ML21014A346

American Nuclear Insurers, Evidence of Financial Protection

ML21014A346
Person / Time
Site:	La Crosse  File:Dairyland Power Cooperative icon.png
Issue date:	12/05/2020
From:	Uricchio G American Nuclear Insurers
To:	Document Control Desk, Office of Nuclear Material Safety and Safeguards
Shared Package
ML21014A344	List: ML21014A345 ML21014A346
References
LC-2020-0026
Download: ML21014A346 (2)

Text

EVIDENCE OF FINANCIAL PROTECTION To:

Document Control Desk U.S. Nuclear Regulatory Commission Washington, DC 20555-0001 This is to confirm that there is In force as of the effective date of this Evidence of Financial Protection a Nuclear Energy Liability Policy (Facility Form) and a certificate to the Master Worker Polley [Nuclear Energy Liability Policy (Facility Worker Form)] issued by the members of American Nuclear Insurers, hereafter callect the "companies", to the Insured named herein, with respect to the Nuclear Faclllty at the Location stated below. If such policy and/or certificate are cancelled or otherwise terminated prior to the end of December 31st of the calendar year in which the Effective Date of this Evidence of Financial Protection occurs, the companies will mail written notice thereof to the United States Nuclear Regulatory Commission in accordance with policy provisions and this Evidence of Financial Protection shall thereupon terr11lnate.

Otherwise this Evidence of Financial Protection shall terminate as of the end of such December 31st.

Name and Malling Address of Insured Effective Date of this Evidence of Financial Protection Dairyland Power Cooperative PO Box 817 3200 East Avenue South LaCrosse, WI 54602-0817 Policy/Certificate Number Facility Form Polley No. NF -0217 Facility Worker Form Certificate No. NW -0596 Location of the Nuclear Facility VIiiage of Genoa, Vernon County, State of Wisconsin January 1, 2021 Policy/Certificate Effective Date August 10, 1973 January 1, 1998 Limit of Liablllty

$30,600,000

• This is an aggregate limit of liability shared by all participants to the Master Worker Polley [Nuclear Energy Llablllty Policy (Facility Worker Form)] of which each certificate is a part and Is subject to all of the provisions of such Polley and certificate having reference thereto.

NRC1001 {12/1/2014)

Page 1 of 2 American Nuclaar Insurers 95 GIBStonbury Blvd.. Surte 300 c Glastonbury, CT 06033-4453 Cl Voice. (860) 882-1301 0 Fax. (880) 659-0002 Evidence of Rnanclal Protection Fonn

This Evidence of Financial Protection Is not an insurance policy, is issued as a matter of information only and confers no rights upon the holder. This Evidence of Financial Protection neither affirmatively nor negatively amends, extends or alters the coverage afforded by the above stated policies and certificates.

Notwithstanding any requirement, term or condition of any contract or other document with respect to which this Evidence of Financial Protection may be issued or may pertain, the insurance afforded by the policies and certificates described herein is subject to all the terms, exclusions and conditions of the policies and certificates. The Limits of Liability shown above may have been reduced by payment of claims or claims expenses.

./4.~

(Sig~uthorized Representative)

Gary S. Uricchio - Senior Vice President, Underwriting (Name and Title of Authc;>rlzed R_epresentatlve) 12/5/2020 (Date)

Page 2 of 2 NRC1001 (12/1/2014)

Evidence of Financial Protection Form