ML17156A561

Acord Corp., Certificate of Liability Insurance

ML17156A561
Person / Time
Site:	Zion File:ZionSolutions icon.png
Issue date:	05/22/2017
From:	Acord Corporation
To:	Document Control Desk, Office of Nuclear Reactor Regulation
References
Download: ML17156A561 (5)

Text

0000520 SP 0284 -C01-P00520-t DOCUMENT CONTROL DESK U.S. NUCLEAR REGULATORY COMMISSION WASHINGTON, DC 20555-0001

~

• ~

5.o- zqs

.,'.~ _; '

~ :- . *** 1*

);".  :"'.

, .. *\. .- .,. *: - ._I "~ :

\ *'"

.... *1* ,_"\,- .~' ;  :

,; ( ' ~** .

i:*: .,:

J\'.  !.-*

'.* ._* *.!:-*:. (\ r;: .. :*3  !'t .. 1 *

+*-: ; ! ; '"{. ~*

.I';;,;*~ '* i'J*~:*-.*1r--'1.<:L .. 1::*::-1':".'!1*/{.:-.:*

• j"

.. iiiiiiiiiii -

iiiiiiiiiii

= .:'.!... :

. iiiiiiiiiii .,,,,;,

iiiiiiiiiii

' \ '~

.3;,1.

_:i*; " \' ~r . *; .

• 1. . , i.*:1.*

\.'

.: .. *.,)

. iiiiiiiiiii

. ~, ;I

• .. ~ *.: ... '.:

iiiiiiiiiii

. === '.."

)*

r

• ,, .. i*". .;;' ,'*i

~

.:_.*1 i,."l. ,.

.; ~;.

">>"*  :-.~I~." '

• -.i *,~

,/,

<.: ~ ' .. :*.... * .. ." ~. . :.. ~ *..;-.*  :.".\;t :J" { *~*. . J.J,'.: ,,

• .:1;*,,

','::

• j  :

0284-01-00-0000520-0001-0001717

DATE (MM/DDNYYY)

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 05/22/2017 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.

IMf>ORTANT: 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, ceitain 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 Temple, Suite 700 PHONE IAJC No Ev+**

I FAX

!AJC Nol:

Salt Lake City, UT 84101 E-MAIL ADDRESS:

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

J36105-NRC-NEL-17-18 INSURER A : American Nuclear Insurers INSURED INSURERS: ..

ZionSolutions, LLC '*f and Exelon Generation Company, LLC INSURERC:

299 South Main Street, Suite 1700 INSURERD: . '

Salt Lake City, UT 84111 - ~,.

INSURERE:

INSURER F:

COVERAGES CERTIFICATE NUMBER: SEA-002671181-09 REVISION NUMBER:8 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIQD '*

INDICATED. N0TWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH *\HJ~<

CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TE~MP.".

EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ., :*:--

INSR ADDLSUBR .. , it*,

LTR TYPE OF INSURANCE 1.rc:nlwvo POLICY NUMBER LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ .. *-

,____~ CLAIMS-MADE D OCCUR DAMAGE TO RENTED PREMISES fEa occurrencel $

~ ,.

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

, GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $

D H POLICY OTHER:

D AUTOMOBILE LIABILITY PRO-JECT LOC PRODUCTS - COMP/OP AGG fOMBINED SINGLE LIMIT Ea accidentl ANY AUTO BODILY INJURY (Per person) $

,____ ALL OWNED ~ SCHEDULED BODILY INJURY (Per accident) $

~AUTOS ~AUTOS NON-OWNED PROPERTY DAMAGE $

~ HIRED AUTOS ,____ AUTOS IPer accident\

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

WORKERS COMPENSATION I PER STATUTE I I OTH-ER AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $

OFFICER/MEMBER EXCLUDED? ON/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $

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

A Nuclear Energy *Liability NF-0201 01/01/2017 01/01/2018 See attached Acord 101 Insurance 'See Attached Acord 101' DESCRIPTION OF OPERATIONS I LOCATIONS I 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 ~

© 1988-2014 ACORD CORPORATION. All rights reserved.

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

~ . . ~'. :

• • ... ; J '

.*., *\

,:. *-*-*1

. iiiiiiiiiii

• .~ ' *'.1 iiiiiiiiiii.

=

. . r* , -. *' i ~'

>'.~ I 1- . .' ,**:: ,: *'. : ?: '*.

_.} . ** {.* ... *.'

. ~I . ; ~ .. ,. ) _1 **

• ,_1.:*

• ~ *.. f.'

• -: 'J . ,- J ~- ... **

• .1

':I

. !.\

..~ ' :.~ .' \ ~.  ! I ,.

. ' ..  : ~*- ....

1, .* *' ~j. *',.J,'

':.1.

..* : *1.: . ~- ,; .. * *-*"::1'****."  ;:.*:f,'.:: ,. '\_}. .. *'.i

• 1. ~'.** ' ' : ' ,*.;/:;

\:.! ..:.*  ;.:,.: 1:1-.. 1**

"i*.

0284-01-00-0000520-0002-0001718

AGENCY CUSTOMER ID: J36105 ~~~~~~~~~~~~~~~~~~~~~~~~

LOC #: 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 NAICCODE EFFECTIVE DATE:

ADDITIONAL REMARKS THIS ADDITION.AL REMARKS FORM IS A SCHEDULE TO ACORD FORM, '.:.*_ ..,,

• i-:*

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 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 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 expens'es.

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 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 havjng 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