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Marsh USA, LLC - Certificate of Liability Insurance
	ML23356A140
Person / Time
Site:	Cooper
Issue date:	11/14/2023
From:	; Marsh USA
To:	; Document Control Desk, Office of Nuclear Reactor Regulation
References
	Download: ML23356A140 (4)
	v • d • e

SP 0000769

D sk 0443 . -C01*P00769-I

Document Control e Commission R gulatory U.S. Nucle_ ar D~ 20555-0001 Washington, 0443-01-00-00007 69-0001-0004106

DATE (MM/DD/YYYYJ CERTIFICATE OF LIABILITY INSURANCE 11/14/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLD.ER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR N.EGATIVELY ArAEND, EXTEN'l 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 ri hts to the certificate holder in lieu of such endorsement(s).

PRODUCER "MARSH USA, LLC FAX 2405 Grand Boulevard, #900 A/C No :

Kansas City, MO 64108 1----~--~l~NS=U~R=E=R~S~lA ~ F~F~ORDING COV~E~RA~G=E~-~ NAIC#

CN 101345075--Nud-24-25 INSURER A : American Nuclear Insurers INSURED INSURERS:

Nebraska Public P01Ner District 141415lh St. INSURERC:

Columbus, NE 68601-5226 INSURER D:

V INSURER E:

0 INSURER F:

COVERAGES CERtlFICATE NUMBER: CHl-009957689-05 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.

ADDL SUBR INSR LTR TYPE OF INSURANCE ,.,~n wun POLICY NUMBER ,:Shl%~1 POLICY EXP IMM/DD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $

CLAIMS-MADE OCCUR u"""Aljt: 1u Kt:N I Eu ,

PREMISES /Ea occurrence) $

MED EXP (Any one person) $

r-r-

PERSONAL & ADV INJURY $

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

JECT PRO-R POLICY OTHER:

LOC PRODUCTS - COMP/OP AGG COMBINED SINGLE LIMIT

-- AUTOMOBILE LIABILITY ANY AUTO

/Ea accidentl BODILY INJURY (Per person)

OWNED - SCHEDULED

- AUTOS ONLY HIRED r- AUTOS NON-OWNED BODILY INJURY (Per accident) $

PROPERTY DAMAGE

- AUTOS ONLY - AUTOS ONLY /Per accidentl $

H UMBRELLA LIAB OCCUR EACH OCCURRENCE $

r-EXCESSLIAB CLAIMS-MADE AGGREGATE $

DED I I RETENTION $ $

WORKERS COMPENSATION I PER STATUTE I I OTH-ER AND EMPLOYERS" LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) 0 N/A I ., *, E.L DISEASE - EA EMPLOYEE $

If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $

A NUCLEAR ENERGY LIABILITY SEE ATTACHED 01/01/2024 01/01/2025 LIMIT SEE ATTACHED DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace la required)

I I

CERTIFICATE HOLDER CANCELLATION Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE U.S. Nuclear RegulatOI}' Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Washington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE

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

AGENCY CUSTOMER ID: _C _N_ 10_1_3_4_50 _ 7_5_ _ _ _ _ _ _ _ _ _ _ __

LOC #:* Kansas City ADDITIONAL REMARKS ..

SCHEDULE - Page 2 of 2 AGENCY N""1ED INSURED

'MARSH USA, llC . ,. " -. -*

~.i Nebraska Public Power District 1414 15th' St.

<>OU.CY NUMBER

i,,*;1*;

s,

'i l* *>'"

~in C:ilumbus, NE 68601-5226

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CARRIER

.INAIC,CODE.

EFFECTIVE DATE:

ADDITIONAL REMARKS * .'

I THIS ADDITIONAL REMARKS FORM IS'A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance

,,. , I 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 Liabili~J :nsurance 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 ~rein. If such 1>91icy

' ~

is..C/lllcelled or olll!HWis!l Iterminated prior to the end of Decefn~r

* ' '. * , I ' * * ** . *. '

31st ol the calenda"r year in which

!he Effective

~

Date of this Certificate occurs, notice will be delivered in accordance wnh the-policy provisions. Otherwise this Certificate shaA terminate as of l!l~ ~n,d of s~ch Decef!lber 31st. ~-Certificate will NOT be issued for any subseqllent calend3r yea1 unless requested in writing. ***

..-H

j Types of Insurance: NF - [Faciley Form), NW- [Master Worker Certificate]; NS- [US Domestic Suppliers & Transporters), FS- [Foreign Suppliers &Transporters], N -

[Second.-y 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 1/4miles south of Brownville, Nebraska NAMED INSURED [LISTED ON POLICY]: Nebraska Public Power District POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:

NF-0200 11/01/197f ** $500 Million NW-0583 11/01/1971 $500 Million N-0041 08/01/1977 THIS CERTIFICATE IS ISSUED AS A MATIER OF INFORM/\TION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.

The insurance aflolded by the policy(ies) is subjeci 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 ooiend, extend or alter the coverage affoided by the policy. The Limij of Liabiley shown above may have been reduced by payment of claims or ~!aims expenses.

COMMENTS/NOTES "Master Worker Certificate - This ~_mlt 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 Ce!'ificate having reference thereto. Such limit may have been reduced by payment of claims or claims expenses.

"."Secondary Financial Protection Certificate - An8f1,Ci/ll ,piotec:1ic;>n availa~~ under an i~u_stry retrospective rating plan.

,

II-'

Marsh

Dear Certificate Holder:

To streamline certificate delivery for our clients and in an effort to support our firm's commitment to sustainability, going forward, we will only be providing renewal certificates of insurance electronically.

If you need to continue receiving a copy of the attached certificate, please send an email to USOperations.email@marsh.com and include the following:

-- Certificate# (Shown below Insured Name- e.g., ABC-123456789-01)

- E-Mail for future delivery For your convenience, If we do not receive your response, we will conclude that you no longer require proof of insurance from the named insured and will remove you from our records.

Thank you, US Operations, Marsh USA, LLC A business of Marsh Mclennan

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ML23356A140

Text

Dear Certificate Holder:

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