ML16118A288

Re Ginna Nuclear Power Plant, LLC - Certificate of Liability Insurance

ML16118A288
Person / Time
Site:	Ginna
Issue date:	03/17/2016
From:	Alderson C Acord Corporation, Promark Associated Agencies
To:	Document Control Desk, Office of Nuclear Reactor Regulation
References
Download: ML16118A288 (3)

Text

DATE (MM'DD/YYYY)

ACORD

~

CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I 3/17/2016 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 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 ~2~I~?T Jennifer Dissette Premark Associated Agencies, Inc. f,.~gN,t i:vt1* (716) 633-8401 I rie~ Nol: (716) 633-8429 6470 Main St., Ste #2 ~DMD~~ss: jdissette@promarkinsurance.com PO Box 530 INSURER(S) AFFORDING COVERAGE NAIC#

Williamsville NY 14231-0530 INSURER A :RLI Insurance Companv - A&E 13056 INSURED INSURER B One Beacon Insurance Companv 21970 MRB Group INSURER C:

145 Culver Road, Suite 160 INSURER D:

INSURER E:

Rochester NY 14620 INSURER F:

COVERAGES CERTIFICATE NUMBER;CL1631703524 REVISION NUMBER:

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 ADDL SUBR POLICY EFF LTR TYPE OF INSURANCE 1*0Cn 1m1n POLICY NUMBER IMM/DD/YYYYI ,~g}-~%Yv~1 LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A

D CLAIMS-MADE [i] OCCUR DAMAGE TO RENTED PREMISES IEa occurrence\ $ 1,000,000 PSB0003207 5/1/2016 5/1/2017 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 R GEN'LAGGREGATE LIMIT APPLIES PER:

POLICY 0PRO-OTHER:

JECT DLOC GENERALAGGREGATE PRODUCTS - COMP/OP AGG 2,000,000 2,000,000 COMBINED SINGLE LIMIT

- AUTOMOBILE LIABILITY rEa accident\ $ 1,000,000

- ANY AUTO BODILY INJURY (Per person) $

A ALL OWNED SCHEDULED PSA0001996 BODILY INJURY (Per accident) $

AUTOS AUTOS 3/5/2016 3/5/2017

- NON-OWNED x rp~~~~c~~t~AMAGE

-x HIRED AUTOS

- AUTOS $

M x UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5 000 000 A

I OED I x RETENTION$ 10 000 PSE0003023 5/1/2016 5/1/2017 $

WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN x I ~f~TUTE I I OTH- ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1 000 000 A

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) 0 N/A PSW0001923 5/1/2016 5/1/2017 E.L. DISEASE - EA EMPLOYEE $ 1 000 000 I g~~~~;;;'f-f~~ 'bn~'6PERATIONS below E.L. DISEASE - POUCY LIMIT $ 1 000 000 B Professional Liability DPL-4987-15 12/31/2015 12/31/2016 Per Claim 2,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be atached if more spaceis required)

Holder is an additional insured for the general liability only in regards toservices provided by the insured to the entity when required by executed written contract. Professional Liability limits shown are per claim and aggregate for a l l projects of the named insured.

CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RE Ginna Nuclear Power THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

Plant, LLC 750 East Pratt Street Baltimore, MD 21202 AUTHORIZED REPRESENTATIVE c Alderson/HWITTM C~P-----* ..-..I  :-~£__,.........

© 1988-2014 ACORD CORPORATION. All rights reserved.

ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 r?o14011

DATE (MMIDD/YYYY)

ACORD THIS CERTIFICATE IS ISSUED AS A CERTIFICATE OF LIABILITY INSURANCE MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I 3/17/2016 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 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 ~2~~~CT Jennifer Dissette Premark Associated Agencies, Inc. r.~W'!.\:. Cv+I* (716) 633-8401 I rie~ Nol: (716) 633-8429 6470 Main St., Ste #2 ~t1DA~ss: jdissette@promarkinsurance.com PO Box 530 INSURER!Sl AFFORDING COVERAGE NAIC#

Williamsville NY 14231-0530 INSURER A :RLI Insurance Comoanv - A&E 13056 INSURED INSURER B One Beacon Insurance Comoany 21970 MRB Group INSURERC:

145 Culver Road, Suite 160 INSURER D:

INSURER E:

Rochester NY 14620 INSURER F:

COVERAGES CERTIFICATE NUMBER:CL1631703524 REVISION NUMBER:

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  ;:SUBR MMIDD/YYYYl r~2hl~/'v~y, I POLICY EFF LTR TYPE OF INSURANCE I~~.,"~ \Af\fn POLICY NUMBER LIMITS x COMMERaAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A I CLAIMS-MADE [iJ OCCUR PREMISES !Ea occurrencel $ 1,000,000 PSB0003207 5/1/2016 5/1/2017 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY* $ 1,000,000

=i GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY OTHER:

0 PRO-JECT DLoc GENERAL AGGREGATE PRODUCTS - COMP/OP AGG 2,000,000 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000

- (Ea accident\

ANY AUTO BODILY INJURY (Per person) $ '

A -

ALL OWNED - SCHEDULED

-x AUTOS

-x AUTOS PSA0001996 3/5/2016 3/5/2017 BODILY INJURY (Per accident) $

- HIRED AUTOS

-M NON-OWNED AUTOS PROPERTY DAMAGE IPer accidentl $

A

-x UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE EACH OCCURRENCE AGGREGATE 5,000,000 5 000 000 OED Ix I RETENTION$ 10 000 PSE0003023 5/1/2016 5/1/2017 $

WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN x I ~f~TUTE I I OTH- ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1 000 000 A

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) ~ N/A PSW0001923 5/1/2016 5/1/2017 E.L. DISEASE - EA EMPLOYEE $ 1 000 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 000 000 B Professional Liability DPL-4987-15 12/31/2015 12/31/2016 Per Claim 2,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remall<s Schedule, may be atached if more spaceis required)

The County of Ontario is an additional insured for the general l i a b i l i t y only in regards to services provided by the insured to the entity when required by executed written contract.

CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE R.E. Ginna Nuclear Power Plant THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

1503 Lake Road Ontario, NY 14519 AUTHORIZED REPRESENTATIVE c Alderson/HWITTM c--:_I-*- -.. . . ...-.! . 6 __. . .

~z HH**<

© 1988-2014 ACORD CORPORATION. All rights reserved.

ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS0251?014011

-.. ~-1_

Promark Agencies 64 70 Main Street Suite 2 P.O.Box530 Williamsville, New York 14231-0530 BM! Ji. L

DATE (MM'DD/YYYY)

ACORD

~

CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I 3/17/2016 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 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 ~2~I~?T Jennifer Dissette Premark Associated Agencies, Inc. f,.~gN,t i:vt1* (716) 633-8401 I rie~ Nol: (716) 633-8429 6470 Main St., Ste #2 ~DMD~~ss: jdissette@promarkinsurance.com PO Box 530 INSURER(S) AFFORDING COVERAGE NAIC#

Williamsville NY 14231-0530 INSURER A :RLI Insurance Companv - A&E 13056 INSURED INSURER B One Beacon Insurance Companv 21970 MRB Group INSURER C:

145 Culver Road, Suite 160 INSURER D:

INSURER E:

Rochester NY 14620 INSURER F:

COVERAGES CERTIFICATE NUMBER;CL1631703524 REVISION NUMBER:

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 ADDL SUBR POLICY EFF LTR TYPE OF INSURANCE 1*0Cn 1m1n POLICY NUMBER IMM/DD/YYYYI ,~g}-~%Yv~1 LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A

D CLAIMS-MADE [i] OCCUR DAMAGE TO RENTED PREMISES IEa occurrence\ $ 1,000,000 PSB0003207 5/1/2016 5/1/2017 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 R GEN'LAGGREGATE LIMIT APPLIES PER:

POLICY 0PRO-OTHER:

JECT DLOC GENERALAGGREGATE PRODUCTS - COMP/OP AGG 2,000,000 2,000,000 COMBINED SINGLE LIMIT

- AUTOMOBILE LIABILITY rEa accident\ $ 1,000,000

- ANY AUTO BODILY INJURY (Per person) $

A ALL OWNED SCHEDULED PSA0001996 BODILY INJURY (Per accident) $

AUTOS AUTOS 3/5/2016 3/5/2017

- NON-OWNED x rp~~~~c~~t~AMAGE

-x HIRED AUTOS

- AUTOS $

M x UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5 000 000 A

I OED I x RETENTION$ 10 000 PSE0003023 5/1/2016 5/1/2017 $

WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN x I ~f~TUTE I I OTH- ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1 000 000 A

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) 0 N/A PSW0001923 5/1/2016 5/1/2017 E.L. DISEASE - EA EMPLOYEE $ 1 000 000 I g~~~~;;;'f-f~~ 'bn~'6PERATIONS below E.L. DISEASE - POUCY LIMIT $ 1 000 000 B Professional Liability DPL-4987-15 12/31/2015 12/31/2016 Per Claim 2,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be atached if more spaceis required)

Holder is an additional insured for the general liability only in regards toservices provided by the insured to the entity when required by executed written contract. Professional Liability limits shown are per claim and aggregate for a l l projects of the named insured.

CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RE Ginna Nuclear Power THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

Plant, LLC 750 East Pratt Street Baltimore, MD 21202 AUTHORIZED REPRESENTATIVE c Alderson/HWITTM C~P-----* ..-..I  :-~£__,.........

© 1988-2014 ACORD CORPORATION. All rights reserved.

ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 r?o14011

DATE (MMIDD/YYYY)

ACORD THIS CERTIFICATE IS ISSUED AS A CERTIFICATE OF LIABILITY INSURANCE MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I 3/17/2016 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 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 ~2~~~CT Jennifer Dissette Premark Associated Agencies, Inc. r.~W'!.\:. Cv+I* (716) 633-8401 I rie~ Nol: (716) 633-8429 6470 Main St., Ste #2 ~t1DA~ss: jdissette@promarkinsurance.com PO Box 530 INSURER!Sl AFFORDING COVERAGE NAIC#

Williamsville NY 14231-0530 INSURER A :RLI Insurance Comoanv - A&E 13056 INSURED INSURER B One Beacon Insurance Comoany 21970 MRB Group INSURERC:

145 Culver Road, Suite 160 INSURER D:

INSURER E:

Rochester NY 14620 INSURER F:

COVERAGES CERTIFICATE NUMBER:CL1631703524 REVISION NUMBER:

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  ;:SUBR MMIDD/YYYYl r~2hl~/'v~y, I POLICY EFF LTR TYPE OF INSURANCE I~~.,"~ \Af\fn POLICY NUMBER LIMITS x COMMERaAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A I CLAIMS-MADE [iJ OCCUR PREMISES !Ea occurrencel $ 1,000,000 PSB0003207 5/1/2016 5/1/2017 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY* $ 1,000,000

=i GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY OTHER:

0 PRO-JECT DLoc GENERAL AGGREGATE PRODUCTS - COMP/OP AGG 2,000,000 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000

- (Ea accident\

ANY AUTO BODILY INJURY (Per person) $ '

A -

ALL OWNED - SCHEDULED

-x AUTOS

-x AUTOS PSA0001996 3/5/2016 3/5/2017 BODILY INJURY (Per accident) $

- HIRED AUTOS

-M NON-OWNED AUTOS PROPERTY DAMAGE IPer accidentl $

A

-x UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE EACH OCCURRENCE AGGREGATE 5,000,000 5 000 000 OED Ix I RETENTION$ 10 000 PSE0003023 5/1/2016 5/1/2017 $

WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN x I ~f~TUTE I I OTH- ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1 000 000 A

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) ~ N/A PSW0001923 5/1/2016 5/1/2017 E.L. DISEASE - EA EMPLOYEE $ 1 000 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 000 000 B Professional Liability DPL-4987-15 12/31/2015 12/31/2016 Per Claim 2,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remall<s Schedule, may be atached if more spaceis required)

The County of Ontario is an additional insured for the general l i a b i l i t y only in regards to services provided by the insured to the entity when required by executed written contract.

CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE R.E. Ginna Nuclear Power Plant THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

1503 Lake Road Ontario, NY 14519 AUTHORIZED REPRESENTATIVE c Alderson/HWITTM c--:_I-*- -.. . . ...-.! . 6 __. . .

~z HH**<

© 1988-2014 ACORD CORPORATION. All rights reserved.

ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS0251?014011

-.. ~-1_

Promark Agencies 64 70 Main Street Suite 2 P.O.Box530 Williamsville, New York 14231-0530 BM! Ji. L