS\,JED ,TO, WI;. INSURED NAMED ABOVE. FOR THE POL.ICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM dR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WIHICH THIS i CERTIFICATE MAY BE ISSUED OR MAY* PERTAIN, THE INSURANCE AFFORDED ' BY THE POLICIES DESCRIBED HEREIN ' 1s SUBJECT TO ALL THE TERMS, ;

EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PI\ID CLAIMS.'

INSR ADDL SUBR POLICYEFF .,

LTR TYPE OF INSURANCE , ,.. c:n wvn POLICY NUMBER !MM/DD/YYYYl r::'LICY EXP M/DD/YYYYl

' LIMITS COMMERCIAL GENERAL LIABILITY

,, EACH OCCl,/RRENCE $

t--

D CLAIMS-MADE OCCUR UJ<MAGI:: I u Hl::N I c:u PREMISES /Ea occurrene9l $

t--

MEO EXP (Any one person) $

PERSONAL & ADV INJURY $

t--

Fl GEN'L AGGREGATE LIMIT APPLIES PER POLICY OTHER JECTPRO- LOC GENERAL AGGREGATE PRODUCTS - COMP/OP AGG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $

t--

!Ea accident\

ANY AUTO BOOILY INJURY (Per person) $

t--

OWNED - SCHEDULED BOOILY INJURY (Per accident) $

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

AUTOS ONLY t - - AUTOS ONLY

/Per accident\

H UMBRELLA LIAB EACH OCCURRENCE $

- OCCUR EXCESSLIAB CLAIMS-MADE AGGREGATE $

OED I I RETENTION $ $

WORKERS COMPENSATION AND EMPLOYERS' LIABILITY

,, I,

' 'YERSTATUTE I I ER OTH-Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE EL EACH ACC IDENT OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) I .. ,

0 N/A .,, .;,, .. ,,

.EL DISEASE - EA EMP,LOYEE $

If yes, describe under I DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $

A Nuclear Energy Liability See Attached 01/01/2023 01/01/2024 See Attached Insurance 'I DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101; Addltlonat Remar1<s 'Schedule, miy be attached If more **pace Is required)

,.* , i ,;!*, I ., ' '

..-. ,, i '

I 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

~'\A,QI0""4 ~

I

© 1988-2016 ACORD CORPORATION. 1 All rights reserved.

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

' * ,1 * . , ...

AGENCY CUSTOr,, ER ID: C N 102679986

... A, * * - ~ - - - - - - - -- -- -- - -- - -

LOC #: St. Louis AQDITIONAL R.i ;MA~KS SGHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA, Inc. Amencan,lilectric Power Attn : Catry C. Hundley POLICY NUMBER ' 1 ~iver ide Plaza

.. -Co!umbe!:.,'OH 4321&2355' ..

CARRIER \ I , NAI' C cpot.*i ,i t-E_F_F_E_C_TI_V_E_D_A_TE- : - -- -- - - - -- -----,-,,-,--,,,....--.-r.--:_-,,-._ - ..,-,-,

I ,I,~ *) * . .- -- -- ,- 1

' ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACOR!;) F.ORNI, FORM NUMBER: 25 FORM T!TLE: Certificate of Liabilit;y: Jr.1s1.1rance 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_cle!l(.E1J.et9.j L.ia~jJity lnsur1mce Policy is~ueif bymel(lbers 9fi merican*Nu9lear Insurers as lo

,. in~icated (Coml)anies1, lhe-tnsurtd named hetbin'i with respect'.io thii Nuclea(Facility attheil.ocaf10n*s~own and/or with respecit to the lnsured's Oj)erations described herein.' If * *'*1*

');i~ch _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 qate'of this Certific~tr occ~rs,,noi~~.-~ 1-~ deliy~ie1.'

in accordance with the policy provisions. Otherwise 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 ,. , ,*.

calendar year unless rll<!~ested in writing. 'fol ,,

_I. J~ .... * ** * ' .:..

wt * ( .1:*.1,

, * . 1 , :. ~ c.,; * .. ,:;:\i'. *-** i i.1!r Types of Insurance: NF - [Facility_F?frn]:_~'l\1- [Master,'(\lprker Certificate], NS - [US Domestic Supplier's & Transporters], FS - [Foreign Suppliers & Transporters], N - !Secondary Financial Protection Certificate] ,, ' "

COVERAGE FOR NUCLEAR FACILITIES:

1. SITE #1 - D.C. Cook LOCATI ON OF NUCLEAR FACILITY: The Donald C. Cook Electric Plant In Lake Township, Berrien County, Michigan NAMED INSURED [LISTED ON POLICY]: Indiana 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 iN FORMATION 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 contract 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 claims I ' f f,, * , ~ .

or claims.expenses.

->-~* ** ! \ r I I COMMENTS/NOTES:

. .. Master Worker Certificate - This limit is shared by* all '(?lrjirX.;al~s to !h_e M,aster_,Worker Ppl\yYof which_e;/~P CertiflCil~ i~ a_pilrt ~n\1 is su_bject 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 expenses .

... Secondary Financial Protection Certificate - Financial protection available under an industry retrospective rating plan.

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ML22333A266

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