ML18327A034
| ML18327A034 | |
| Person / Time | |
|---|---|
| Site: | Browns Ferry, Watts Bar, Sequoyah  |
| Issue date: | 10/29/2018 |
| From: | Mukherjee M Marsh USA |
| To: | Document Control Desk, Office of Nuclear Reactor Regulation |
| References | |
| Download: ML18327A034 (3) | |
Text
0001773 SP 0663 -C01-P01773-I Document Control Desk U.S. Nuclear Regulatory Commission Washington, DC 20555-0001
DATE(MM/DDNYYY)
ACORD
\,,. ......../
CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MA TIER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I 10/29/2018 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 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 CONTACT NAME:
MARSH USA, INC.
TWO ALLIANCE CENTER PHONE IAJC No Extl:
I FAX IAJC Nol:
3560 LENOX ROAD, SUITE 2400 E-MAIL ADDRESS:
ATLANTA, GA 30326 INSURER(Sl AFFORDING COVERAGE NAIC#
CN102113409-1-Nuke-19-20 INSURER A : American Nuclear Insurers INSURED INSURERS:
Southern Company Services, Inc.
Attn: Deborah Gaffney INSURERC:
dsgaffne@southemco.com INSURERD:
30 Ivan Allen Jr. Boulevard NW Bin SC1404 INSURER E:
Atlanta, GA 30308 INSURERF:
COVERAGES CERTIFICATE NUMBER: ATL-004728778-10 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 PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WIHICH 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 POLICY EXP LTR TYPE OF INSURANCE ***<>n un,n POLICY NUMBER IMM/DDNYYYI IMM/DD/YYYYI LIMITS
-D COMMERCIAL GENERAL LIABILITY CLAIMS-MADE D OCCUR EACH OCCURRENCE DAMAGE TO RENTED PREMISES /Ea occurrence\
$
$
-- MED EXP (Any one person)
PERSONAL & ADV INJURY
$
$
R GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY DPRO-OTHER:
JECT DLoc GENERAL AGGREGATE PRODUCTS - COMP/OP AGG
$
$
$
- AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I Ea accidentl
$
-- 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 accidenl\
$
- UMBRELLA LIAB EXCESSLIAB H OCCUR CLAIMS-MADE EACH OCCURRENCE AGGREGATE
$
$
OED I I RETENTION$ $
WORKERS COMPENSATION I STATUTE PER I I OTH-ER AND EMPLOYERS' LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTJVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
D N/A E.L. DISEASE - EA EMPLOYEE $
$
If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached Acord 101 01/01/2019 01/01/2020 See Attached Acord 101 see addl page text 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 USA Inc.
Manashi Mukherjee ...M..o..'VUIO ...... ~
I
© 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: _C_N_1_0_2_1_13'-4_0_9_ _ _ _ _ _ _ _ _ _ __
LOC #: Atlanta
-~
ACORD ADDITIONAL REMARKS SCHEDULE Page 2 of 2
"---
AGENCY NAMED INSURED MARSH USA, INC. Southern Company Services, Inc.
Attn: Deborah Gaffney POLICY NUMBER dsgaffne@southemco.com 30 Ivan Allen Jr. Boulevard NW CARRIER I NAICCODE Bin SC1404 Atlanta, GA 30308 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 Insurer.; 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 catendar 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 Supplie~s &Transporter.;], FS- [Foreign Supplier.; &Transporters]
COVERAGE FOR NUCLEAR FACILITIES:
- 1. SITE #1 - BROWNS FERRY LOCATION OF NUCLEAR FACILITY: Browns Ferry Nuclear Power Plan! 10 Ml NWofDeca!ur, AL NAMED INSURED [LISTED ON POLICY]: Tennessee Valley Authority POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0198 09/22/1971 $375 Million NW-0581 09/22/1971 $375 Million**
- 2. SITE #2 - SEQUOYAH LOCATION OF NUCLEAR FACILITY: Sequoyah Nuclear Power Plant 9.5 Ml NE of Chattanooga, TN NAMED INSURED [LISTED ON POLICY]: Tennessee Valley Authority POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0247 03/11/1977 $375 Million NW-0614 03/11/1977 $375 Million**
- 3. SITE #3 - WATTS BAR LOCATION OF NUCLEAR FACILITY: Watts Bar Nuclear Power Plant 10 Ml S of Spring City, TN NAMED INSURED [LISTED ON POLICY]: Tennessee Valley Authority 5/)-390/3q I POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0256 09/04/1979 $375 Million NW-0618 09/04/1979 $375 Million**
- 4. SITE #4 - MUSCLE SHOALS LOCATION OF NUCLEAR FACILITY: TVA Power Service Shop 1, 3 and 4 in Muscle Shoals, AL NAMED INSURED [LISTED ON POLICY]: Tennessee Valley Authority POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0349 05/01/1999 $1 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 expenses.
COMMENTS/NOTES:
- Master Worker Certificate - This limit is shared by all Certificates to !he 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.
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD