ML16042A178

Certificate of Liability Insurance

ML16042A178
Person / Time
Site:	Susquehanna
Issue date:	01/11/2016
From:	Mukherjee M Marsh USA
To:	Document Control Desk, Office of Nuclear Reactor Regulation
References
Download: ML16042A178 (3)

Text

00021'96 *,SP 0027 -C!*P()2i197-I Document!Control Desk U.S,, Nuclea,'regufatory Commission Washington, DC 20555-0001

ACORD CERTIFICATE OF LIABILITY [NSUPJAMCE DAE, M/OIYY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO[J ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTE.ND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF 1NSURAk*CE- DOES NOT CONSTITUTE ,A CONTRACT 5ETWVEEN TH.-T ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND YI-E CERTIFICATE i-EOLDER.

IMPORTANT: If the certificate holder is an ADDITIONAL INSUREDJ, t~o poEcy~ie.* r*,st be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policiws may require an on erse*-.e*.t. A sta~ernsnt cn this certificate does not confer rights to the certificate holder in lieu of such endorsement/s).

PRODUCER 1CONTACT Marsh USA Inc. IPHONI. FAX 1717 Arch Streetj ACN xtACNo Philadelphia, PA 19103-2797 [E-MAIL SADDRESS:

• INSURER(S) AFFORDING COVERAGE NAIC #

S27324-NUC-NUC-15-16 IINSURER A: American Nucleor Insurers INSUREDssuhnaNcerLCadAlgeyINSURER Ba:

Cooperat~ve,N SuqeanElectric Ier'nc.LL n lehn INSUJRER C::______

Corporate R!sk &Insurance INEINJUER D:

835 Hamilton Street, Suite 150, GENPL7NI Allentown, PA 18101 IEPRE

_____________________________________________________ INSURER F :

COVERAGES CERTIFICATE NuMBER*: CLE-004443748-03 REVISION NUMBER:5 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO T]HE 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 IN,~* SUBR

.V PCLICY*NU_.?:R -

POLICY EFF MNIJD/YYYY POLICY EXP (5MIfDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $

-- 1 DAMAGE TO RENTED CLAIMS-MADE LjOCCUR PREMISES lEa occurrence) $

__________________________MED EXP (Any one person) $

________________PERSONAL &ADV INJURY $

POLICY D

GEN'L AGGREGATE LIMIT APPLIES PER:

PRO- I--

JECT LOCLOG GENERAL AGGREGATE PRODUCTS - COMPIOP AGO OTHER: j -_____________________$

ICOMBINED AUTOMBILE IABILTY SINGLE LIMIT 1$

AUOOIELAIIY*(Ea accidentt $___________

A1~y A'..TO .1BODILY INJURY (Per person)I$

ALL OWNED SCHEDULED BODILY INJURY (Per accident) $

AUTOS

__HIRED AUTOS AUTOSI NON-OWNED

__AUTOS j.

IPROPERTY

- Per accidenlt DAMAGE $

__UMBRELLA LIAB l OCCUR EACH OCCURRENCE $

EXCESS LIAB I ICLAIMS-MADE AGGREGATE $

DED I [RETENTIONS$ $

WORKERS COMPENSATION T PERsTTT 0 ITH-E AND.EMPLOYERS' LIABILITY Y/II ANY PROPRIETORIPARTNERIEXECUTIVE fl"i-,"I .L. EACH ACCIDENT $

OFFICERIMEMBER EXCLUDED? [, J r./AA (Mandatory in NH) E .L. DISEASE - EA EMPLOYEE $

If yes, describe under.-j

___DESCRIPTION OF OPERATIONS below .,___E.L.___DISEASE-_____POLICY__ LIMIT_______$

1Acord A Nuclear Energy Liabilty See= Attached 101/01/2015 0!!0112.q!6 See Attached Insurance Acord 101 101 DESCRIPTION OF OPE:RATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional remarks Schedule, may be c.'..ach3d if more space Is required)

CERTIFICATE HOLDER CANCELLALTION 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 IManashi c f March USA Inc.

Mukherjee .. ,.*.J  ; *",LeaJ.t4_-Jt-L

© 1988-2014 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD ACORD 25 (2014101)

AGENCY CUSTOMER ID.: S27324 LOC #: Philadelphia ACORD ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. Susquehanna Nuclear, LLC and Allegheny

_________________________________________________________________Electric Cooperative, Inc.

POLICY NUMBER Corporate Risk &Insurance 835 Hamilton Street, Suite 150, GENPL7N Allentown, PA 18101 CARRIER NAIC CODE I 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 Insured'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 willbe delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate as of the end of such December 31st. ACertificate willNOT he 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], N- [Secondary Financial Protection Certificate]

COVERAGE FOR NUCLEAR FACILITIES:

• 1. SITE #1 -SUSQUEHANNA LOCATION OF NUCLEAR FACILITY: Susquehanna Nuclear Power Plant in Salem Township, Luzeme County, Pennsylvania NAMED INSURED [LISTED ON POLICY]: Susquehanna Nuclear, LLC &Allegheny Electric Cooperative, Inc.

POLICY NUJMBER: POLICY EFFECTIVE: LIMITOF LIABILITY:

NF-0262 01/01/1981 $375 Million NW-0622 01/01/1981 $375 Million**

N-0084 07/17/1982**

N-0096 03/23/1984 "

THIS CERTIFICATE IS ISSUED AS A MATTER 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 itis 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 uxpenses.

COMMENTS/NOTES:

• • Master Worker Certi~cate - This limit is shared by allCertificates to the Master Worker Policy of which each Certficate in a part and is subject to allof the provisions of such Policy and Certificate having reference thereto. Such limit may have been reduced by payment of claims or claims expenses.

• "Secondary Financial Protection Certificate - Financial protection available under an industry retrospective rating plan.

ACORD 101 (2008101[) © 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

00021'96 *,SP 0027 -C!*P()2i197-I Document!Control Desk U.S,, Nuclea,'regufatory Commission Washington, DC 20555-0001

ACORD CERTIFICATE OF LIABILITY [NSUPJAMCE DAE, M/OIYY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO[J ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTE.ND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF 1NSURAk*CE- DOES NOT CONSTITUTE ,A CONTRACT 5ETWVEEN TH.-T ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND YI-E CERTIFICATE i-EOLDER.

IMPORTANT: If the certificate holder is an ADDITIONAL INSUREDJ, t~o poEcy~ie.* r*,st be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policiws may require an on erse*-.e*.t. A sta~ernsnt cn this certificate does not confer rights to the certificate holder in lieu of such endorsement/s).

PRODUCER 1CONTACT Marsh USA Inc. IPHONI. FAX 1717 Arch Streetj ACN xtACNo Philadelphia, PA 19103-2797 [E-MAIL SADDRESS:

• INSURER(S) AFFORDING COVERAGE NAIC #

S27324-NUC-NUC-15-16 IINSURER A: American Nucleor Insurers INSUREDssuhnaNcerLCadAlgeyINSURER Ba:

Cooperat~ve,N SuqeanElectric Ier'nc.LL n lehn INSUJRER C::______

Corporate R!sk &Insurance INEINJUER D:

835 Hamilton Street, Suite 150, GENPL7NI Allentown, PA 18101 IEPRE

_____________________________________________________ INSURER F :

COVERAGES CERTIFICATE NuMBER*: CLE-004443748-03 REVISION NUMBER:5 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO T]HE 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 IN,~* SUBR

.V PCLICY*NU_.?:R -

POLICY EFF MNIJD/YYYY POLICY EXP (5MIfDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $

-- 1 DAMAGE TO RENTED CLAIMS-MADE LjOCCUR PREMISES lEa occurrence) $

__________________________MED EXP (Any one person) $

________________PERSONAL &ADV INJURY $

POLICY D

GEN'L AGGREGATE LIMIT APPLIES PER:

PRO- I--

JECT LOCLOG GENERAL AGGREGATE PRODUCTS - COMPIOP AGO OTHER: j -_____________________$

ICOMBINED AUTOMBILE IABILTY SINGLE LIMIT 1$

AUOOIELAIIY*(Ea accidentt $___________

A1~y A'..TO .1BODILY INJURY (Per person)I$

ALL OWNED SCHEDULED BODILY INJURY (Per accident) $

AUTOS

__HIRED AUTOS AUTOSI NON-OWNED

__AUTOS j.

IPROPERTY

- Per accidenlt DAMAGE $

__UMBRELLA LIAB l OCCUR EACH OCCURRENCE $

EXCESS LIAB I ICLAIMS-MADE AGGREGATE $

DED I [RETENTIONS$ $

WORKERS COMPENSATION T PERsTTT 0 ITH-E AND.EMPLOYERS' LIABILITY Y/II ANY PROPRIETORIPARTNERIEXECUTIVE fl"i-,"I .L. EACH ACCIDENT $

OFFICERIMEMBER EXCLUDED? [, J r./AA (Mandatory in NH) E .L. DISEASE - EA EMPLOYEE $

If yes, describe under.-j

___DESCRIPTION OF OPERATIONS below .,___E.L.___DISEASE-_____POLICY__ LIMIT_______$

1Acord A Nuclear Energy Liabilty See= Attached 101/01/2015 0!!0112.q!6 See Attached Insurance Acord 101 101 DESCRIPTION OF OPE:RATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional remarks Schedule, may be c.'..ach3d if more space Is required)

CERTIFICATE HOLDER CANCELLALTION 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 IManashi c f March USA Inc.

Mukherjee .. ,.*.J  ; *",LeaJ.t4_-Jt-L

© 1988-2014 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD ACORD 25 (2014101)

AGENCY CUSTOMER ID.: S27324 LOC #: Philadelphia ACORD ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. Susquehanna Nuclear, LLC and Allegheny

_________________________________________________________________Electric Cooperative, Inc.

POLICY NUMBER Corporate Risk &Insurance 835 Hamilton Street, Suite 150, GENPL7N Allentown, PA 18101 CARRIER NAIC CODE I 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 Insured'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 willbe delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate as of the end of such December 31st. ACertificate willNOT he 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], N- [Secondary Financial Protection Certificate]

COVERAGE FOR NUCLEAR FACILITIES:

• 1. SITE #1 -SUSQUEHANNA LOCATION OF NUCLEAR FACILITY: Susquehanna Nuclear Power Plant in Salem Township, Luzeme County, Pennsylvania NAMED INSURED [LISTED ON POLICY]: Susquehanna Nuclear, LLC &Allegheny Electric Cooperative, Inc.

POLICY NUJMBER: POLICY EFFECTIVE: LIMITOF LIABILITY:

NF-0262 01/01/1981 $375 Million NW-0622 01/01/1981 $375 Million**

N-0084 07/17/1982**

N-0096 03/23/1984 "

THIS CERTIFICATE IS ISSUED AS A MATTER 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 itis 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 uxpenses.

COMMENTS/NOTES:

• • Master Worker Certi~cate - This limit is shared by allCertificates to the Master Worker Policy of which each Certficate in a part and is subject to allof the provisions of such Policy and Certificate having reference thereto. Such limit may have been reduced by payment of claims or claims expenses.

• "Secondary Financial Protection Certificate - Financial protection available under an industry retrospective rating plan.

ACORD 101 (2008101[) © 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD