U-003072, Marsh USA, Inc., Certificate of Liability Insurance
| ML20021A046 | |
| Person / Time | |
|---|---|
| Site: | Palo Verde  |
| Issue date: | 12/31/2019 |
| From: | Mukherjee M Marsh USA |
| To: | Document Control Desk, Office of Nuclear Reactor Regulation |
| References | |
| HOU-003072783-19, Rev 38 | |
| Download: ML20021A046 (3) | |
Text
0002591 9P 0022 -C01-P02S92*1 Document Control Desk U.S. Nuclear Regulatory Cor.imiss1on Washington, DC 20555-0001
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I DATE (MMIDDIYYYY)
ACORD'11 CERTIFICATE OF LIABILITY INSURANCE
~ - 12131'2019 THIS CERTIFICATE IS ISSUED AS A MA TIER 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.
2929 Allen P ~ , Suite 2500 PHONE Air u- c_.,. IIA/C FAX Nol:
Houston, TX no1 E-MAIL ADDRESS:
INSURERIS) AFFORDING COVERAGE NAIC#
CN1021137~EL-19-20 INSURER A : American Nuclear Insurers INSURED INSURERB:
Arizona Public S81Vice Compaly, et al*
Mail Station: 9618 PO Box 53999 INSURERC :
Phoenix, AZ. 85072-3999 INSURERD :
INSURERE :
INSURERF:
COVERAGES CERTIFICATE NUMBER* HOU-003072783-19 REVISION NUMBER: 38 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 VVITH RESPECT TO WHICH THIS "
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TE~~ *. *.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. *H" INSR ADDL ISUBR POUCYEFF POLICY EXP LTR TYPE OF INSURANCE ,.,.,n ..,.,n POLICY NUMBER IMM/DD/YYYYI IMMIDDIYYYYI LIMITS o_..:i.
. \ * 't COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
D CLAIMS-MADE D OCCUR DAMAG!: I u R!:N I cu PREMISES /Ea occurrence I $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
Fl GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY DPRO-OTHER:
JECT DLoc GENERAL AGGREGATE PRODUCTS - COMP/OP AGG AUTOMOBILE LIABILITY fE~~:1:I~~ll NGLE LIMIT s
- ANY AUTO BODILY INJURY (P<< peraon) $
f--
OWNED AUTOS ONLY HIRED AUTOS ONLY
- SCHEDULED AUTOS NON-OWNED AUTOS ONLY BODILY INJURY (Per accident)
PROPERTY DAMAGE
/Per accidentl s
s s
- UMBRELLA UAB EXCESSLIAB H OCCUR CLAIMS-MADE EACH OCCURRENCE AGGREGATE OED I I RETENTION $ $
WORKERS COMPENSATION AND EMPLOYERS' LIABILITY I PER STATUTE I I OTH-ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandato,y In NH) 0 NIA E.L. DISEASE - EA EMPLOYEE $
~tsi:i."fit ~1~PERATIONS below E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached 01/01'2020 01/01/2021 See Attached Insurance "Acord 101" Acord 101 DESCRIPTION OF OPERATIONS/ LOCATIONS/ ',/EHICLES (ACORD 101, Additional Remark* Schedule, may be attached If more apace la required)
CERTIFICATE HOLDER CA NC ELLA TION Document Conlrol 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.
I Manashi Mukherjee -!'-l.A~...... ~
© 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: CN102113796 LOC #: Houston L---' ADDITIONA 1 REMARKS SCHEDULE .. Page of AGENCY NAMED INSURED Marsh USA Inc. Arizona Public Service Company, et al' Mail Station: 9618 PO Box 53999 POLICY NUMBER Phoenix, loZ 85072-3999 CARRIER I NAICCODE 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 Liability Insurance Policy issued by members of American Nuclear Insurers as indicated (Companies), to the Insured named herein, with respect to the Nucleao- Facility al the Location shown and/or with respect to the lnsured's operations described herein. If such policy is cancelled or otherwise terminated prior to the end of December 31st of the calendar year in which the Effective Date of this Certificate occurs, notice will be delivered in accordance with the policy provisions. Otherwise this Certificate shall tenninate as of the end of such December 31st A Certificate will NOT be issued for any subsequent calendao- year unless requesled in writing.
Types of Insurance: NF - [F,dty FormL NW- [Master Worker Certificate], NS- [US Domestic Suppliers &Transporters], FS - [Foreign Suppliers &Transporters]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1
- PALO VERDE LOCATION OF NUCLEAR FACILITY: Palo Verde Nuclear Generating Station localed in W111tersburg, Arizona NAMED INSURED [LISTED ON POLICY]: Arizona Public Service, et al POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0266 08/07/1981 $450 Million NW-0!25 08/07/1981 $450 Million" COVERAGE FOR SUPPLIERS & TRANSPORTERS:
- 2. US DOMESTIC S&T DESCRIPTION OF OPERATIONS: Furnishing of services, materials, parts or equipment in connection with the plaming, construction, maintenance, involving the handling, storage, shipment use or disposal of specified types of nuclear materials.
NAMED INSURED [LISTED ON POLICY): Arizona Public Service, et al POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NS-0467 05/20/1985 $450 Million THIS CERTIFICATE IS ISSUED AS A MATIER 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 amend, extend or aller 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 by payment of claims or claims expenses.
'The following are Named Insureds: Arizona Public Service Company, Southern California Edison Company, Sat River Project Agricultural Improvement and Power District, Public Service Company of New Mexico, El Paso Electric Company, Southern California Public Power Authority, and The Department of Water and Power of the City of Los Angeles.
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD