ML16032A123
| ML16032A123 | |
| Person / Time | |
|---|---|
| Site: | Columbia  |
| Issue date: | 01/07/2016 |
| From: | Vong V Marsh USA |
| To: | Document Control Desk, Office of Nuclear Reactor Regulation |
| References | |
| Download: ML16032A123 (6) | |
Text
0 001.7 60 SP 0022 -001-P01760-1 Document Control Desk U.S. Nuclear Regulatory Commission Washington, DC 20555-0001 c*o ~~f4 (7
- '.1 .';.,
- 1/2
.4.- .1--....
.4
-S a-S
-I~i *-
S I -P S
e I -* i~i S 1 '~'
-S
.'" . . -'L. .= .' . .... . .. .. ;.. ....... ' :., :.
0022-01-00-0001760-0001-0006740
ACO~RD DATE (MM/DDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 01/07/2016 THIS CERTIFICATE IS ISSUED AS A MATTER 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 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 MarshUSAInc.NAME:
MrhUAIn.PHONE FAX 1301 5th Avenue, Suite 1900 (AlC, No, Esf): tNC. Not:
Seattle, WA 98101 ADPESMAI INSURER(S) AFFORDING COVERAGE NAIC #
J26976-NUC2-16-17 iNSURER A : American Nuclear Insurers INSURED INSURER B :
Energy Northwest Attn: Marie Thomas INSURER C :
P.O. BOX 968 INsuRER D :
Richiand, WA 99352
_______________________________________________INSURER F:
COVERAGES CERTIFICATE NUMBER: SEA-002714992-02 REVISION NUMBER:2 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 SUJBR POLICY EFF POLICY EXP LRTYPE OF INSURANCE (N*ip WV POLICY NUMBER (MMIDD/YYYY) 'MMIDD/YYYY1 LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
m DAMAGE TO RENTED CLAIMS-MADE [, OCCUR PREMISES (Ea occurrencet $
___________________________MED EXP (Any one person) $
_____________________PERSONAL & ADV INJURY $
POLICY D-PRO-° GEN'L AGGREGATE LIMIT APPLIES PER:
JECT i* LOC GENERAL AGGREGATE .
PRODUCTS - COMPIOP AGG OTHER: ____________$
_AUTO'MOEILE LIABILITY (ECOMBINEDac etSINGLE LIMIT $
ANY AUTO BODILY INJURY (Per person) $
-- ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
__AUTOS _ AUTOS lNON-OWNED PROPERTY DAMAGE
__HIRED AUTOS AUTOS (Per accident)
__UMBRELLA UAB OCCUR EACH OCCURRENCE $
EXCESS MAB I CLAIMS-MADE AGGREGATE .$
DEDI RETENTIONS$ $
WORKERS COMPENSATION PRE STATTE1 IERH AND EMPLOYERS' LIABILITY Y I. N ANY PROPRIETOR/PARTNER/EXECUTIVE F'-G1 E.L. EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? N IA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
'ESCRIPTION D_ OF OPERATIONS below _______________ _____E.L. DISEASE - POLICY LIMIT $
A Nudear Energy Liability See Attached Acord 101 01/01/2016 0)1/01/2017 See Attached Acord 101 Insurance DESCRIPTION OF OPERATIONS I LOCATIONS I vEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is requir~ed)
CERTIFICATE HOLDER CANCELLATION DocuentContol eskSHOULD 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.
i ~ ~~~~Van H. Vong "77T*,.*
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014101)
it. 1.:,* .
a a
a a
a a
a ,., ., . , ,
e * 't, ., ,'.
a a
a a
a a
a 0022-01-00-0001760-0002-0006741
AGENCY CUSTOMER ID: J26976 LOC #: Seattle ACORD Page 2 of2 ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Marsh USA, Inc. Energy Northwest
________________________________________________________________Attn: Made Thomas POUCY NUMBER P.O. BOX 968 Richiand, WA 99352 CARRIER NAIC CODE I EFFECTIVE DATE:
[THIS ADDITIONAL REMARKS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUM*BER: 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 inwhich 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 Decembnr3lst. A Certificate willNOT 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 Protecfion Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
1.SITE #1- COLUMBIA GENERATING STATION LOCATION OF NUCLEAR FACILITY: Allof the premises including the land and allbuilding and structures of Energy Northwest Columbia Generating Station including but not limited to the reactors formerly known as WNP 1,WNP 2 and WNP located approximately 12 miles NW ot Richiand, Washington.
NAMvED INSURED ['LISTED ON POLICY]: Energy Northwest "
POLICY NUMBER: POLICY EFFECTIVE: LIMITOF LIABILITY:
NF-0270 08101/1982 $375 Million NW-0628 08/01/1982 $375 Million**
N-0091 12/20/1983**
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policyjies) 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 Limitof Liability shown above may have been reduced by payment of claims or claiins 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 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 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
11101111111111 11111111 11111111111 11111111111111 C
6 9C C
U, C
C
0 001.7 60 SP 0022 -001-P01760-1 Document Control Desk U.S. Nuclear Regulatory Commission Washington, DC 20555-0001 c*o ~~f4 (7
- '.1 .';.,
- 1/2
.4.- .1--....
.4
-S a-S
-I~i *-
S I -P S
e I -* i~i S 1 '~'
-S
.'" . . -'L. .= .' . .... . .. .. ;.. ....... ' :., :.
0022-01-00-0001760-0001-0006740
ACO~RD DATE (MM/DDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 01/07/2016 THIS CERTIFICATE IS ISSUED AS A MATTER 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 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 MarshUSAInc.NAME:
MrhUAIn.PHONE FAX 1301 5th Avenue, Suite 1900 (AlC, No, Esf): tNC. Not:
Seattle, WA 98101 ADPESMAI INSURER(S) AFFORDING COVERAGE NAIC #
J26976-NUC2-16-17 iNSURER A : American Nuclear Insurers INSURED INSURER B :
Energy Northwest Attn: Marie Thomas INSURER C :
P.O. BOX 968 INsuRER D :
Richiand, WA 99352
_______________________________________________INSURER F:
COVERAGES CERTIFICATE NUMBER: SEA-002714992-02 REVISION NUMBER:2 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 SUJBR POLICY EFF POLICY EXP LRTYPE OF INSURANCE (N*ip WV POLICY NUMBER (MMIDD/YYYY) 'MMIDD/YYYY1 LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
m DAMAGE TO RENTED CLAIMS-MADE [, OCCUR PREMISES (Ea occurrencet $
___________________________MED EXP (Any one person) $
_____________________PERSONAL & ADV INJURY $
POLICY D-PRO-° GEN'L AGGREGATE LIMIT APPLIES PER:
JECT i* LOC GENERAL AGGREGATE .
PRODUCTS - COMPIOP AGG OTHER: ____________$
_AUTO'MOEILE LIABILITY (ECOMBINEDac etSINGLE LIMIT $
ANY AUTO BODILY INJURY (Per person) $
-- ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
__AUTOS _ AUTOS lNON-OWNED PROPERTY DAMAGE
__HIRED AUTOS AUTOS (Per accident)
__UMBRELLA UAB OCCUR EACH OCCURRENCE $
EXCESS MAB I CLAIMS-MADE AGGREGATE .$
DEDI RETENTIONS$ $
WORKERS COMPENSATION PRE STATTE1 IERH AND EMPLOYERS' LIABILITY Y I. N ANY PROPRIETOR/PARTNER/EXECUTIVE F'-G1 E.L. EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? N IA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
'ESCRIPTION D_ OF OPERATIONS below _______________ _____E.L. DISEASE - POLICY LIMIT $
A Nudear Energy Liability See Attached Acord 101 01/01/2016 0)1/01/2017 See Attached Acord 101 Insurance DESCRIPTION OF OPERATIONS I LOCATIONS I vEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is requir~ed)
CERTIFICATE HOLDER CANCELLATION DocuentContol eskSHOULD 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.
i ~ ~~~~Van H. Vong "77T*,.*
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ACORD 25 (2014101)
it. 1.:,* .
a a
a a
a a
a ,., ., . , ,
e * 't, ., ,'.
a a
a a
a a
a 0022-01-00-0001760-0002-0006741
AGENCY CUSTOMER ID: J26976 LOC #: Seattle ACORD Page 2 of2 ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Marsh USA, Inc. Energy Northwest
________________________________________________________________Attn: Made Thomas POUCY NUMBER P.O. BOX 968 Richiand, WA 99352 CARRIER NAIC CODE I EFFECTIVE DATE:
[THIS ADDITIONAL REMARKS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUM*BER: 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 inwhich 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 Decembnr3lst. A Certificate willNOT 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 Protecfion Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
1.SITE #1- COLUMBIA GENERATING STATION LOCATION OF NUCLEAR FACILITY: Allof the premises including the land and allbuilding and structures of Energy Northwest Columbia Generating Station including but not limited to the reactors formerly known as WNP 1,WNP 2 and WNP located approximately 12 miles NW ot Richiand, Washington.
NAMvED INSURED ['LISTED ON POLICY]: Energy Northwest "
POLICY NUMBER: POLICY EFFECTIVE: LIMITOF LIABILITY:
NF-0270 08101/1982 $375 Million NW-0628 08/01/1982 $375 Million**
N-0091 12/20/1983**
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policyjies) 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 Limitof Liability shown above may have been reduced by payment of claims or claiins 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 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 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
11101111111111 11111111 11111111111 11111111111111 C
6 9C C
U, C
C