ML23356A141

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Marsh USA, LLC - Certificate of Liability Insurance
ML23356A141
Person / Time
Site: Cooper Entergy icon.png
Issue date: 11/15/2023
From:
Marsh USA
To:
Document Control Desk, Office of Nuclear Reactor Regulation
References
Download: ML23356A141 (1)
v • d • e


Text

0001505 SP 0443 -C01-P01605-1

  • Document Control Desk U.S. Nuclear Regulatory Commission Washington, DC 20555-0001 0443-01 ~1505-0001-0005668

DATE (MMIDD/YYYY)

CERTIFICATE OF LiABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I 11/15/2023 CERTIFICATE DOES NOT AFFIRMATIVELY OR N!:GATIVELY AMEND, E.'(>("Ef'JD OR AL*TER THE COVERAGE AFFORDED BY THI= 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 pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed.

If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policl88 may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s).

PRODUCER "M\RSH USA, LlC 2405 Grand Boulevard, #900 l\lrlS8S Ct:;, MO 64108 -

e------------.----'---'-INS=IUR=ERf=:5),_,_AFFO"--'-':..:RDl=NG=-.:COVE=-=-=RA=O::=E'-----'------i-----'-'NAl:..::..:::C-=-I----I CN10134507~ucl-24-25 INSURER A : Arnenc31 Nuclear Insurers INSURED INSURERS:

Nebraska Pub11C PON8T DJS!nct 141415th St INSURERC.

Coklnbus, NE 68601-5226 INSURERD.

INSURERE':'

INSURERF:

COVERAGES CERTIFICATE NUMBER* CHl-009957689-07 REVISION NUMBER* 1 THIS IS TO CERTIFY TI-IAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERJOD :

INDICATED NOTVVITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO Vv'HICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AU. THE TERMS, EXCLUSIONS AND CONDmONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS

,Y, POLICY EFF POLICY EXP I~ TYPE OF INSURANCE 1u0n lwvn POLICY NUMBER LIMJTS COMMERCIAL OENERAL UABIUlY EACH OCCURRENCE $

0 CLAJMS-MADE OCCUR DAMAGE TU t<Cr< 1 cu Pl><'lAIQES (Ea _ _ _ ,

MED EXP IAnv one oersoo)

PERSONAL & ADV INJURY $ <

GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $

PRO-JECT Loe

~

POLICY PRODUCTS - COMP/OP AGG $

OTHER AUTOIAOBILE LIABlUTY r~~flNGLE LIMIT $

~

AffYAUTO BODILY INJURY (Per perwn) $

f--

O'M,IED

- SCHEDULED BODILY INJURY (Per BCCldent) $

- AUTOS ONLY HIRED - AUTOS NON-OWNED ~?~~,RAMAGE $

- AUTOS ONLY

- AUTOS ONLY UMBRELLA UAB EXCESSUAB OED I I H

RETENTION $

OCCUR CLAJMS-MADE I

l .,

EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY I ~':%urE I I~~

Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) 0 N/A EL' Ol<>EASE - EA EMPLOYEE $

., I irsc~ ~ERATIONS below .,

E L DISEASE - POLICY LIMIT A NUCLEAR ENERGY LIABILITY SEE ATTACHED 0Ml1/2024 01/01/2025 UMIT SEE ATTACHED DESCRIPTION Of OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, - n l l l Rem r1<a Schadule, may be attached If mora apace is required)

\

I CERTIFICATE HOLDER CANCELLATION Dorunent Cootrol Desk SHOULD ANY OF Tl-IE ABOVE DESCRJBED POLICIES BE CANCELLED BEFORE U S Nuclear Re<Jualmy Co1m11ssmn THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Washmgton, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE

~~~e I

~ 1988-2016 ACORD CORPORATION. All rights reserved.

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

AGENCY CUSTOMER ID: CN101345075

.,:.:. ,n,t

  • LOC #: _Ka_n_sa_s_C_lty _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

AC~ ADDITIO.NAL REMARKS SCHEDULE Page 2 of 2 L----'

AGEHCY ~ED INSUREJ) , _- '. * -

'MARSH USA, LLC .. _'.' ~ c, , . Neaaska Pub<<: Power D1stnct 0'--'-~-"'-'-*_....,___----'_~*-'-=-*e.>,,*- - - - - - - - , . . . . f

  • '..c.'*'"-'- ' - ' ,, ' ' 1414-15th St 11 ' ' '

POLICY NUMBER , _: ,.:.. *Columbus, NE 60001-5226

-\' ' - ,.,,

CARRIER NAJC: CODE:* , .I

_,, '.;:*,~*:* ! f-E_FFECTIVE _ _ _D_A_TE. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _- i I

ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, i FORM NUM,BER: 25 FORM TITLE: Certificate of Liability Insurance CERTIF1CA1:E OF NUClEAR ENERGY LIABILITY INSURANCE ThlS IS to certify that there~ 1n force as of the effectJve d!ie of ltus Cerlifblle S Nude!r" Enet;Q): ~~.lqsura,ce Polley ISSood by members of Amencai1 Nuclear Insurers as IDOOlled (Compames}, to the ln6UT8d nmied heroo, wrth respect to the Nuclew F~. ~ the Locabon shown and/or Will respect to the lnSlf8d's operabons descnbed herem If such pol!cy 1s ~celled orolhelwlse term1naled poor 16the 6(ld of ~ 3 1 s t of the calendll"yea 11 wh!ch, the Effective Dale octt;iii; CertJllcala-

, ~, 1, - ' * ' '( , \ l , ,

occurs. nobce wul be der.'81ed 11 accordooce W1lh the Jdlcy prOY1SIOllS. OtherwlS8 this pertificala shall termma~ as of 1ho end rl such December 31st A CertJllca!e Will

. NOT be ISSll8d for i.iy Sl!tisequent ca!elldar year unless _;aquested. 11 wntlng * ' ' *

  • Types of lnSIJllflC8 NF- [Foolrty Foon1 NW- ~ter_Worke!'Certrlk:alej, NS- [US Oomes1Jc Suppll8r's &'rransprriirsi FS- (Fore!Qn Suppliers & Tra;isporlera1 N-

[Second!I)' Fll!rlCflli f:'roteclon Certd!calel ',,'

- ' ,\

COVERAGE FOR NUCLEAR FACILITIES

  • 1 SITE #1 - Cooper Nuc!eoc Staoon LOCATION OF NU ClEAR FACILITY: L:ocaEd oo the west bart r1 the "'5soon River at flll8r nlle 532 2 m Noo.iJa County, Nebraska which ls apprtJXH116lel'/ 2 1/4 l11lies south of BrownV11!e, Ne!:raska ,

NAMED INSURED [LISTED ON POUCY]: Nebraska Public f'OWff Dlstrd POUCY NUMBER POLICY EFFECTIVE* LIMIT OF LIABILITY.

NF-0200 11/01/1911' *' "'$500 Milhon NW-0583 1111l1n971 $500 ~

N-0041 08/01/1977 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFQRMA.TION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFlCATE H()Ll)ER The 111SUf!l1C8 afforded by the poG'{18S} IS subject to' the exciJSKlllS, coodlOOflS ood other p!OVl!llOIIS of the polrcy(18S} Nerther thJs Certiflrale nor ooy contract Of other document with respect 'to whlcll rt IS Issued shall 9l19nd, extend or alter the coverage cfurded by the policy. The Lm of uablhty shown above may have been reduced by payment of clam; or clams exp8ll888 COMM!:NTSINOTE~

"Masilr Worker Certfflcale - Thls !mt IS shared !JY all ~ kl the Masffl WorkEI' Policy ~ whcil 8!d1 Cerboca!e ls a PIJ'1 and is subject kl al of the provlSIOOS of S1Jch Polq and Ce.1ilicale havllg refefooce thereto Such 1ml may have been reduced by payment of clams or cia1111S expenses *

'"Secondary Fmancial Prolecllon Ce!Wcate - Fmanaal prol6ctJon llV!!lable Ul1der an industry retrospec!Ml ratmg plan.

>~ :

r' ~* I ' ,* I ,.-,

ACORD 101 (2008/01) il:> 2008 ACORD CORPORATION. All rights 1 The ACORD name and logo are registered marks of ACORD 0443-01-00-0001 ~-0()()6868

  • 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 condude 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 busin~ of Marsh Mcl1:nnan

'* - I! ,-,, Ir,*.'

1**.

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