ML19295D254

Certificate of Liability Insurance - Pacific Gas & Electric Company

ML19295D254
Person / Time
Site:	Diablo Canyon, Humboldt Bay
Issue date:	10/07/2019
From:	Kolstad E Marsh Risk & Insurance Services
To:	Document Control Desk, Office of Nuclear Material Safety and Safeguards, Office of Nuclear Reactor Regulation
References
Download: ML19295D254 (3)

Text

0004495 SP 0557

-C01-P04497-I Document Control Desk U.S. Nuclear Regulatory Commission Washington, DC 20555-0001

/Uf1S5 D /

t100(

/If /c I<._

/\\);vj55

ACORD CERTIFICATE OF LIABILITY INSURANCE I

DATE(MM/DDNYYY)

~-

10/07/2019 THIS CERTIFICATE IS ISSUED AS A MA TIER 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 conditi_ons 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 MARSH RISK & INSURANCE SERVICES NAME:

PHONE I FAX 345 CALIFORNIA STREET, SUITE 1300 IA/C No l'xtl*

IAIC Nol:

CALIFORNIA LICENSE NO. 0437153 E-MAIL SAN FRANCISCO, CA 94104 ADDRESS:

INSURER(Sl AFFORDING COVERAGE NAIC#

CN102994327 --NUC2-20-21 INSURER A: Amertcan Nuclear Insurers INSURED INSURERS:

PACIFIC GAS & ELECTRIC COMPANY ONE MARKET SPEAR TOWER INSURERC:

SUITE2400 INSURERD:

SAN FRANCISCO, CA 94105 INSURER E:

INSURERF:

COVERAGES CERTIFICATE NUMBER:

SEA-003211131-10 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 ADDL SUBR POLICYEFF POLICY EXP LIMITS LTR TYPE OF INSURANCE

'""n un,n POLICY NUMBER IMM/DDNYYYI IMM/DDNYYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE

-D CLAIMS-MADE D OCCUR DAMAGE TO RENTED PREMISES /Ea occurrence!

MED EXP (Any one person)

PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:

GENERAL AGGREGATE Fl DPRO-DLOC PRODUCTS - COMP/OP AGG POLICY JECT OTHER:

AUTOMOBILE LIABILITY fE~~~b~d~~tf lNGLE LIMIT ANY AUTO BODILY INJURY (Per person)

OWNED SCHEDULED BODILY INJURY (Per accident) $

AUTOS ONLY -

AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY

/Per accidentl UMBRELLA LIAB H OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED I I RETENTION $

WORKERS COMPENSATION I PER I I OTH-AND EMPLOYERS' LIABILITY STATUTE ER YIN ANYPROPRIETOR/PARTNER/EXECUTIVE D E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?

N/A (Mandatory in NH)

E.L. DISEASE - EA EMPLOYEE $

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

Nuclear Energy Liability See Attached Acord 101 01/01/2020 01/01/2021 See Attached Acord 101 Insurance 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 Risk & Insurance Services I

Eric T Kolstad

~ ~--~~-

© 1988-2016 ACORD CORPORATION. All rights reserved.

ACORD 25 (2016/03)

The ACORD name and logo are registered marks of ACORD

AGENCY CUSTOMER ID: CN102994327 LO C #: San Francisco AC~

'--*-*-/

ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED MARSH RISK & INSURANCE SERVICES PACIFIC GAS & ELECTRIC COMPANY ONE MARKET SPEAR TOWER POLICY NUMBER SUITE 2400 SAN FRANCISCO, CA 94105 CARRIER I NAICCODE 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], N- [Secondary Financial Protection Certificate]

COVERAGE FOR NUCLEAR FACILITIES:

1. SITE #1 - DIABLO CANYON LOCATION OF NUCLEAR FACILITY: Dlablo Canyon Nuclear Power Plant 12 Ml WSW of San Luis Obispo, CA NAMED INSURED [LISTED ON POLICY]: Pacific Gas and Electric Company POLICY NUMBER:

POLICY EFFECTIVE:

LIMIT OF LIABILITY:

NF-0228 NW-0605 N-0074 N-0076

2. SITE #2-HUMBOLDT BAY 07/05/1974 07/05/1974 09/22/1981 04/26/1985

$450 Million

$450 Million" LOCATION OF NUCLEAR FACILITY: Humboldt Bay Nuclear Power Plant (Shutdown July 76) in Humboldt County, California NAMED INSURED [LISTED ON POLICY]: Pacific Gas and Electric Company POLICY NUMBER:

POLICY EFFECTIVE:

LIMIT OF LIABILITY:

NF-0113 01/01/1962

$53.3 Million NW-0534 01/01/1998

$450 Million" THIS CERTIFICATE IS ISSUED AS A MATIER 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:

" 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 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.

Page 2

of 2

ACORD 101 (2008/01)

© 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD