ML17340A335

Certificate of Liability Insurance for Zionsolutions, LLC

ML17340A335
Person / Time
Site:	Zion  File:ZionSolutions icon.png
Issue date:	11/15/2017
From:	Berrett T Marsh Risk & Insurance Services
To:	Document Control Desk, Office of Nuclear Reactor Regulation
References
Job Code J36105
Download: ML17340A335 (2)

Text

DATE (MM/DD/YYYY)

ACORD CERTIFICATE OF LIABILITY INSURANCE

~ r I 11/15/2017 THIS CERTIFICATE IS ISSUED AS A MATTER 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 Risk & Insurance Services 15 West South Temile, Suite 700 Salt Lake City, UT 4101 PHONE

/Alf' No. l'vt\*

E-MAIL I r.e~ Nol:

ADDRESS:

Attn: SaltLakeCity.certrequest@marsh.com;Fax212.948.4373 INSURER(S) AFFORDING COVERAGE NAIC#

J36105-NRC-NEL-18-19 INSURER A: American Nuclear Insurers INSURED INSURERB:

ZionSolutions, LLC and Exelon Generation Company, LLC INSURERC:

299 South Main Street, Suite 1700 INSURERD:

Salt Lake City, UT 84111 INSURERE:

INSURERF:

COVERAGES CERTIFICATE NUMBER: SEA-003329625-11 REVISION NUMBER: 11 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.

INSR LTR TYPE OF INSURANCE ... ...

ADDL SUBR

~~ ,~ POLICY NUMBER 1~2}-J%~Vv1 1~m-Ji1v~Vv, LIMITS

-D COMMERCIAL GENERAL LIABILITY CLAIMS-MADE D OCCUR EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence)

-- 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 COMBINED SINGLE LIMIT $

- (Ea accident)

ANY AUTO* BODILY INJURY (Per p~rson)

-- OWNED AUTOS ONLY HIRED AUTOS ONLY

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

PROPERTY DAMAGE I Per accident) $

H

- UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE EACH OCCURRENCE AGGREGATE OED I I RETENTION$ $

WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N I ~ffTuTE I I OTH- ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $

OFFICER/MEMBER EXCLUDED?

(Mandatory In NH)

D N/A E.L. DISEASE - EA EMPLOYEE $

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

A Nuclear Energy Liability NF-0201 01/01/2018 01/01/2019 See attached Acord 101 Insurance 'See Attached Acord 101' DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)

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 Risk & Insurance Services I

Tiffani Berrett ~

© 1988-2016 ACORD CORPORATION. All rights reserved.

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

AGENCY CUSTOMER ID: J36105 LO C #: Salt*Lake City ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Risk & Insurance Services ZionSolutions, LLC and Exelon Generation Company, LLC '

POLICY NUMBER 299 South Main Street, Suite 1700 Salt Lake City, UT 84111 CARRIER I NAIC CODE 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 Nuclear Facility at 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 terminate as of the end of such December 31st. A Certificate will NOT be issued for any subsequent calendar year unless requested in writing.

Types of Insurance: NF - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's & Transporters], FS - [Foreign Suppliers & Transporters]

COVERAGE FOR NUCLEAR FACILITIES:

1. SITE#1-ZION NUCLEAR STATION LOCATION OF NUCLEAR FACILITY: Zion Nuclear Station, located on the Western Edge of Lake Michigan in Lake County, IL NAMED INSURED [LISTED ON POLICY]: Zion Solutions, LLC and Exelon Generation Company, LLC [NOTE 1]

POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:

NF-0201 12/16/1971 $100 Million NW-0584 12/16/1971 $450 Million" THIS CERTIFICATE IS ISSUED AS A MAITER 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 alter 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:

NOTE 1 -Additional Insured Definition: Any other person or organization with respect to his legal responsibility for covered damages or covered environmental cleanup costs because of bodily injury, property damage or environmental damage caused by the nuclear energy hazard. (does not include as an insured the United States of America or any of its agencies, except the Tennessee Valley Authority)

" Master Worker Certificate - This li_mit 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.

ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD