Dan Evans
t4MARSHMarsh USA Inc.Three Logan Square1717 Arch Street, Suite 1100Philadelphia, PA 19103+1 215 246 [email protected]
U.S. Nuclear Regulatory CommissionATTN: Document Control DeskWashington, DC 20555-0001
February 19, 2016
Subject: 2016 Nuclear Liability Certificates of Insurance
Enclosed, please find the 2016 Nuclear Liability CertificatesMarsh for insurance' brokerage services. The Certificatefinancial protection.
of Insurance for licensees that utilizeof Insurance provides evidence of
If you have any questions, please do not hesitate to contact me.
Best regards,
............ .Dan EvansNuclear Client Advisor, U.S. Nuclear Energy Practice
Enclosure
Copy:T. Farward, C. Hardie
i• MARSH &McLENNAN g
~PCOMPANIESSOLUTIONS...DEFINED, DESIGNED, AND DELIVERED.
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ACO9RDCERTIFICATE OF LIABILITY INSURANCE
SDATE (MMIDD/YYYY)02/12/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTMARSH USA, INC. NAME:
PHONE FAX20 CHURCH STREET, 8TH FLOOR ANOC No, Ext : (A/C, No:HARTFORD, CT 06103 E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
282248-NUC-16-17 INSURER A : American Nuclear Insurers
INUEConnectfcut Yankee Atomic Power Company INSURER B :
362 Injun Hollow Road INSURER C :East" Hampton, CT 06424 INSURER D :
INSURER E :
_________________________________________________________INSURER F: ______
COVERAGES CERTIFICATE NUMBER: NYC-007079786-02 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 PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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 HAVEF BEEN REDUCED RY PAID CLAIMS.
INSR ADDL SUBR POLICY EFF POLICY EXPLTR TYPE OF INSURANCE 5NP V POLICY NUMBER IMMIDD/YYYYI (MMIDD/YYYYI LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $-- CIMSMD I[ CU DAMAGE TO RENTED
CLAMSMAD L OCURPREMISES (Ea occurrence) $
___________________________MED EXP (Any one person) $
_____________________PERSONAL & ADV INJURY $GENtL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY LJ JECT [J LOC PRODUCTS -COMP/OP AGG $
__OTHER: $_AUTOMOBILE LIABILITY COMBINED(E cietSINGLE LIMIT $
ANY AUTO BODILY INJURY (Per person) $ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
__AUTOS __AUTOSNON-OWNED PROPERTY DAMAGE $
__HIRED AUTOS __AUTOS IPer accident)$
$__UMBRELLA LIAB • OCCUR EACH OCCURRENCE $
EXCESS LIAB ICLAIMS-MADE AGGREGATE $
DEDI RETENTIONS$ $
WORKERS COMPENSATION ]PERsTTT 0 THERAND EMPLOYERS' LIABILITY Y I NL.L& __________
ANY PROPRIETORJPARTNEPJE.XECUTIVE E.L. EACH ACCIDENT $OFFICERJMEMBER EXCLUDED? N1 NI A _________
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $If yes, describe underDESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101
Insurance
DESCRIPTION OF OPERATIONS /LOCATIONS/IVEHICLES (ACORD I01, Additional Remarks Schedule, may be attached if more apace Is requiredl
CERTIFICATE HOLDER CANCELLATION
Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOREU.S. Nuclear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWashington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh USA Inc.
Craig A. Parrow •,.-•
© 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 282248LOC #: Hartford
ACOIRD ADDITIONAL REMARKS SCHEDULE Page 2 of2
AGENCY NAMED INSUREDMARSH USA, INC. Connecticut Yankee Atomic Power Company
___________________________________________________________362 Injun Hollow RoadPOLICY NUMBER East Hampton, CT 06424
CARRIER NAIC CODE
i 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 asindicated (Companies), to the Insured named herein, with respect to the Nuclear Facility at the Location shown and/or with respect to the Insured's operafions 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 he delivered
is accordance with the policy provisions. Otherwise this Certificate shall terminate as of the end of such December 31st. A Certificate will NOT be lossed for any subsequent
calendar year unless requested in mritfing.
Types of Insurance: NE - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's & Transporters], FS - [Foreign Suppliers & Transporters]
COVERAGE FOR NUCLEAR FACILITIES:
1. SITE #1 - CONNECTICUT YANKEELOCATION OF NUCLEAR FACILITY: Connecticut Yankee Plant located in Middlesex County, State of Connecticut
NAMED INSURED [LISTED ON POLICY]: Connecticut Yankee Atomic Power Company
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0151 09/15/1 966 $100 MillionNW-0552 09/1 5/1 966 $375 Million**
THIS CERTIFICATE IS ISSUED AS A MArIER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policy(ies) is subject to the exclusions, condifions and other provisions of the policy(ies). Neither this Certificate nor any contract or other documentwith respect to which it is issued shall amend, extend or alter the coverage afforded by the policy. The Uimit of Liability shown above may have been reduced by payment ot 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 sublect 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
A CORD•CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)02/12/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTMARSH USA, INC. NAME:
PHONE FAX20 CHURCH STREET, 8TH FLOOR AIc. No, Ext) (A/C, No:HARTFORD, CT 06103 EMI
INSURER(S) AFFORDING COVERAGE NAIC U
J44032-NUC-15-16 INSURER A : American Nuclear Insurers
INSU RED INSURER B :Maine Yankee Atomic Power Company
321 Old Ferry Road INSURER C :Wiscasset, ME 04578 INSURER D :
INSURER E :
INSURER F: :_____
COVERAGES CERTIFICATE NUMBER: NYC-007316427-02 REVISION NUMBER: 5
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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 SUBRc POLICY EFF POLICY EXPLTR TYPE OP INSURANCE Img WVP POLICY NUMBER (MMIDD/YYYYI IMMIDD/YYYYI LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
m DAMAGE TO RENTEDCLAIMS-MADE [jOCCUR PREMISES (Es occurrence) $
___________________________MED EXP (Any one personl $
__________________PERSONAL &ADV INJURY $GENtL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY JECT LI LOC PRODUCTS - COMPIOP AGO $
OTHER: $AUTOMBILELIABLITYCOMBINED SINGLE LIMIT $AUTOMBILELIABLITY(Ea accident)$
ANY AUTO BODILY INJURY (Per person) $ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
__AUTOS __AUTOSNON-OWNED PROPERTY DAMAGE $
__HIRED AUTOS __AUTOS (Per accident)$
$_• UMBRELLA LIAB t• OCCUR EACH OCCURRENCE $
,EXCESS LIAR CLAIMS-MADE AGGREGATE $
_ EDDED RETENTIONS$WORKERS COMPENSATION !PERSTTT 0 TH-EAND EMPLOYERS' LIABILITY ERNANY P ROPRI ETOR/PARTN ER/EXECUTIVE E.L. EACH ACCIDENT $OFFICER/MEMBER EXCLUDED?_jjjN I A(Mandatory in NH) E.L. DISEASE - BA EMPLOYEE $If yes, describe underDESCRIPTION OF OPERATIONS below ____ _E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101
Insurance
DESCRIPTION OP OPERATIONSI LOCATIONS IVEHICLES (ACORD 1O1, 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 BEFOREU.S. Nuclear Regulatory commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWashington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh USA Inc.
Manashi Mukherjee J.a"•wswokL .t•M[a,• e4-t,.•
© 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORDACORD 25 (2014101)
AGENCY CUSTOMER ID: J44032LOC #: Hartford
.0•ACO9RD ADDITIONAL REMARKS SCHEDULE Page 2 of2
AGENCY NAMED INSUREDMARSH USA, INC. Maine Yankee Atomic Power Company
___________________________________________________________321 Old Ferry RoadPOLICY NUMBER Wiscasset, ME 04578
CARRIER /NAIC CODE
l 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 LIABIUTY INSURANCE
Thin is to certify that there is in force as of the effective date of this Certificate a Nuclear Energy Uability Insurance Policy issued by members of American Nuclear Insurers asindicated (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 31sat of the calendar year in which the Effective Date of this Ceritifcate 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 subsequentcalendar 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 - MAINE YANKEELOCATION OF NUCLEAR FACILITY: TOWN OF WISCASSET, LINCOLN COUNTY, STATE OF MAINE
NAMED INSURED [LISTED ON POLICY]: Maine Yankee Atomic Power Company
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY3:NF-0194 08/0111971 $100 MillionNW-0578 08101/1971 $375 Million"
THIS CERTIFICATE IS ISSUED AS A MATI'ER 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 policyjies). 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 Umit of Liability shown above may have been reduced by paywent of claims
or claims expenses.
COMMENTS/NOTES:
Muster 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
sand 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
ACORD CERTIFICATE OF LIABILITY INSURANCE SDATE (MM/DDIYYYY)021122016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTMARSHUSAINC.NAME:MRHUAIN.PHONE FAX
TWO ALLIANCE CENTER AIC.No.Exth (A/C No):3560 LEN OX ROAD, SUITE 2400 E-MAILATLANTA, GA 30326 ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
J21970-4-Nuke.-16-17 INSUJRER A: American Nuclear Insurers
INUESouthern Company Services, Inc.INUEB:
Attn: Deborah Ga~frney INSURER C :dsgaffne~southemco.com INSURER D :30 Ivan Allen Jr. Boulevard NWBin SC1 404 INSURER E :Atlanta, GA 30308 INSURER F: _______
COVERAGES CERTIFICATE NUMBER: ATL-003946656-02 REVISION NUMBER: 2THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,FXCI ISI(ONS ANfl CONDITIONS OF SUICH P0OLICIFS. LIMITS SHOWN MAY HAVF RFFN REflIJCED RY PAIfl Cl AIMS
INS ADL SUB~R POLICY EFF POLICY EXPLTR TYPE OF INSURANCE *NSD *VI0g POLICY NUMBER (MMIDD/YYYYI IMM/DD/YYYYI LIMITS
.• COMMERCIAL GNRLIALIYEACH OCCURRENCE $
-FCAMSMD 1 CU DAMAGE TO RENTEDCLAMSMAD K OCURPREMISES (Ea occurrence) $
____________________MED EXP (Any one person) $
_____________________PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $D PRO-°POLICY JECT LOC PRODUCTS - COMP/OP AGG $
__OTHER: $AUTOMBILELIABLITYCOMBINED SINGLE LIMIT $
BODILY INJURY (Prpro)$
ALL WNED __] U~osCHEDLEDBODILY INJURY (Per accident) $.• AUOSNN-WNDPROPERTY DAMAGE[_.• IRED UTOS UTOS(Per accident)$
$UMRELALIB .•OCUREACH OCCURRENCE $
EXESLA CAM-AEAGGREGATE $
AND EMPLOYERS' LIABILITY ERI I__________
ANY PROPRIETORJPARTNERIEXECUTIVE • E.L. EACH ACCIDENT $OFFICERJMEMEER EXCLUDED? [jN I A _________
'(Mandatory in NH) EL. DISEASE - EA EMPLOYEE $If yes, describe underSDESCRIPTION OF OPERATIONS below __ _____E.L DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101 see addi page text
Insurance
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If mome apace Is required)
CERTIFICATE HOLDER CANCELLATION
Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOREU.S. Nuclear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWashington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Manashi Mukherjee .3 4
-O.'L9,.•,..i dAL,JJ. a.LL-.•
© 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01)
AGENCY CUSTOMER ID: J21970LOC #: Atlanta
ACORD ADDITIONAL REMARKS SCHEDULE Page 2 of 3
AGENCY NAMED INSUREDMARSH USA, INC. Southern Company Services, Inc.
_______________________________________________________________Attn: Deborah GaiffneyPOLICY NUMBER [email protected]
30 Ivan Allen Jr. Boulevard NWBin SC1404
CARRIER NAIC CODE 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 ot the etfective date ot this Certificate a Nuclear Energy Uiability Insurance Policy issued by members ot 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 31 st 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 & Tranuporters], FS - [Foreign Suppliers & Transporters], N - [SecondaryFinancial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
1. SITE #1 - JOSEPH M. FARLEYLOCATION OF NUCLEAR FACILITY: Joseph M. Fardey Nuclear Power Plant 16.5 MI E of Dothan, AL
NAMED INSURED [LISTED ON POLICY]: Alabama Power Company and Southern Nuclear Operating Company
POUiCY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0238 02/01/1976 $375 MillionNW-0609 02101/1976 $375 Million"
N-0052 08/01/1977 *
N-0073 10/23/11980**
2. SITE #2 -HATCHLOCATION OF NUCLEAR FACILITY: Hatch Nuclear Power Plant 11 MI N of Basley, GA
NAMED INSURED [LISTED ON POLICY]: Georgia Power Company, Southemn Nuclear Operating Company, Oglethorpe Power Corporation, Municipal Electric Authority of
Georgia, City of Dalton, Georgia
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0215 06/26/1973 $375 Million
NW-0594 06/26/1 973 $375 Million•
N-0051 08/01/1 977 *
N-0067 06/1 3/1 978**
3. SITE #3 - ALVIN W. VOGTLELOCATION OF NUCLEAR FACILITY: Alvin W. Vogtie Nuclear Power Plant 26 Ml SSE of Augusta, GANAMED INSURED [lISTED ON POLICY]: Georgia Power Company, Southern Nuclear Operating Company, Oglethorpe Power Corporation, Municipal Electric Authority of
Georgia, MEAG Power SPVM, LLC, MEAG Power SPVJ, LLC, MEAG Power SPVP, LLC and City of Dalton, Georgia
POLICY NUMBER: POUiCY EFFECTIVE: LIMIT OF LIABILITY:
NF-0302 06/01/11986 $375 MillionNW-0653 06/01/1986 $375 Million"
N-0111 01/16/1987 "
N-01 17 02/09/1 989 *
THIS CERTIFICATE IS ISSUED AS A MAtTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policylies) 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, estend or alter the coverage afforded by the policy. The Limit of Liability shown shove 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
AGENCY CUSTOMER ID: J21 970LOC #: Atlanta
AWORD ADDITIONAL REMARKS SCHEDULE Page 3 of3AGENCY NAMED INSURED
MARSH USA, INC. Southern Company Servces, Inc.__________________________________________________________Attn: Deborah Gaffney
POLICY NUMBER [email protected] Ivan Allen Jr. Boulevard NWBin 601404
CARRIER NAIC CODE 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
**Master Worker Certificate - This limit is shared by all Certificates to the Master Worker Policy of which each Certificate is a part and is sublect to all of the provisions of such Policyand Certificate having reference thereto. Such limit may have been reduced by payment of claims or claims expenses.
Secondary Financial Protection Certiticate - 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
AGENCY CUSTOMER ID: 798153LOC #: Hartford
ACO~RD ADDITIONAL REMARKS SCHEDULE Page 2 of 2AGENCY NAMED INSURED
MARSH USA, INC. Yankee Atomic Electric Company______________________________________________________________49 Yankee Road
POLICY NUMBER Rowe, MA 01367
CARRIER /NAIC CODE
J 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 is force as of the effective date st this Certificate a Nuclear Energy Uability Insurance Policy issued by members of American Nuclear Insurers as indicated (Companies), to the Insured namedherein, with respect to the Nuclear Facility at the Location shows and/or with respect to the Issured's operations described herein, It such policy is cancelled or otherwise terminated prior to the end of December 31st ofthe calender year in which the Effective Date of this Certifi cafe occurs, notice will be delivered in accordance with the policy pruvinions. Otherwise this Certificate shall terminate as of the end of such December 31st. ACertifcate 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 - YANKEE ROWELOCATION OF NUCLEAR FACILITY: Town of Rowe, State of MassachusettsNAMED INSURED [USTED ON POLICY]: Yankee Atomic Electric Company
POLICY NUMBER: POLICY EFFECTIVE:
NF-0076 10/23/1959LIMIT OF LIABILITY:
$100 Million
$375 Miilion**NW-0522 10/23/1959
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 Certifi cafe nor any contract or other document with respect to which it is issued shallamend, extend or alter the coverage afforded by the policy. The Limit of Uiability 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 referencethereto. 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
ACORD CERTIFICATE OF LIABILITY INSURANCEDATE (MM/ODDYYYY)
01/1912016w I
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder In lieu of such endorsement(sl.
PRODUCER CONTACTMARSHUSAINC.NAME:MRHUAIC.PHONE IFAX
20 CHURCH STREET, 8TH FLOOR (AC, No, Eat: I(CO NO):HARTFORD, CT 06103 E-MAILAttn: Hartford certrequest~marsh com I Fax: 212-948-01866ADES
INSURER(SI AFFORDING COVERAGE NAIC #7981 53--NUC-16-17 INSURER A : American Nuclear Insurers
INSUREDINUEB:Yankee Atomic Electric Company ISRRB49 Yankee Road INSURER C :Rowe, MA 01367 INSURER 0:
INSURER E :
__________________________________________________________ INSURER F: ______
COVERAGES CERTIFICATE NUMBER: NYC-007330493-03 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 PERIODINDICATED. NOTIWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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 SUiBR POLICY EFF POLICY EXP-T TYPE OF INSURANCE !NSD WVIM POLICY NUMBER (M(DDYyy 9{MiD/Yyy LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $II DAMAGE TO RENTED
SCLAIMS-MADE KJ OCCUR PREMISES lEa occurence) $____________________________MED EXP (Any one person) $
_______________________PERSONAL & ADV INJURY $GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $D PRO-[
POLICY JECT LOC PRODUCTS-COMP/OP AGO $
__OTHER: $AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
__ (Ea accident)ANY AUTO BODILY INJURY (Per person) $ALL OWNED •-SCHEDULED BDL NUY(e ciet
__AUTOS AUTOS BDL NUY(e cietNON-OWNED PROPERTY DAMAGE
-- HIRED AUTOS AUTOS (Per accident) $
i I $
__UMBRELLA LIAB [• OCCUR EACH OCCURRENCE $
EXCESS LIAB I ICLAIMS-MADE AGGREGATE ,
DED! RETENTION S __________
WORKERS COMPENSATION STATUERE ________
AND EMPLOYERS' LIABILITY Y/NIR
ANY PROPRIETORIPARTNERJEXECUTIVE FTF E.L. EACH ACCIDENT $OFFICER/MEMBER EXCLUDED? [JN1 A A_________(Mandatory In NH) EL. DISEASE - EA EMPLOYEE $If yes, describe underDESCRIPTION OF OPERATIONS below ___________E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached Acoid 101 01/01/2016 01/01/2017 See Attached Acord 101
Insurance
DESCRIPTION OF OPERATIONS I LOCATIONS)I VEHICLES (ACORD 1 01, Additional Remarks Schedule, may be attached If mome space Is required)
CERTIFICATE HOLDER CANCELLATION
Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOREU.S. Nuclear Regu~latory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWashington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh USA Inc.
Manashi Mukherjee .. ,• ~ ~ ..
© 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
ACORD 25 (2014/01)
AwD CERTIFICATE OF LIABILITY INSURANCEDATE (MMIDD/YYYY)
12/08/2015I
THIS CERTIFICATE IS ISSUED AS A MA'n'ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s}.
PRODUCER CONTACTMarsh USA Inc. NAME:
PHONE FAX500 Dallas St, Suite 1500 nc. No. Ext; (AC, No):Houston, TX 77002 EMI
INSURER(S) AFFORDING COVERAGE NAIC #
897592-Energ-Nucle-16-17 INSURER A : American Nuclear InsurersINSURED INSURERB :Energy Future Holdings Corp.1601 Bryan Street INSURER C :Dallas, TX 75201 INSURER D :
INSURER E :
_________________________________________________________ INSURER F: ______
COVERAGES CERTIFICATE NUMBER: HOU-002497200-03 REVISION NUMBER:4
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
I:Y I IQI~l(kIO Akflr ('IMflTICIFI t(l C1 I(PW Dfl Ir'II= I IIWllTO QWr~lA/el I~AlV WA'.I= DFI•I= iOflIr ifltrl IV DAIR t' AIIUIOINSR ADDL SUBR~ POLICY EFF POLICY EXPLTR TYPE OF INSURANCE INp WVw POLICY NUMBER IMMIDD/YYYY I (MMIDD/YYYY) LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1 DAMAGE TO RENTED
JCLAIMS-MADE OCCUR PREMISES (Ea occurrence) $
____________________MED EXP (Any one person) $
_____________________PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $[m PRO- II
POLICY LiJECT LOC PRODUCTS -COMPIOPAGG $
__OTHER: $____________________AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT
__ {lEa accident)$
ANY AUTO BODILY INJURY (Per person) $ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
__AUTOS __AUTOS___________NON-OWNED PROPERTY DAMAGE $
__HIRED AUTOS __AUTOS (Per accident)$
$__UMBRELLA LUAB OCCUR EACH OCCURRENCE $
EXCESS LIABR CLAIMS-MADE AGGREGATE $
_ EDDED RETENTIONS$ $WORKERS COMPENSATION IPER 0H
AND EMPLOYERS' LIABILITY YIN ERANY PROPRI ETORIPARTNERJEXECUTiVE FF E.L. EACH ACCIDENT $OFFICERIMEMBER EXCLUDED? [JN I A(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $If yes, describe underDESCRIPTION OP OPERATIONS below E.L DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101
Insurance
DESCRIPTION OF OPERATIONS I(LOCATIONS I VEHICLES (ACORD iai, Addit~onal Remarks Schedule, may be attached If more apace Is required)
CERTIFICATE HOLDER CANCELLATION
Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOREU.S. Nuclear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWashington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh USA Inc.
I ~ ~~Jessie Guerrero ,::!.- :;;--'----•:- ......
ACORD 25 (2014101)© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 897592LOC #: Houston
A CORD ADDITIONAL REMARKS SCHEDULE Page 2 of 2
AGENCY NAMED INSUREDMarsh USA Inc. Energy Future Holdings Corp.
______________________________________________________________ -1601 Bryan StreetPOLICY NUMBER Dallas, TX 75201
CARRIER NAIC CODE
L 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 theme is in force as of the effective date of fhis Certificate a Nuclear Energy Uabilify Insurance Policy issued by members of American Nuclear Insurers asindicated (Companies), to the Insured named herein, with respect to the Nuclear Facility at the Location shown and/or with respect to the Insumeds 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 mill he 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 unleus requested in writing.
Types of Insurance: NE - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's & Transporters], ES - [Eoreign Suppliers & Transporters], N- [SecondaryFinancial Protect ion Certificate]
COVERAGE EOR NUCLEAR FACILITIES:
1. SITE #1 - COMANCHE PEAKLOCATION OF NUCLEAR FACILITY: Comanche Peek Nuclear Power Plant is located on the south hunk of Squaw Creek Reservoir near the town of Glen Rose in Somervell
County, Texas approximately 35 miles southwest of Fort Worth and 67 miles southwest of Dallas, Texas.
NAMED INSURED [LISTED ON POLICY]: Luminant Generation Company LLC
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0274 01101/1983 $375 MillionNW-0631 01/01/1983 $375 Million"
N-0090 02/08o990 **N-OilS 02102/1993 *
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS ND RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policyjies) is subject to the exclusions, conditions and other provisions of the policyjies). 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 Umit of Uability 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 Proftaction 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
ACORDCERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
02/10/2016
THIS CERTIFICATE IS ISSUED AS A MATT'ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(lest must be endorsed. If SUBROGATION IS WAIVED, subject tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
:PRODUCER CONTACTMars USAInc.NAME:Mas S n.PHONE FAX
100 North Tryon Street, Suite 3600 A/c, No, Extt: A/C, No):Charlotte, NC 28202 E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
22830 -ONE-1/1-16-17 INSURER A : American Nuclear InsurersINSURED INSURER B :
Duke Energy CorporationATTN: Ed Adams IINSURER C :
[email protected] INSURER D :550 S. Tryon StreetDEC40-C INSURER E :Charlotte, NC 28202 INSURER F :
COVERAGES CERTIFICATE NUMBER: ATL-003526555-06 REVISION NUMBER: 19
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
INSR ADDL S5UBR- POLICY EFF POLICY EXPLTR TYPE OF INSURANCE INS WVD POLICY NUMBER IMMIDD/YYYY' 'MM/DD/YYYY) LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
II DAMAGE TO RENTED]CLAIMS-MADE I OCCUR PREMISES tEa occurrence) $
___________________________MED EXP (Any one person) $
_____________________PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $7 PRO- 7POLICY I JECT LOC PRODUCTS - COMP/OP AGG $
__OTHER: $AUTOMBILELIABLITYCOMBINED SINGLE LIMIT $AUTOMBILELIABIITYtEa accident)
ANY AUTO BODILY IN JURY (Per person) $ALL OWNED SCHEDULED BODILY iNJURY tPer accident) $
__AUTOS __AUTOSNON-OWNED PROPERTY DAMAGE $
__HIRED AUTOS __AUTOS (Per accident)
$__UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAB I CLAI MS-MADE AGGREGATE $
DEDDED RETENTIONS $WORKERS COMPENSATION {PER OH
AND EMPLOYERS' LIABILITY Y I N ER
ANY PROPRIETORJPARTNERJEXECUTIVE flf E.L. EACH ACCIDENT $OFFICER/MEMBER EXCLUDED? [ 2 N A(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $If yes, describe underDESCRIPTION OF OPERATIONS below EL. DISEASE - POLICY LIMIT $
A Nuclear Energy Uiability SEE ATTACHED 01/01/2016 01/01/2017 SEE ATTACHED
DESCRIPTION OF OPERATIONS I LOCATIONS/IVEHICLES (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 BEFOREU.S. Nuclear Regulatory Commnission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWashington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh USA Inc.
Karen A. Burke Kd-J.*- •
© 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01)
V
AGENCY CUSTOMER ID: 22830LOC #: Charlotte
ACO9RD ADDITIONAL REMARKS SCHEDULE Page 2of 4
AGENCY NAMED INSUREDMarsh USA Inc. Duke Energy Corporation
_________________________________________________ATTN: Ed AdamsPOLICY NUMBER [email protected]
550 S. Tryon StreetDEC40-C
CARRIER /NAIC CODE Charlotte, NC 28202
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 theme is in force as of the effective date of this Certificate a Nuclear Energy Uability Insurance Policy issued hy members of American Nuclear Insurers asindicated (Companies), to the Insured named herein, mith respect to the Nuclear Facility at the Location shown sod/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 in which the Effective Date of this Certficate occurs, notice will be delivered
in accordance with the policy provisions. Otherwise this Certificate shall terminate as ot the end of such December 31st. A Certificate will NOT be issued for any subsequent
calendar year unless requested is writing.
Types of Insurance: NP - [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 - CATA WBALOCATION OF NUCLEAR FACILITY: Catawba Nuclear Power Plant in the NE portion of York County, SC
NAMED INSURED [LISTED ON POLICY]: Duke Energy Carolinas, LLC
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0281 12/01/1983 $375 Million
NW-0637 12/01/1983 $375 Million"
N-0097 07/18/1 984
N-0106 12/01/1983
2. SITE #2- MCGUIRE
LOCATION OF NUCLEAR FACILITY: McGuire Nuclear Power Plant located 17 ml N/NW of Chariotte, NC
NAMED INSURED [USTED ON POLICY]: Duke Energy Carolinas, LLC
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF UABIUITY:NF-0248 05/01/1977 $375 Million
NW-0615 05/01/1977 $375 Million**
N-0069 01/23/1981 *N-0092 03/03/11983
3. SITE #3 - OCONEE
LOCATION OF NUCLEAR FACILITY: Oconee Nuclear Power Plant in Oconee County, South Carolina
NAMED INSURED [LISTED ON POLICY]: Duke Energy Carolinas, LLC
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:NF-0182 03/01 /1 970 $375 Million
NW-0569 03/01/1970 $375 Million**
N-0022 08/01/11977
N-0023 08/01/11977
N-0024 08/01/1 977**
4. SITE #-4- BRUNSWICKLOCATION OF NUCLEAR FACILITY: Brunswick Nuclear Power Plant 2.5 MI N of Sosthport, NC
NAMED INSURED [LISTED ON POLICY]: Duke Energy Progress, LLC
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:NF-0218 10/25/11973 $375 Million
NW-0597 10/25/1973 $375 Million**
N-0054 08/01/1977 *
N-0055 08/01/1977
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 22830LOC #: Charlotte
ACO9RD ADDITIONAL REMARKS SCHEDULE Page 3 of 4
AGENCY NAMED INSUREDMarsh USA Inc. Duke Energy Corporation
________________________________________________ATTN: Ed AdamsPOLICY NUMBER [email protected]
550 S. Tryon StreetDEC40-C
CARRIER /NAIC CODE Charlotte, NC 28202
EFFECTIVE DATE:
ADDITIONAL REMARKS[THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance
5. SITE #5 - CRYSTAL RIVERLOCATION OF NUCLEAR FACILITY: Crystal River Nuclear Power Plant 7.5 MI NW of Crystal River, Citros County, FL
NAMED INSURED [LISTED ON POLICY]: Duke Energy Floride, inc.; Seminole Electric Cooperative, Inc.; Orlando Utilities Commission and City of Odando; City of Gainesville,Florida; City of Ocala; City of Leesbarg, Florida; City of Kissimmee, Florida, A Municipal Corporation; City of
New Smymna Beach, Florida and Utilities Commission of New Smymna Beach, Florfda; City of Alachua, Florida; The City of Bushnell; Florida Progress CorporationPOLICY NUMBER: PDUCY EFFECTIVE: LIMIT OF LIABILITY:NF-0195 07/01/1971 $375 MillionNW-0579 07/01/1971 $375 Million**
6. SITE #6 - SHEARON HARRISLOCATION OF NUCLEAR FACILITY: Shearon Heelis Nuclear Power Plant 20 MI SW of Raleigh, NC
NAMED INSURED [LISTED ON POLICY]; Duke Energy Progress, Inc.
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
N F-0288 06101/1984 $375 MillionNW-0642 06101/1984 $375 Million**
N-0112 10/24/1986
7. SITE #7- H. B. ROBINSONLOCATION OF NUCLEAR FACILITY: H.B. Robinnon Nuclear Power PlantS5 MI WNW from Hertsville, SC
NAMED INSURED [LISTED ON POLICY]: Duke Energy Progress, Inc.POLICY NUMBER: POUCY EFFECTIVE: LIMIT OF LIABILITY:
NF-0180 10/1 5/1 969 $375 Million
NW-0567 10/15/1969 $375 Million**
N-0021 08/01/11977**
8. SITE #8 -LEVYLOCATION OF NUCLEAR FACILITY: Levy Nuclear Plant 39 MI SW of Gainsville, FLNAMED INSURED [LISTED ON POLICY]: Duke Energy Florida, Inc.
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:NF -0354 01/01/2015 $1 Million
9. SITE #9 - LEELOCATION OF NUCLEAR FACILITY: Lee Nuclear Site 6 Ml S of Blacksburg, SC
NAMED INSURED [USTED ON POLICY]: Duke Energy Carolinas, LLCPOUCY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0355 1/1/2016 $1 Million
THIS CERTIFICATE IS ISSUED AS A MATIER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policylies) is subject to the encluoions, conditions and other provisions of the pelicylies). Neither this Certificate nor any contract or other documentwith respect to which it is issued shall amend, extend or alter the coverage afforded by the policy. The Uimit of Uability shown above may have been reduced by payment of claims
or claims expenses.
COMMENTS/NOTES:
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 22830LOC #: Charlotte
A CORD ADDITIONAL REMARKS SCHEDULE Page 4 of 4
AGENCY NAMED INSUREDMarsh USA Inc. Duke Energy Corporation
_______________________________________________________ATTN: Ed AdamsPOLICY NUMBER ed.adams~duke-energy.com
550 S. Tryon StreetDEC4O-C
CARRIER /NAIC CODE Charlotte, NC 28202
EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: Certificate of Liability InsuranceI
**Master Worker Certificate - This limit is shared by all Certificates to the Master Worker Policy of which each Certificate is a part and is sabject to all of the provisions of such Policyand Certificate having reference thereto. Sach limit may have been reduced by payment of claims or claims enpenses.
**Secondary Financial Protection Certificate - Financial protection available ander an industry retrospective rating plan.
ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
ACO~RDCERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)02/10/2016
THIS CERTIFICATE IS ISSUED AS A MATT-ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTMarsh USA Inc. NAME:
PHONE FAX100 North Tryon Street, Suite 3600 A/c. No. Ext|: (A/C, No):Chadotte, NC 28202 E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #070250-SCAN-NUKE-16-17 INSURER A : American Nuclear Insurers
INUESCANA CorporationINUEB:
ATTN: John Mellette INSURER C :[email protected] INSURER D :100 SCANA ParkwayCayce, SC 29033 INSURER E :
_________________________________________________________INSURER F: :_____COVERAGES CERTIFICATE NUMBER: ATL-003396433-02 REVISION NUMBER:3
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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 SUB~R POLICY EFF POLICY EXPLTR TYPE OF INSURANCE IN•;u *V'" POLICY NUMBER (MMIDD/YYYY1 IMMIDD/YYYY) LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
II DAMAGE TO RENTEDCLAIMS-MADE KJOCCUR PREMISES (Ea occurrence) $
___________________________MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $• O ICYI PRO- m-
PLCLJJECT LiLOC PRODUCTS - COMPIOP AGG $
__ OTHER: $AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
__ (Ea accidenltANY AUTO BODILY INJURY (Per person) $ALL OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS __AUTOS
NON-OWNED PROPERTY DAMAGE $__HIRED AUTOS __AUTOS (Per accident)$
$__UMBRELLA LIAB l OCCUR EACH OCCURRENCE $
EXCESS LIAB I ICLAIMS-MADE AGGREGATE $
DEDBED RETENTIONS 5
WORKERS COMPENSATION IPERTAT TE I°TH-EAND EMPLOYERS' LIABILITY Y I NANY PROPRIETORJPARTNERJEXECUTIVE E.L. EACH ACCIDENT $OFFICER/MEMBER EXCLUDED? N1 N A(Mandatory In NH) E.L. DISEASE - RA EMPLOYEE $If yes, describe underDESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101
Insurance
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If mome space Ia required)
CERTIFICATE HOLDER CANCELLATION
Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOREU.S. Nuclear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWashington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh USA Inc.
© 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01)
AGENCY CUSTOMER ID: 070250LOG #: Charlotte
ACORD ADDITIONAL REMARKS SCHEDULE Page 2 of2
AGENCY NAMED INSUREDMarsh USA Inc. SCANA Corporation
_______________________________________________________________ATTN: John MellettePOLICY NUMBER [email protected]
100 SCANA ParkwayCayce, SC 29033
CARRIER NAIC CODE
1 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 Uability Insurance Policy issued hy 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, It
such policy is cancelled or otherwise terminated pdor to the end of December 3lst of the calendar year in which the Effective Date of this Certificate occurs, notice will he 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 wdting.
Types of Insurance: NF - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's & Transporters], FS - [Foreign Suppliers & Transporters], N - [SecondaryFinancial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
1. SITE #1 - VIRGIL C. SUMMER NUCLEAR STATIONLOCATION OF NUCLEAR FACILITY: Virgil C. Summer Nuclear Station 2.5 miles N of Purr, Fairfield County, South Carolina
NAMED INSURED [LISTED ON POLICY]: South Carolina Electric & Gas Company and South Carolina Public Service Authority
POUCY NUMBER: POLICY EFFECTIVE: LIMIT OF UABILITY:
NF-0252 03/21/1978 $375 MillionNW-0616 03/21/1978 $375 Million"
N-0078 08/05/1 982 *
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policylies) is subject to the exclusions, conditions and other provisions of the policyjies). Neither this Certificate nor any contract or other documentwith respect to which it in issued shall amend, extend or alter the coverage afforded by the policy. The Umit of Liability ahown above may have been reduced by payment of claims
or claims expenses.
COMMENTS/NOTES:
"Master Worker Certificate - This limit is shared by all Certiticates to the Master Worker Policy of which each Certificate is a part and is subject to nil of the provisions of ouch 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
ACOIRDCERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
02/10/2016
THIS CERTIFICATE IS ISSUED AS A MA'I-ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTMars USAinc.NAME:Mas S n.PHONE FAX
100 North Tryon Street, Suite 3600 A/C.No.Extl: A/C, No):Charlotte, NC 28202 E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #t
936236-*..-FinPr-16-17 INSURER A : American Nuclear Insurers
INSURED INSURERSB:BWXT Nuclear Operations Group, Inc.2016 Mt. Athos Road INSURER C :Lynchburg, VA 24504 INSURER D :
INSURER E :
______________________________________________________ INSURER F :
COVERAGES CERTIFICATE NUMBER: ATL-003416213-02 REVISION NUMBER:7
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,aALI f OlaJIlNO flNlr' a,a"JI"aLITI r".,In tsrou r r'1 ' .JU 'lIPISICQ LtII I,'I • •.J "CAl IJU' h, fltVU \IZ: DC:IZ=IN Df::rl IJU EL DV rtarL, t.,LI IVAO.
INRADDL SUBR POLICY EFF POLICY EXPLTR TYPE OF INSURANCE INsla •p POLICY NUMBER IMM/DD/YYYYI IMM/DD/VYYYI LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $DAMAGE TO RENTED]CLAIMS-MADE Li OCCUR PREMISES (Ea occurrencel $
___________________________MED EXP (Any one person) $
___________________PERSONAL & ADV INJURY $GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY LJ PEOT LJ LOC PRODUCTS -COMP/OP AGG $
__OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $__ (Ea accident)
ANY ATOEDGILY INJURY (Per person) $
ALL WNED SCHEULEDBODILY INJURY (Per accident) $
NNONDPROPERTY DAMAGE $__ HIEDAUTS __ UTOS(Per accident)
$
__UMRELALIB -• OCUREACH OCCURRENCE $
EXESLAB LIM-AEAGGREGATE $
AND EMPLOYERS' LIABILITY ERINANY PROPRIETORIPARTNER(EXECUTIVE r--- E.L. EACH ACCIDENT $OFFICERJMEMBER EXCLUDED? L2NI/ A(Mandatory In NH) EL. DISEASE - CA EMPLOYEE $If yes, describe underDE:SCRIPTION OF OPERATIONS below ______E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Uability See Attached 01/01/2016 01/01/2017 See Attached
Insurance "Acord 101' Acord 101
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1011, Additional Remarks Schedule, may be attached If more apace is required)
CERTIFICATE HOLDER CANCELLATION
Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOREU.S. Nuclear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWashington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh USA Inc.
© 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01)
AGENCY CUSTOMER ID: 936236LOC #: Charlotte
ACO~RD ADDITIONAL REMARKS SCHEDULE Page 2 of2
AGENCY NAMED INSUREDMarsh USA Inc. BWXT Nuclear Operations Group, Inc.
___________________________________________________________2016 Mt. Athos RoadPOLICY NUMBER Lynchburg, VA 24504
CARRIER NAIC CODE
L 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 Uability 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 31sat of the calendar year in which the Effective Date of this Certificate occars, 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 reqaested in wrilting.
Types of Insurance: NF - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Suppliers & Transporters], FS - [Foreign Suppliers & Transporters]
COVERAGE FOR NUCLEAR FACILITIES:
1. SITE #1 - LYNCHBURG FUEL FABRICATION FACILITYLOCATION OF NUCLEAR FACILITY: Lynchburg Fuel Fabrication Facility 550 acre plant site, approx 7mi east of Lynchburg, VANAMED INSURED [LISTED ON POLICY): BWXT Nuclear Operations Group, Inc. and AREVA Inc.
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0111 10/01/1961 $200 Million
NW-0533 10/01/1961 $375 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 documentwith 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.
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
ACORDCERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)02/09/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTMarsh Risk & Insurance Services NAME:FA
PHONEFA4445 Eastgate Mall {AIC, No, Ext): A/C, No):San Diego, CA 92121 E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC 1/
03434B-NRC-GA-16-17 INSURER A : American Nuclear Insurers
INSURED ISRRBGeneral AtomicsINUEB:P0 Box 85608 INSURER C :San Diego, CA 92138 INSURER D :
INSURER EB:
______________________________________________________ INSURER F :
COVERAGES CERTIFICATE NUMBER: LOS-001836936-03 REVISION NUMBER:3
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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.
LTR TYPE OF INSURANCE INp V POLICY NUMBER IMM/DD/YYYYI IMM/DD/YYYYI LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
II DAMAGE TO RENTEDCLAIMS-MADE LiOCCUR PREMISES (Ea occurrence) $
__________________________MED EXP (Any one person) $
___________________PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $II PRO- 7--POLICY ~jJECT LOC PRODUCTS- COM P/OPAGO $
OTHER:$AUTOMBILELIABLITYCOMBINED SINGLE LIMIT $AUTOMBILELIABIITYlEa accident)
ANY AUTO BODILY INJURY (Per person) $ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
__AUTOS __AUTOS ___________NON-OWNED PROPERTY DAMAGE
__HIRED AUTOS __AUTOS (Per accidentl
5UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
__ flED RETENTIONSWORKERS COMPENSATIONST TPER 0 ITH-EAND EMPLOYERS' LIABILITY ERY________N_ANY PROPRIETORJPARTNER/EXECUTIVE r1 E.L. EACH ACCIDENT $OFFICER/MEMBER EXCLUDED? IJ NA ____________
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $If yes, describe underDESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached 01/01/2016 01/01/2017 See Attached
DESCRIPTION OF OPERATIONS I LOCATIONS/IVEHICLES IACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
Document Centro[ Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOREU.S. Nuclear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWashington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh Risk & Insurance Services
© 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 034348LOC #: San Diego
A CORD ADDITIONAL REMARKS SCHEDULE Page 2 of2
AGENCY NAMED INSURED
Marsh Risk & Insurance Services General Atomics_______________________________________________________________ PG Box 85608
POLICY NUMBER San Diego, CA 92138
CARRIER /NAIC CODE
J EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: Certificate of Liability InsuranceI
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 hy members of American Nuclear Insurers asindicated (Companies), In the Insured named herein, with respect to the Nuclear Facility at the Location shown and/or with respect to the Insured's operations descrtbed herein. If
such policy is cancelled or otherwise terminated prior to the end of December 31 st of the calendar year in which the Effective Date of this Certiti cafe occurs, notice will be deliveredin accordance with the policy provisions. Otherwise this Certificate shall terminate us 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 Certficate), NS - [US Domestic Supplier's & Transporters], PS - [Foreign Suppliers & Transoporters]
COVERAGE FOR NUCLEAR FACILITIES:
1. SITE #1 - GENERAL ATOMICSLOCATION OF NUCLEAR FACIUITY: Sun Diego, CANAMED INSURED [LISTED ON POLICY]: General Atomics
POLICY NUMBER: POLICY EFFECTIVE:
NF-0034 0313111958
NW-051 2 03/31/1958
LIMIT OF UIABIUITY:$40 Million
$375 Million"
THIS CERTIFICATE IS ISSUED AS A MATTFER 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 policyjies). Neither this Certificate nor any contruct or other document
with respect to which it is issued shall amend, estend or alter the coverage afforded by the policy. The Limit of Liability shown above may have been reduced by payment of claimsor 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 CertiJficate having reference thereto. Ssch limit may have been reduced by payment of claims or claims expenses.
ACORO 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY)02109/2016
THIS CERTIFICATE IS ISSUED AS A MATT'ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTMarsh USA Inc. NAME:
PHONE FAX1717 Arch Street AC, NoExt): (AC, No):Philadelphia, PA 19103-2797 E-MAILAttn: [email protected]/ fax - 212-948-0360 ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #IS27324-NUC-ENR-16-17 INSURER A : American Nuclear Insurers
INSURED INSURER B :Susquehanna Nuclear, LLC and AlleghenyElectric Cooperative, Inc. INSURER C :Corporate Risk & Insurance INSURER D :835 Hamilton Street, Suite 150, GENPL7NAllentown, PA 18101 INSURER B :
_________________________________________________________INSURER F: ______
COVERAGES CERTIFICATE NUMBER: CLE-004443748-05 REVISION NUMBER:9
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONflITIONS OF SI ICH P0OLICIES L IMITS SHOWN MAY HAVF RFFN R~FlIIJCI:: RY PAIDi CI AIMS
INSR ADDL SUBR POLICY EFF POLICY EXPLTR TYPE OF INSURANCE yN•D WVD' POLICY NUMBER (MMIDD/YYYYI IMMIDD/YYYY1 LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
77 DAMAGE TO RENTEDCLAIMS-MADE LiOCCUR PREMISES (Ea occurrence) $
__________________________MED EXP (Any one person) $
______________________PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $D PRO-°POLICY JECT LOC PRODUCTS - COMP/OP AGG S
__OTHER: $AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO BODILY INJURY (Per person) $ALL OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS __AUTOS
NON-OWNED PROPERTY DAMAGEHIRED AUTOS __AUTOS (Per accident) $__________
$-- UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAR ICLAIMS-MADE AGGREGATE $
__DED RETENTIONS$ $WORKERS COMPENSATION IPER 0H
AND EMPLOYERS' LIABILITY Y I NIJL~ __________
ANY PROPRIETORJPARTNERIEXECUTIVE F1 E.L. EACH ACCIDENT $OFFICERJMEMBER EXCLUDED? [hNt A A________(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $If yen, describe underDESCRIPTION OP OPERATIONS below E.L. DISEASE - POLICY LIMIT $
ANuclear Energy Liability See Attached 01/01/2016 01/01/2017 See Attached Acord 101
Insurance Acord 101
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 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 BEFOREU.S. Nuclear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWashington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh USA Inc.
Manashi Mukherjee ..3"i4.e.•.J Ltc..CJt
© 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01)
AGENCY CUSTOMER ID: S27324LOC #t: Philadelphia
A CORD ADDITIONAL REMARKS SCHEDULE Page 2 of2
AGENCY NAMED INSUREDMarsh USA Inc. Susquehanna Nuclear, LLC and Allegheny
______________________________________________________________ -Electric Cooperative, Inc.POLICY NUMBER Corporate Risk & Insurance
835 Hamilton Street, Suite 150, GENPL7N-Allentown, PA 18101
CARRIER NAIC CODE
L 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 asindicated (Companies), to the insured named herein, with inspect to the Nuclear Facility at the Location shown and/or with respect to the Insredas 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 Etfective 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 issaued for any sabsequent
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 - SUSOUEH-ANNALOCATION OF NUCLEAR FACILITY: Sasquehanna Naclear Power Plant is Salem Township, Luzeme Coanty, PennsylvaniaNAMED INSURED [LISTED ON POLICY]: Susquehanna Nuclear, LLC & Allegheny Electric Cooperative, Inc.
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0262 01/01/1981 $375 MillionNW-0622 0110111981 $375 Million's
N-0084 07/17/1982 *
N-0096 03/23/1 984
THIS CERTIFICATE IS ISSUED AS A MATTFER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policy(ies) is sabject to the euclasions, conditions and other provisions of the policy(ies). Neither this Certificate nor any contract or other docamentwith respect to which it is issued shall amend, extend or alter the coverage afforded by mhe 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 Cerfif cafes 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 espouses.
NOTE 1 - NS-0422: Suppliers & Transporters Coverage - Additional Named Insured - Restricted CoverageSuch insarance as is afforded by the policy shall also apply to Allegheny Electric Cooperative, Inc. and Tales Energy Corporation, but solely with respect to liability for bodily injury,property damage or environmental damage which arises oat of naclear material which has been sused or is to be used, or baa been irradiated in the course of the operation of ameactor in which it has an ownership interest, located at the Sasqaehanna Steam Electric Station.
ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
ACO~RDCERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)01/0812016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF iNSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTMarsh Risk & Insurance Services NAME:FAPHONEFA
CA License #0437153 inc.NoExt): (A/C No):777 South Figueroa Street E-MAILLos Angeles, CA 90017 ADDRESS:
Attn: LosAngeles.CertRequest~marsh.com/IF: 212-948-0535 INSURER(S) AFFORDING COVERAGE NAIC #53370-NLSAN-CAS-16-17 INSURER A : American Nuclear Insurers
EDISON INTERNATIONAL ISRRB
2244 WALNUT GROVE AVENUE INSURER C :
ROSEMEAD, CA 91770 INSURER D0:
INSURER E :
_________________________________________________________ INSURER F :______
COVERAGES CERTIFICATE NUMBER: LOS-001710439-09 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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 CI AIMS.
INSR •.D SUBS POLICY EFF POLICY EXPLTR TYPE OF INSURANCE rNp raVjp POLICY NUMBER (MM/DD/YYYYI) MMIDD/YYYY) LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
m • DAMAGE TO RENTEDSCLAIMS-MADE LJ OCCUR PREMISESlEa .... urre..e ) $
__________________________M ED EXP (Any one person) $
___________________PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE SPOLICY D• PRO- [• LOC PRODUCTS -COMPIOP AGO $
OTHER: $
AUTOMOBILE LIABILITY (ea accidenit)
ANY AUTO BODILY INJURY (Per person) $ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
__AUTOS __AUTOSNON-OWNED PROPERTY DAMAGE $
__HI RED AUTOS __AUTOS (Per accident) $__________
$__UMBRELLA LIABR • OCCUR EACH OCCURRENCE S
EXCESS LIAB I ICLAIMS-MADE AGGREGATE $
__DED! RETENTION $ $WORKERS COMPENSATION LI A PER ~ __________
AND EMPLOYERS' LIABILITY Y I NIE
ANY PROPRIETORJPARTNER/EXCCUTIVE F•1 EL. EACH ACCIDENT $OFFICERJMEMBER EXCLUDED? Li N I A(Mandatory In NH) EL. DISEASE - EA EMPLOYEE $If yes, describe underDESCRIPTION OF OPERATIONS below _____________EL. DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101
Insurance
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mome space is requiredl
CERTIFICATE HOLDER CANCELLATION
Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOREU.S. Nuclear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWashington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh Risk & Insurance Services
Cynthia Guist •o.,lr,,•. ,,, .1
© 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01)
AGENCY CUSTOMER ID: 53370LOC #: Los Angeles
ACORD ADDITIONAL REMARKS SCHEDULE Page 2 of2
AGENCY NAMED INSUREDMarsh Risk & Insurance Services EDISON INTERNATIONAL
____________________________________________________ 2244 WALNUT GROVE AVENUEPOLICY NUMBER ROSEMEAD, CA 91770
CARRIER NAIC CODE
.L 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 INSURANCEThis is to certify that there is in torce as of the effective dale of this Certificate a Nuclear Energy Liability Insurance Policy issued by members of Americas 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, It
sach policy is cancelled or otherwise terminated prior to the end of December 31 st of the calendar year in which the Effectiye 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 suhsequent
calender year unless requested in writing.
Types of Insurance: NE - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's & Transporters], ES - [Foreign Suppliers & Transporters], N - [SecondaryFinancial Protection Certificate]
COVERAGE FOR NUCLEAR
FACILITIES:
1. SITE #1 -SAN ONOFRE
LOCATION OF NUCLEAR FACILITY: San Onotre Nuclear Generating Station 3 miles S of City of San Clemente in San Diego County, California
NAMED INSURED [USTED ON POLICY]: Southern Califomnia Edison Company, San Diego Gas & Electric Company, The City of Anaheim, The City of Riverside
POLICY NUMBER: POUCY EFFECTIVE: LIMIT OF LIABILITY:
NF-0146 04/06/1966 $375 Million
NW-0549 01/01/1998 $375 Million"N-008l1 02/16t/1 982
N-00fl7 11/15/1982**
THIS CERTIFICATE IS ISSUED AS A MAlT-ER 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 Uimit of Liability shown shove 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 ot 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 (2008101) © 2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
ACO2RD CERTIFICATE OF LIABILITY INSURANCE SDATE (MM/DD/YYYY)02109/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTMarsh USA Inc. NAME:
PHONE FAX500 Dallas St, Suite 1500 (A/C, No, Ext): (A/C, No):Houston, TX 77002 E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIc #
J03175-Sp-16-17 INSURER A : American Nuclear Insurers
INSURED INSURER E :Arizona Public Service Company, et alMail Station: 9618 PO Box 53999 INSURER C :Phoenix, AZ 85072-3999 INSURER D :
INSURER E :
_________________________________________________________INSURER F: :_____
COVERAGES CERTIFICATE NUMBER: HOU-002668951-05 REVISION NUMBER: 21
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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.
LTR TYPE OF INSURANCE I•p VVV POLICY NUMBER (MID/YY (MMID/YYYY LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
II DAMAGE TO RENTEDCLAIMS-MADE LJOCCUR PREMISES (Ea occurrence) $
___________________________MED EXP (Any one person) $
_____________________PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $POLICY D PRO- D--- LOC PRODUCTS- COMP/OP AGG
__OTHER: $AUTOMOBILE LIABILITY COMEINED SINGLE LIMIT $
__ ~(Ea accident)
ANY AUTO BODILY INJURY (Per person) $ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
__AUTOS __AUTOSNON-OWNED PROPERTY DAMAGE $
__HIRED AUTOS __AUTOS (Per accident)$
$UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $
EXCESS LIAB i CLAIMS-MADE AGGREGATE $
__DEDI RETENTIONS $
WORKERS COMPENSATIONST~TPR I ITEAND EMPLOYERS' LIABILITY Y I NJ~L~ANY PROPRIETOR/PARTNER/EXECUTIVE r1 E.L. EACH ACCIDENT $OFFICER/MEMBER EXCLUDED? N1 N A___________(Mandatory In NH) E.L. DISEASE - EA EMPLOYES $If yes, describe underD)ESCRIPTION OP OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Uability See Attached 01/01/2016 01/01/2017 See Attached Acord 101
Insurance Acord 101
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mome space Is required)
CERTIFICATE HOLDER CANCELLATION
Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOREU.S. Nuclear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWashington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh USA Inc.
Manashi Mukherjee .. t"4,kj; L,-
© 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01)
AGENCY CUSTOMER ID: J03 175LOC #: Houston
ACORD ADDITIONAL REMARKS SCHEDULE Page 2 of2
AGENCY NAMED INSUREDMarsh USA Inc. Arizona Public Service Company, et al
______________________________________________________________Mail Station: 9618 P0 Box 53999POLICY NUMBER Phoenix, AZ 85072-3999
CARRIER NAIC CODE
.L 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 usindicated (Companies), to the Insured named herein, with respect to the Nucleer 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 in which the Effective Date of this Certificate occurs, notice will be delivered
is accordance with the policy provisions. Otherwise this Certificate shall terminate as ot 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- [SecondaryFinancial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
1. SITE #1 - PALO VERDELOCATION OF NUCLEAR FACILITY: Palo Verde Nuclear Generating Station located in Wintersburg, Arizona
NAMED INSURED [LISTED ON POLICY]: Arizona Public Service Company, at al
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0266 08/07/1 981 $375 Million
NW-0625 08/07/1 981 $375 Million'
N-0088 12131/1984 *
N-0107 12109/1985
N-01 14 03/25/1987**
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 claimsor claims expenses.
COMMENTS/NOTES:
**Muster 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 nil 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
AC1R CERTIFICATE OF LIABILITY INSURANCE[/DAE(MDD/YYY
THIS CERTIFICATE IS ISSUED AS A MATT-ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTMarsh USA, Inc. NAME:
PHONE FAX1301 5th Avenue, Suite 1900 A/C. No. Ext-; (A/C, No):Seattle, WA 98101 E-MAIL
ADDRESS:INSURER(S) AFFORDING COVERAGE NAIC #
J26976-NUC2-16-17 INSURER A : American Nuclear Insurers
INSURED INSURER B:Energy NorthwestAttn: Marie Thomas INSURER C :P.O. Box 968 INSURER D0:Richland, WA 99352
INSURER E :
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 PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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 EXPLTR TYPE OF INSURANCE ffl@ WV POLICY NUMBER IMM/DD/YYYY) IMM/DD/YYYYI LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
II DAMAGE TO RENTED. CLAIMS-MADE L..... OCCUR PREMISES lEa occurrence) $
___________________________MED EXP (Any one person) $
_____________________PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY D JPRO LOC PRODUCTS -COMP/OPAGG $
__OTHER:$
_AUTOMOBILE LIAEILITY (ECOMBINEDacietSINGLE LIMIT $
ANY AUTO BODILY INJURY (Per person) $ALL OWNE•D SCHEDULED BDL NUY(e ciet
__AUTOS __AUTOS BDL NUYle cietNON-OWNED PROPERTY DAMAGE
__HIRED AUTOS __AUTOS (Per accident)$
$
__UMBRELLA LIABR [ OCCUR EACH OCCURRENCE $
EXCESS LIAB I CLAIMS-MADE AGGREGATE $
__DED RETENTIONS $______$__
WORKERS COMPENSATION IPERSTTT 0 TH-RAND EMPLOYERS' LIABILITY YN ER ___________
ANY PROPRIETOR/PARTNER/EXECUTIVE r7F EL. BACH ACCIDENT $OFFICER/MEMBER EXCLUDED? _ 2 j I A(Mandatory In NH) EL. DISEASE - BA EMPLOYEE $If yes. describe underDESCRIPTION OF OPERATIONS below _______________E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Uabilty See Attached Acord 101 01/01(2016 01/01/2017 See Attached Acord 101
Insurance
DESCRIPTION OF OPERATIONS I LOCATIONS/IVEHICLES (ACORD l01, Additional Remarks Schedule, may be attached if more space is requlredi
CERTIFICATE HOLDER CANCELLATION
Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOREU.S. Nuclear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWashington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh USA Inc.
I ~ ~~Van H. Vong"7'z •
© 1988-2014 ACORD CORPORATION. All rights reserved,The ACORD name and logo are registered marks of ACORD
ACORD 25 (2014101)
AGENCY CUSTOMER ID: J26976LOC #: Seattle
®ACO~RD ADDITIONAL REMARKS SCHEDULE Page 2 of2
AGENCY NAMED INSUREDMarsh USA, Inc. Energy Northwest
_________________________________________________________________tn:__MaArie MrieohomaPOLICY NUMBER P.O. Box 968
Richiand, WA 99352
CARRIER NAIC CODE
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 torce as of the effective date of this Certificate a Nuclear Energy Uability 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 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 31sat A Certificate will NOT be lossed 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 - [SecondaryFinancial Protection Certificate]
CDVERAGE FOR NUCLEAR FACILITIES:
1. SITE #1 - COLUMBIA GENERATING STATIONLOCATION OF NUCLEAR FACILITY: All of the premises including the land and all building and structures of Energy Northwest Columbia Generating Station including bat not
limited to the reactors formerly knlown as WNP 1, WNP 2 and WNP located approximately 12 miles NW of Richiand, Washington.
NAMED iNSURED [LISTED ON POLICY]: Energy Northwest
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:NF-0270 08/01/1982 $375 Million
NW-0628 08/01/1982 $375 Million**
N-0091 12120/1983 *
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 conhract or other document
with respect to which it is issued shall amend, extend or alter the coverage afforded by the policy. The Uimit 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.
ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
ACO9RDCERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)01/07/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTMARSH RISK & INSURANCE SERVICES PHNAE:A
345 CALIFORNIA STREET, SUITE 1300 IA/C. No. Extt: (A/C, Nol:CALIFORNIA LICENSE NO. 0437153 E-MAILSAN FRANCISCO, CA 94104 ADES
INSURER(S) AFFORDING COVERAGE NAIC #
021716-NUC2-16-17 INSURER A : American Nuclear InsurersINSURED INSURER B :
PACIFIC GAS & ELECTRIC COMPANYONE MARKET SPEAR TOWER INSURER C :SUITE 2400 INSURER D :SAN FRANCISCO, CA 94105
INSURER EB:
______________________________________________________ INSURER F
COVERAGES CERTIFICATE NUMBER: SEA-002937975-03 REVISION NUMBER: 3
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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.
LTR TYPE OF INSURANCE INj•p W3• POLICY NUMBER IMMIDD/YYYYI IMM/DD/YY'YYI LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
m DAMAGE TO RENTEDCLAIMS-MADE U OCCUR PREMISES lEa occurrence) S
___________________________MED EXP (Any one person) S
_____________________PERSONAL & ADV INJURY SGEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE
POLICY [j PRO- [j LOC PRODUCTS-COMP/OPAGG $
OTHER: $AUTOMBILELIABLITYCOMBINED SINGLE LIMIT $AUTOMBILELIABIITY Ea accident)$
ANY AUTO BODILY IN JURY (Per person) $ALL OWNED SCHEDULED BODILY INJURY IPer accident) $
__AUTOS __AUTOSNON-OWNED PROPERTY DAMAGE $
__HIRED AUTOS __AUTOS (Per accident)$
$__UMBRELLA LIAB OCCUR EACH OCCURRENCE S
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEDDED RETENTIONS$ $WORKERS COMPENSATION IPER OH
AND EMPLOYERS' LIABILITY Y' ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $OFFICER/MEMBER EXCLUDED? [ 2 JN/ A A__________ _______
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $If yes, describe underDESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Uability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101
Insurance
DESCRIPTION OF OPERATIONS I LOCATIONS/IVEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace is required)
CERTIFICATE HOLDER CANCELLATION
Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOREU.S. Nuclear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Washington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh Risk & Insurance Services
Eric t Kolstad • .--"-., E -
© 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01)
AGENCY CUSTOMER ID: 021716LOC #: San Francisco
ACORD ADDITIONAL REMARKS SCHEDULE Page 2 of2
AGENCY NAMED INSUREDMARSH RISK & INSURANCE SERVICES PACIFIC GAS & ELECTRIC COMPANY
__________________________________________________ONE MARKET SPEAR TOWERPOLICY NUMBER SUITE 2400
SAN FRANCISCO, CA 94105
CARRIER /NAIC CODE
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 LIABIUITY INSURANCE
This is to certify that there is in force as of the effective date of this Certificate a Nuclear Energy Uiability Insursance Policy issued by members of American Nuclear Insurers asindicated (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 pdior to the end of December 31 st of the calender year in which the Effective Date of this Certificate occurs, notice mill be delivered
in accordance with the policy provisions. Otherwise this Certificate shall terminate an of the end of such December 31st. A Certificate mill 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 FACILUTIES:
1. SITE #1 - DIABLO CANYONLOCATION OF NUCLEAR FACILITY: Diablo Canyon Nuclear Power Plant 12 MI WSW of San Luis Obispo, CA
NAMED INSURED [LISTED ON POLICY]: Pacific Gas and Electric Company
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
N F-0228 07/05/1 974 $376 Million
NW-0605 07/05/1 974 $375 Million**
N-0074 09/22/1981 *
N-0076 04/26/1 985
2. SITE #2 - HUMBOLDT BAYLOCATION OF NUCLEAR FACILITY: Humboldt Bay Nuclear Power Plant (Shutdown July 76) in Humboldt County, Californie
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 01/01/1 998 $375 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 policyjies]. 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 Uability shown above may have been reduced by payment of claims
or claims expenoes.
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 cinims 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
ACO1RD CERTIFICATE OF LIABILITY INSURANCE S DATE (MMIODDYYYY)01/11/12016
THIS CERTIFICATE IS ISSUED AS A MATTrER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTMARSHUSAINC.NAME:MRHUA N.PHONE FAX
TWO ALUIANCE CENTER ANCNoExt): (A/C No):3560 LENOX ROAD, SUITE 2400 E-MAILATLANTA, GA 30326 ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
S77608-NucI-Nuke-16-17 INSURER A :American Nuclear Insurers
INSU RED INSURER B:Tennessee Valley AuthorityAttention: Kirk Kelley INSURER C :400 W. Summit Hill Drive, WT 4C INSURER D0:Knoxville, TN 37919 ______
INSURER E :
_________________________________________________________ INSURER F: ______
COVERAGES CERTIFICATE NUMBER: ATL-003494057-06 REVISION NUMBER:21
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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 ADOL. SUBIt POLICY EFF POLICY EXPLTR TYPE OF INSURANCE gR•p WVp POLICY NUMBER IMMIDDIYYYYI {MMIDD/YYYYI LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $II DAMAGE TO RENTED
CLAIMS-MADE Lj OCCUR PREMISES lEa occurrence) $
____________________________MED EXP (Any one person) $
_________________PERSONAL &ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $SPOLICY JEC PRO [ LOC PRODUCTS -COMP/OPAGG $
OTHER:$
_AUTOMOBILE LIABILITY COMBINED(E acetSINGLE LIMIT $
ANY AUTO BODILY INJURY (Per person) $ALL OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $__HIRED AUTOS __AUTOS (Per accidenlt)
$
-- UMBRELLA LIAB [• OCCUR EACH OCCURRENCE $
EXCESS LIABR CLAIMS-MADE AGGREGATE S
DEDDED RETENTIONS $______________$_____WORKERS COMPENSATION PER 0H
AND EMPLOYERS' LIABILITY YIN' EA~IJR ________
ANY PRO PRIETOR/PARTNERJEXECUTIVE F1 E.L. EACH ACCIDENT $OFFICER/MEMBER EXCLUDED? [±N/ A _________
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $If yes, describe underDESCRIPTION OF OPERATIONS below ___E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101 see addl page text
Insurance
DESCRIPTION OF OPERATIONS ( LOCATIONS ( VEHICLES (ACORD l01, 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 BEFOREU.S. Nuclear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Washington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh USA Inc.
Ronald A. Santaniello. _•¢,,.J , ,
© 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01)
AGENCY CUSTOMER ID: S77608LOC #: Atlanta
AWORD ADDITIONAL REMARKS SCHEDULE Page 2 of3
AGENCY NAMED INSUREDMARSH USA, INC. Tennessee Valley Autthonty
______________________________________________________________ Attention: Kirk KelleyPOLICY NUMBER 400 W. Summit Hill Drive, WVT 4C
Knoxville, TN 37919
CARRIER NAIC CODE
J EFFECTIVE DATE:
ADDITIONAL REMARKS[THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance
CERTIFICATE OP NUCLEAR ENERGY LIABIUTY INSURANCE
This is to certify that there is in force as of the effective date of this Certificate a Nuclear Energy Uability Insurance Policy issued by members of American Nuclear Insurers asindicated (Companies), to the Innured named herein, with raspect to the Nuclear Facility at the Location shown and/or with respect to the Insured's operations described herein, if
such policy in cancelled or otherwise terminated prior to the end of December 31st of the calendar year in which the Effective Date ot this Certificate occurs, notice will be deliveredin accordance with the policy provisions. Dtheawse this Certificate shall terminate as of the end of such December 31st. A Certifcate will NOT be issued for any subsequentcalendar year unless requested in writing.
Types of Insurance: NF - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplieris & Transporters], ES - [Foreign Suppliers & Transporters], N - [Secondary
Financial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
1. SITE #1 - BROWNS FERRYLOCATION OF NUCLEAR FACILITY: Browss Ferry Nuclear Power Plant 10 MI NW of Decatur, AL
NAMED INSURED [LISTED ON POLICY]: Tennessee Valley Authority
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-01g8 09122/1971 $375 MillionNW-0581 09/22/1971 $375 Million**
N-0038 08101/1977 *N-003g 08/01/1977 *
N-0040 08101/1977 *
2. SITE #2 - SEOUOYAH
LOCATION OF NUCLEAR FACILITY: Sequsyati Nuclear Power Plant 9.5 MI NE of Chattanooga, TNNAMED INSURED [LISTED ON POLICY]: Tennessee Valley Authority
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:NF-0247 03/11/1977 $375 MillionNW-06514 03/11/1977 $375 Million**N-0066 02/29/1980
N-0075 0812511981
3. SITE #3 - WATTS BARLOCATION OF NUCLEAR FACILITY: Watts Bar Nuclear Power Plant 10 MI S of Spring City, TN
NAMED INSURED [USTED ON POLICY]: Tennessee Valley Authority
POUCY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:NF-0256 09/04/1979 $375 Million
NW-0618 09/04/1979 $375 Million"
N-0080 11/09/11995**
N-0120 10/22/2015 *
THIS CERTIFICATE IS ISSUED AS A MATrER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the poilcylies) is subject to the exclusions, conditions and other provisions of the policy(ies). Neither this Certificate nor any contract or other documentwith respect to which it is issued shall amesnd, extend or alter the coverage afforded by the policy. The Umit of Uability shown above may have been reduced by payment of claims
or claims enpenses.
COMMENTS/NOTES:
ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: S77608LOC #: Atlanta
ACORDADDITIONAL REMARKs scHEDULE Page 3 of3
AGENCY NAMED INSUREDMARSH USA, INC. Tennessee Valley Authority
______________________________________________________________ Attention: Kirk KeileyPOLICY NUMBER 400 W. Summit Hill Drive, WT 40
~Knoxville, TN 37919
CARRIER NAIC CODE
EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance ______
Master Worker Certificate - This limint 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 Policyand Certificate having reterence 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
ACORDCERTIFICATE OF LIABILITY INSURANCE SDATE (MMIDD/YYYY)
0110812016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTMarsh Risk & Insurance Services NAME:FA
PHONEFACA Ucense #0437153 AIc. No, Extl: AC, No):777 South Figuerea Street E-MAILLos Angeles, CA 90017 ADDRESS:
Attn: LosAngeles.CertRequest~marsh.com IF: 212-948-0535 INSURER(SI AFFORDING COVERAGE NAIC #08819 -DRI-AII-16-17 INSURER A :American Nuclear Insurers
INUEDominion Resources, Inc.INUEB
ATTN: Leslie D. Garber INSURER C :[email protected] INSURER D :701 East Cary Street, 20th FloorRichmond, VA 23219 INSURER E :
__________________________________________________________ INSURER F :
COVERAGES CERTIFICATE NUMBER: LOS-001839081-05 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 PERIODINDICATED. NOTWIWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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 SUBH POLICY EFF POLICY EXPLTR TYPE OF INSURANCE INB p V POLICY NUMBER IMMIDD/YYYY1 IMMIDD/YYYY) LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $m DAMAGE TO RENTED
CLAIMS-MADE KJOCCUR PREMISES (Ea occurrence) $
___________________________MED EXP (Any one personi $
_____________________PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $POLICY LJPJCT :OHR[ LaOC PRODUCTS -OOMP/OP AGO $$
AUTOMOBILE LIABILITY COMEINED SINGLE LIMIT $__ (Ea accident)
ANY AUTO BODILY INJURY (Per person) $ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
__AUTOS __AUTOSNON-OWNED PROPERTY DAMAGE $
__HIRED AUTOS __AUTOS (Per accident)$
$UMBRELLA LIAB •_•OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEDDED RETENTION $ $WORKERS COMPENSATION FI PERH
AND EMPLOYERS' LIABILITY Y I NI ELRANY PROP RIETORIPARTNER/EXECUTrIVE m E.L. EACH ACCIDENT $OFFICERIMEMBER EXCLUDED? [IjN A /______A__tMandatory in NH) E.L. DISEASE - BA EMPLOYEE $If yes, describe underDESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Liability Sue Attached 01/01/2016 01/01/2017 See Attached Acord
Insurance 'Acord 101" 101
DESCRIPTION OF OPERATIONS ILOCATIONS IVEHICLES (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 BEFOREU.S. Nuclear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWashington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of March Rick & insurance Services
! Shannon Moyer
© 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01)
AGENCY CUSTOMER ID: 08819LOC #: Los Angeies
.T®ACO~RD ADDITIONAL REMARKS SCHEDULE Page 2 of3
AGENCY NAMED INSUREDMarsh Risk & Insurance Services Dominion Resources, Inc.
___________________________________________________________ATTN: Leslie D. GarberPOLICY NUMBER [email protected]
701 East Cary Street, 20th FloorRichmond, VA 23219
CARRIER /NAIC CODE
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
EFFECTIVE DATE OF THIS CERTIFICATE: January 1, 2015
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 termilnated pdior to the end of December 31sat of the calendar year in which the Effective Date of this Certificate occurs, nofice will be deliveredin accordance with the policy provisions. Otherwise this Certificate shall terminate as of the end of such December 31sat. A Certificate will NOT be issued for any subsequent
calendar year unless requested in writing.
Types of Insurance: NF - [Facility Fermi, NW- [Master Worker Certificate], NS - [US Dowestic Supplier's & Transporters], FS - [Foreign Suppliers & Transporters], N - [Secondary
Financial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
1. SITE #1 - NORTH ANNA
LOCATION OF NUCLEAR FACILITY: North Anna Nuclear Power Plant 40 MI NW of Richmond, VA
NAMED INSURED [LISTED ON POLICY]: Virginia Electric & Power CompanyPOLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0240 03/26/1976 $375 Million
NW-O610 03/26/1976 $375 Million**
N-0063 11/26/1977 *
N-0070 04/11/1980**
2. SITE #2 - SURRYLOCATION OF NUCLEAR FACILITY: Surry Nuclear Power Plant 17 MI NW of Newport News, VA
NAMED INSURED [LISTED ON POLICY]: Virginia Electric & Power Company
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:NF-0186 06/15/1970 $375 MillionNW-0571 06/15/1970 $375 Million"
N-0027 08/01/1977N-0028 06/01/1977 *
3. SITE #3 - MILLSTONELOCATION OF NUCLEAR FACILITY: Millstone Nuclear Power Plant 3.2 MI WSW of New London, CT
NAMED INSURED [LISTED ON POLICY]: Dominion Nuclear Connecticut, Inc.
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0173 05/01/1 969 $375 Million
NW-0563 05/01 /1 969 $375 Million**
N-0016 08/01/1977**
N-0103 11/25/1985
4. SITE #4 - KEWAUNEELOCATION OF NUCLEAR FACILITY: Kewaunee Nuclear Power Plant in the Town of Caditon, Kewaunee County, WisconsinNAMED INSURED [LISTED ON POLICY]: Dominion Energy Kewaunee, Inc.
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0204 01 /01/1 972 $375 MillionNW-0586 01/01/1972 $375 Million**
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 08819LOC #: Los Angeles
ACORDADDITIONAL REMARKS SCHEDULE Page 3 of3
AGENCY NAMED INSUREDMarsh Risk & Insurance Services Dominion Resources, Inc.
POLICY NUMBER [email protected] East Cary Street, 20th Floor
CARRIER /NAIC CODE RcmnV 31
I EFFECTIVE DATE:
ADDITIONAL REMARKS[THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: Certificate of Liability InsuranceI
THIS CERTIFICATE IS ISSUED AS A MATTqER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policylies) is subject to the exclusions, conditions and other provisions of the policylies). Neither this Certificate nor any contract or other documentwith respect to which it is issued shall amend, extend or alter the coverage afforded by the policy. The Umit 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 Policyand 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 (2008101) © 2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
ACO2RDCERTIFICATE OF LIABILITY INSURANCE S DATE (MMIDD/YYYY)
01/07/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement~s).
PRODUCER CONTACTMARSH USA, INC. NAME:
PHONE FAXTWO ALLIANCE CENTER (A/C, No, Eat): (A/C, Nol:3560 LENOX ROAD, SUITE 2400 E-MAILATLANTA, GA 30326 ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
713170-NUCLE-*16-17 INSURER A : American Nuclear Insurers
INSURED INSURER B :NextEra Energy, Inc.
A~tn: Erica McNabb INSURER C :'[email protected] INSURER D :700 Universe BlvdP.O. Box 14000 INSURER E :Juno Beach, FL 33408 INSURER F: :______
COVERAGES CERTIFICATE NUMBER: ATL-003533264-06 REVISION NUMBER: 6
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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.
LTR TYPE OF INSURANCE INSD yWV3( POLICY NUMBER (MMIDDIYYYYI IMMIDDIYYYY) LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
m DAMAGE TO RENTEDCLAIMS-MADE U OCCUR PREMISES (Ea occurrence) $
SMED EXP (Any one person) $
SPERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY D JPO-T LOC PRODUCTS- COMP/OP AGO $
OTHER: $AUTOOBIL LIAIUTYCOMBINED SINGLE LIMIT $AUOOIELlBLT Ea accident) $___________
. ANY AUTO __BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS __AUTOS
NON-OWNED PROPERTY DAMAGE $__HIRED AUTOS __AUTOS (Per accident)$
$UMBRELLA LIABR~ OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEDBED RETENTION $ $WORKERS COMPENSATION FI FF5ERAND EMPLOYERS' LIABILITY Y I NJ~ ___________
ANY PROPRIETOR/PARTNER/EXECUTIVE r1 E.L. EACH ACCIDENT $OFFICER/MEMBER EXCLUDED? ) N/ A __________
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $If yes, describe underDESCRIPTION OF OPERATIONS below ______ ______E.L. DISEASE - POLICY LIMIT $
A NUCLEAR ENERGY LIABILITY (see attached) 01/01/2016 01/01/2017 SEE ATTACHED ACORD 101
DESCRIPTION OF OPERATIONS / 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 BEFOREU.S. Nuclear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWashington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh USA Inc.
Manashi Mukherjee ,,,4--",.•,,..o,,L .. • •,]u
© 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01)
AGENCY CUSTOMER ID: 713170LOC #: Atlanta
ACORDADDITIONAL REMARKS SCHEDULE Page 2 of 3
AGENCY NAMED INSUREDMARSH USA, INC. NextEra Energy, Inc.
___________________________________________________________________Attn: Erica McNabbPOLICY NUMBER Erica.A.McNabb@FPL~com
700 Universe BlvdP.O. Box 14000
CARRIER /NAIC CODE Juno Beach, FL 33408
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
Thin is to certify that there is in force as of the effective date of this Certificate a Nuclear Energy Uability Inaurance Policy issued by members of American Nuclear Insurers asindicated (Companies), to the Insured named herein, with respect to fhe Nuclear Facility at the Location shown and/or with respect fo the Insured's operations described herein. If
such policy is cancelled or otherwise terminated prior to the end ot December 31sat of the calender year in which the Effective Date of this Certificate occurs, notice will be deliveredin accordance with the policy provisions. Otherwse this Certificate shall terminate as of the end of such December 31st. A Certificate will NOT be issued for any subsequentcaiendar 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 -ST. LUCIELOCATION OF NUCLEAR FACILITY: St. Lucie Nuclear Power Plant on Hutchinson Island, St Lacde County, Ftorida
NAMED INSURED [LISTED ON POLICY]: Florida Power & Ught Company, Ftorida Municipal Power Agency, and Orlando Utilities Commission of the City of Orlando
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0227 06/01/1974 $375 MillionNW-0604 06/01 /1 974 $375 Million•
N-0059 08/01/1977 *N-0089 04/06/1 983**
2. SITE #2 - TURKEY POINTLOCATION OF NUCLEAR FACILITY: Turkey Point Nuclear Power Plant in the Southeast part of Dade County, Florida
NAMED INSURED [LISTED ON POLICY]: Florida Power & Ught Company
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:N F-0185 06/01/1970 $375 MillionNW-0570 06/01/1970 $375 Million•
N-0025 08/01/1977N-0026 08/01/1977**
3. SITE #3 - SEABROOKLOCATION OF NUCLEAR FACILITY: Seabmook Nuclear Power Plant in Seabreok Township, Rockingham County, New HampshireNAMED INSURED [LISTED ON POLICY]: NeutEra Energy Seabrook, LLC; Massachusetts Municipal Wholesale Electric Company; Taunton Municipal Light Plant; and Hudson
Light and Power Department
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABiLITY:NF-0296 12/15/1985 $375 MillionNW-0647 12115/1985 $375 Million**
N-0109 10/17/1986**
4. SITE #4- DUANE ARNOLD
LOCATION OF NUCLEAR FACILITY: Duane Arnold Nuclear Power Plant on the Cedar River approx 2 and 1/3 Miles NNE of Palo, IowaNAMED INSURED [LISTED ON POLICY]: NextEra Energy Duane Arnold, LLC, Central Iowa Power Cooperative and Corn Belt Power Cooperative
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF.0214 05/1 5/1 973 $375 Million
NW-0593 05/1 5/1 973 $375 Million"
N-0050 08/01/1977**
ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 713170LOC #: Atlanta
ACORDADDITIONAL REMARKS SCHEDULE Page 3 of3
AGENCY NAMED INSUREDMARSH USA, INC. NextEra Energy, Inc.
_______________________________________________________________Attn: Erica McNabbPOLICY NUMBER Erica.A.McNabb@FPL~com
700 Universe BlvdP.O. Box 14000
CARRIER NAIC CODE Juno Beach, FL 3340B
EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CertifiCate of Liability Insurance
5. SITE #5- POINT BEACHLOCATION OF NUCLEAR FACILITY: Point Beach Nuclear Power Plant in the Town of Two Creeks, Manitowoc County, WisconsinNAMED INSURED [LISTED ON POLICY]: NextEra Energy Point Beach, LLCPOLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:NF-0178 0811211969 $375 MillionNW-0565 08/1211969 $375 Million*
N-0018 08/01/1977**
N-0019 08/01/1977**
THIS CERTIFICATE IS ISSUED AS A MATITER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policyyies) is subject to the exclusions, conditions end other provisions of the policyjies). Neither this Certificate nor any contract or other document
with inspect to which it is issued shall amend, extend or alter the coverage afforded by the policy. The Umit of Usbility shown above may hnve been reduced by payment of claimsor 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.
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
ACcORD CERTIFICATE OF LIABILITY INSURANCEDATE (MMIDD/YYYY)
01122/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTMARSH USA, INC. NAME:
PHONE FAX445 SOUTH STREET AiCNoExt): AIC, No}:MORRISTOWN, NJ 07960-6454 E-MAILAttn: [email protected] ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #t
074725-OTU-NUCLE-16-17 INSURER A : American Nuclear InsurersINSURED INSURER B :
PSEG NUCLEAR LLCATTN: ROBERT GREEN INSURER C :[email protected] INSURER D :80 PARK PLAZA, MAIL CODE T-6BNEWARK, NJ 07101 INSURER E :
INSURER F: _______
COVERAGES CERTIFICATE NUMBER: NYC-007087875-03 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 PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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.
LTR TYPE OF INSURANCE IN;D• POLICY NUMBER IMalDD/Yyyy)'~' (MMIDD/YyyyI LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
II DAMAGE TO RENTEDSCLAIMS-MADE U• OCCUR PREMISES (Ea occurrence) $
___________________________MED EXP (Any one person) $
_____________________PERSONAL & ADV INJURY $
GENtL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY J ~ECTr LOC PRODUCTS - COMPIOP AGO $ _______
__OTHER: $
AUTOMOBILE LIABILITY (Ea accident) $___________
ANY AUTO BODILY INJURY (Per person) $ALL OWSNED SCHEDULED BODILY IN JURY (Per accident) $
__AUTOS __AUTOSNON-OWNED PROPERTY DAMAGE
__HIRED AUTOS __AUTOS (Per accident) $__________
$
__UMBRELLA LIAB [• OCCUR EACH OCCURRENCE $
EXCESS LIAB ! !CLAIMS-MADE AGGREGATE $
_ EDDED RETENTIONS$_____________ ____ $
WORKERS COMPENSATION IPERSTTT 0 TH-RAND EMPLOYERS' LIABILITY YIN ERN_______ANY PROPRIETOR/PARTNERIEXECUTIVE r-- E.L. EACH ACCIDENT $OFFRCERJMEMBER EXCLUDED? L iN A(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $If yes, describe underD)ESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A NUCLEAR ENERGY LIABILITY SEE ATTACHED ACORD 101 01/0112016 01/0112017 SEE ATTACHED ACORD 101
INSURANCE
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 BEFOREU.S. NUCLEAR REGULATORY COMMISSION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWASHINGTON, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh USA (no.
Manashi Mukherjee ..S"4c.u•, k.t *Ae•;.AJ-L
© 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
ACORD 25 (2014/01)
AGENCY CUSTOMER ID: 074725LOC #: Morristown
ACORD ADDITIONAL REMARKS SCHEDULE Page 2 of2
AGENCY NAMED INSUREDMARSH USA, INC. PSEG NUCLEAR LLC
____________________________________________________ATTN: ROBERT GREENPOLICY NUMBER ROBERT. [email protected]
80 PARK PLAZA, MAIL CODE T-6BNEWARK, NJ 07101
CARRIER /NAIC CODE
L 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 Uability Insurance Policy issued by members of Americas Nuclear Insurers asindicated (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 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], ES- [Foreign Suppliers & Transporters], N - [SecondaryFinancial Protection Certficate]
COVERAGE FOR NUCLEAR FACILITIES:
1. SITE #1 - SALEM NUCLEAR POWER STATIONS AND HOPE CREEK NUCLEAR POWER STATIONLOCATION OF NUCLEAR FACILITY: Salem Nuclear Power Plant and Hope Creek Nuclear Power Plant in Lower Alloways Creek Township, Salem County, New Jersey
NAMED INSURED [LISTED ON POLICY]: PSEG Nuclear LLC and Exelon Generation Company, LLC
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF UABILITY:
NF-0230 10/15/1974 $375 MillionNW-0606 10/15/1974 $375 Million•
N-0060 08/01/1977 •
N-0072 04/1 8/1 980 •
N-0104 04/1 4/1 986 *
THIS CERTIFICATE IS ISSUED AS A MATI'ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policy(ies) is subject to the eoclusions, conditions end other provisions of the policy(ies). Neither this Certificate nor any contract or other documentwith respect to which it is issued shall amend, extend or alter the coverage afforded by the policy. The Umit of Uability shown above may have been reduced by payment of claims
or claims expenses.
COMMENTS/NOTES:
**Master Worker Certificate - This limit is shared by all Certiticates to the Master Worker Policy ot which each Certificate is a part and is subject to all of the provisions of such Policyand Certificate having reference thereto. Such limit may have been reduced by payment of claims or claims expeases.
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
AGENCY CUSTOMER ID: ____________________LeoC #: Minneapolis
ACORD ADDITIONAL REMARKS SCHEDULE Page 2 of2
AGENCY NAMED INSUREDMarsh USA Inc. Xcel Energy, Inc.
______________________________________________________________Attn: Robert L. MillerPOLICY NUMBER [email protected]
414 Nicollet Mall, 4th FloorMinneapolis, MN 55401
CARRIER JNAIC CODE
L 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 theme is is force as of the effective date of this Certificate a Nuclear Energy Liability Insurance Policy issued by members of American Nuclear Insurers asindicated (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 31 st of the calendar year in which the Effective Date of this Certificate occurs, notice will be deliveredin 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 unles;s mequesfed In writing.
Types of insurance: NF - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's & Transporters], FS - [Foreign Suppliers & Transporters], N - [SecondaryFinancial Protection Certitcate]
COVERAGE FOR NUCLEAR FACILITIES:
1. SITE #1 - PRAIRIE ISLANDLOCATION OF NUCLEAR FACILITY: Prairie Island Nuclear Power Pleant on the Mississippi River in Goodhue County, Minnesota
NAMED INSURED [LISTED ON POLICY]: Northern States Power Company
POUCY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0197 09/0f/1 971 $375 MillionNW-0580 09/01/1971 $375 Million**
N-0036 08/01/1977**
N-0037 08/01/1977**
2. SITE #2 - MONTICELLOLOCATION OF NUCLEAR FACILITY: Monticello Nuclear Power Plant on the Mississippi River in Wright County, MinnesotaNAMED INSURED [LISTED ON POLICY]: Northern States Power Compasy
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:NF-0174 06/09/1969 $375 MillionNW-0564 06/09/1969 $375 Million"N-0017 08/01/1977 *
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 whigh it is issued shall amend, extend or alter the coverage afforded by the policy. The Umit of Uability 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 Policyand 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
ACORDCERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)
01/12/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTMarsh USA Inc. NAME:
PHONE FA333 South 7th Street, Suite 1400 tAC. No. Ext): (A/C No):Minneapolis, MN 55402-2400 E-MAIL
ADDRESS:
INSURERtS) AFFORDING COVERAGE NAIC #
-..-NUCLR-15--16 INSURER A : American Nuclear insurers
INSURED INSURER B :Xcel Energy, Inc.Attn: Robert L. Miller INSURER C :[email protected] INSURER D :414 Nicollet Mali, 4th FloorMinneapolis, MN 55401 INSURER B :
_______________________________________________________ INSURER F :
COVERAGES CERTIFICATE NUMBER: CHI-006140703-03 REVISION NUMBER:9
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWIA'THSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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.
INSRADOUR POLICY EFF POLICY EXPLTR "FTYPE OF INSURANCE N V POLICY NUMBER 'MM/DD/YYYY) (M/DyYYYl LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $m DAMAGE TO RENTED
CLAIMS-MADE [JOCCUR PREMISES lEa occurrencel $
____________________________MED EXP (Any one person) $
_______________________PERSONAL & ADV INJURY $GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $D--PRO- I
POLICY JECT LOC PRODUCTS -COMP/OP AGO $
__OTHER: $AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
__ ~lEa accident)$
ANY AUTO BODILY INJURY (Per person) $ALL OWNED SCHEDULED BODILY INJURY (Per accident). $
__AUTOS AUTOSNON-OWNED PROPERTY DAMAGE
__HIRED AUTOS __AUTOS (Per accident)$
= $
-- UMBRELLA LIAB I• OCCUR __ACHOCCURRENCE_ $
EXCESS LIAB I ICLAIMS-MADE AGGREGATE $
DEDDED RETENTION $ I$
WORKERS COMPENSATION IPERSTTT 0 TH-EAND EMPLOYERS' LIABILITY Y IN N~AhJS ________
ANY PROPRIETORIPARTNERJEXECUTIVE E.L. EACH ACCIDENT $OFFICER/MEMBER EXCLUDED? L• N I A_________(Mandatory In NH) E.L DISEASE - EA EMPLOYEE $If yes, describe underDESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Liability 'See Attached ACORD 101' 01/01/2016 01/01/2017 See Attached ACORD 101
Insurance
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remartrs Schedule, may be attached if more space Is required)
CERTIFICATE HOLDER CANCELLATION
Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOREU.S. Nuclear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Washington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh USA Inc.
Manashi Mukherjee ..3#o,•.= .. ;
© 1988-2014 ACORD CORPORATION. All rights reserved.The A CORD name and logo are registered marks of ACORDACORD 25 (2014/01)
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY)01107/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(lest must be endorsed. If SUBROGATION IS WAIVED, subject tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTMARS USAINC.NAME:MAS S N.PHONE FAX
540 W. MADISON tA/C, No, Extt (A/C, No):CHICAGO, IL 60661 E-MAILAttn: [email protected] ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #01 6265-Nucle-Nucle-16-17 INSURER A : American Nuclear Insurers
INSURED INSURER B :FirstEnergy CorporationAttn: Pete Nadel INSURER C :[email protected] INSURER D :76 South Main Street _______
Akron, OH 44308 INSURER E :
_________________________________________________________INSURER F: :_____
COVERAGES CERTIFICATE NUMBER: CHI-005417270-04 REVISION NUMBER:7
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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.
LTR TYPE OF INSURANCE INP V POLICY NUMBER iMMiDD/YyyyI IMMiDD/Yyyy1 LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $-- m[ DAMAGE TO RENTEDCLAIMS-MADE LjOCCUR PREMISES (Ea occurrence) $
___________________________MED EXP (Any one person) $
______________________PERSONAL & ADV INJURY $GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $m-- PRO- II
POLICY LiJECT LOC PRODUCTS- COMP/OP AGO $
__OTHER: $AUTOMBILELIABLITYCOMBINED SINGLE LIMIT $AUTOMBILELIABIITY Ea accidentt
ANY AUTO BODILY INJURY (Per person) $ALL OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS __AUTOS
NON-OWNED PROPERTY DAMAGE__HIRED AUTOS __AUTOS (Per accidenlt $
$
__UMBRELLA LIAB I-•OCCUR EACH OCCURRENCE $
EXCESS LIABR ]CLAIMS-MADE AGGREGATE $
DEDDED RETENTION $ _____$
WORKERS COMPENSATION PER 0H
AND EMPLOYERS' LIABILITY Y IN ERI_______ANY PROPRIETORJPARTNERJEXECUTIVE FTF E.L. EACH ACCIDENT $OFFICERJMEMBER EXCLUDED? [J N A(Mandatory In NH) EL. DISEASE - EA EMPLOYEE $If yes, describe underDESCRIPTION OF OPERATIONS below ______________________E.L. DISEASE - POLICY LIMIT $
A Nuclear Enargy See Attached Acord 101 01/01/2016 01/0112017 See Attached Acord 101
Liability Insurance
DESCRIPTION OF OPERATIONS I LOCATIONS/IVEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more epace Is required)
CERTIFICATE HOLDER CANCELLATION
Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOREU.S. Nuclear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWashington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh USA Inc.
Manashi Mukherjee .3 .,,.a• t,.;
© 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01)
AGENCY CUSTOMER ID: 016265LOC #: Chicago
•ACOIRD ADDITIONAL REMARKS SCHEDULE Page 2 of3
AGENCY NAMED INSUREDMARSH USA INC. FirstEnergy Corporation
______________________________________________________________ Attn: Pete NadelPOLICY NUMBER [email protected]
76 South Main StreetAkron, OH 44308
C:ARRIER /NAIC CODE
/ EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: Certificate of: Liability InsuranceI
CERTIFICATE OF NUCLEAR ENERGY LIABtUTY INSURANCE
This is to certify that there is in force as of the effective date of this Certificate a Nuclear Energy Uability Insurance Policy issued by members of American Nuclear Insurers asindicated (Companies), to the Insured named herein, with respect to the Nuclear Facility at the Location shown and/sr with respect to the Insured's operations described hemein. 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 31 st. 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-[SecondaryFinancial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
1. SITE #1 - BEAVER VALLEYLOCATION OF NUCLEAR FACILITY: Beaver Valley Nuclear Power Plant in Shippingport Borough, Beaver County, Pennsylvania
NAMED iNSURED [USTED ON POLICY]: FirstEnergy Nuclear Generation, LLC, Ohio Edison Company, The Toledo Edison Company and FirstEnergy Nuclear Operafing
CompanyPOLICY NUMBER:
NF-0226
NW-0603
N-005B
N-0110
POLICY EFFECTIVE:08/01/1974
08/'01 /197408/01/1977
05/28/1 987
LIMIT OF LIABILITY:$375 Million
$375 Million**
2. SITE #2 - DAVIS-BESSELOCATION OF NUCLEAR FACILITY: Davis-Reuse Nuclear Power Plant on Lake Erie approx 20 miles ESE of Toledo in Ottawa County, OhioNAMED INSURED [LISTED ON POLICY]: FirstEnergy Nuclear Generation, LLC and FirstEnergy Nuclear Operating CompanyPOLICY NUMBER: POUCY EFFECTIVE: LIMIT OF LIABILITY:
N F-0236 11/01/1975 $375 MillionNW-0608 11/01/1975 $375 Million•
N-0061 08/01/1 977**
3. SiTE #3 -PERRY
LOCATION OF NUCLEAR FACILITY: Perry Nuclear Power Plant on Lake Erie approx 35 miles NE of Cleveland, OhioNAMED INSURED [LISTED ON POLICY]: FirstEnergy Nuclear Generation, LLC, Ohio Edison Company, and FirstEnergy Nuclear Operating Company
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:NF-0291 09/01/1984 $375 Million
NW-0644 09/01/1984 $375 Million*
N-01 02 03/18/1986
4. SITE #4 - SAXTONLOCATION OF NUCLEAR FACILITY: Santon Nuclear Experimental Corporation Facility in Liberty Township, Bedford County, Pennsylvania
NAMED INSURED [LISTED ON POLICY]: Saxten Nuclear Experimental Corporation
POLICY NUMBER: POUCY EFFECTIVE: LIMIT OF LIABILITY:NF-0107 06/01/1961 $1 MillionNW-0532 08/01/1961 $375 Million•
5. SITE #5 - THREE MILE ISLANDLOCATION OF NUCLEAR FACILITY: Three Mile Island Nuclear Power Plant in Londondenry Township, Dauphin County, Pennsylvania
NAMED INSURED [LISTED ON POLICY]: MetropoLitan Edison Company, Jersey Central Power & Light Cowpany, Pennsylvania Electric Company and CPU Nuclear Inc.
ACORD 101 (2008/01) ©@2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 016265LOC #: Chicago
ACO¶R.D ADDITIONAL REMARKS SCHEDULE Page 3 of3
AGENCY NAMED INSUREDMARSH USA INC. FirstEnergy Corporation
_________________________________________________________ - Attn: Pete NadetPOLICY NUMBER [email protected]
76 South Main Street- Akron, OH 44308
CARRIER NAIC CODE
I EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: Certificate of Liability InsuranceI
NW-0599 12131/1973 $375 Million**
THIS CERTIFICATE IS ISSUED AS A MAiFER 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 policylies). Neither this Certificate nor any contract or other documentwith respect to which it is issued shall amend, extend or alter the coverage afforded by the policy. The Umit of Uability shown above may have been reduced by payment of claims
or claims expenses.
COMMENTS/NOTES:
Master Worker Certificate - This limit is shared by ati Certificates to the Master Worker Policy of which each Certificate is a part and is subject to all of the provisions of such Policyand 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
ACR CERTIFICATE OF LIABILITY INSURANCEDATE (MMIDD/YYYY)
0/07/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTMarsh USA Inc. NAME:
PHONE FAX1717 Arch Street (A/c, No, Ext): (A/C, No):Philadelphia, PA 19103-2797 E-MAILAttn: [email protected]/ Fax - 212-948-0360 ADES
INSURER(S) AFFORDING COVERAGE NAIC #
S27339-Exelo-NE-16117 INSURER A :American Nuclear InsurersINSURED INSURER B :
Exelon CorporationATTN: [email protected] INSURER C :2301 Market Street, S21-1 INSURER D :P.O. Box 8699Philadelphia, PA 19101-8699 INSURER E :
INSURER F: :_____
COVERAGES CERTIFICATE NUMBER: CLE-004728374-03 REVISION NUMBER:4
THIS IS TO CERTtFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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.
LTR TYPE OF INSURANCE IN•Df WVP POLICY NUMBER I MM/DD/YYYYI IMM/DD/YYYY1 LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $] DAMAGE TO RENTED
SCLAIMS-MADE L j OCCUR PREMISES lEa occurrence) $
___________________________MED EXP (Any one person) $
_____________________PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY D JPO-T LOC PRODUCTS - COMP/OP AGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $l_ Ea accident)_____________
ANY AUTO BODILY INJURY (Per person) $ALL OWNED SCHEDULED BODILY IN JURY (Per accident) $
__AUTOS __AUTOSNON-OWNED PROPERTY DAMAGE $
__HIRED AUTOS __AUTOS (Per accident)$
$
-- UMBRELLA LIAB l• OCCUR EACH OCCURRENCE $
EXCESS LIABR CLAIMS-MADE AGGREGATE $
_ EDDED RETENTION $ $
WORKERS COMPENSATION IESAUEI ITEAND EMPLOYERS' LIABILITY YN I N~J~5 ________
ANY PROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT $OFFICER/MEMBER EXCLUDED? LI±N/ A _________
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $If yes, describe underDESCRIPTION OF OPERATIONS below __E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached 01/01/2016 01/01/2017 See Attached Acord 101
Insurance "Acord 101"
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mome space Is required)
CERTIFICATE HOLDER CANCELLATION
Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOREU.S. Nuclear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWashington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh USA Inc.
Manashi Mukherjee •.t kL, . ,.;...ade., .c,}.L.
© 1988-2014 ACORD CORPORATION. All rights reserved,The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01)
AGENCY CUSTOMER ID: $27339LOG #: Philadelphia
ACO9RD ADDITIONAL REMARKS SCHEDULE Page 2 of 4
AGENCY NAMED INSUREDMarsh USA Inc. Exelon Corporation
__________________________________________________________ATTN:___mich__eATT: meeca exeee oncorncopccoPOLICY NUMBER 2301 Market Street, $21-1
P.O. Box 8699Philadelphia, PA 19101-8699
CARRIER /NAIC CODE
L 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 Uability Insurance Policy issued by members of American Nuclear Insurers anindicated (Companies), to the Insured named herein, with respect to the Nuclear Facility at the Location shown and/sr with respect to the Insured's operations described herein. If
such policy is cancelled or otherwise terminated prior to the end of December 31sat 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 ot such December 31st. A Certificate will NOT be iussed for any subsequent
calendar year unless requested in writing.
Types of Insurance: NE - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's & Transporters], ES - [Eoreign Suppliers & Transporters], N- [Secondary
Einancial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
1. SITE #1 - BRAIDWOODLOCATION OF NUCLEAR FACILITY: Braidwood Nuclear Power Plant in Reed Township ot Will County in Northeastern Illinois
NAMED INSURED [LISTED ON POLICY]: Exelon Generation Company, LLC
POLICY NUMBER: POUCY EFFECTIVE: LIMIT OF LIABILITY:
NF-0294 08/21/1985 $375 MillionNW-0645 08/21(1985 $375 Million*
N-0108 10/17/1986 "
N-0115 12118/1987 *
2. SITE #2 -BYRONLOCATION OF NUCLEAR FACILITY: Byron Nuclear Power Plant located south-south east of the City of Byron, Rockvale Township, Ogle County, Illinois
NAMED INSURED [LISTED ON POLICY]: Exelon Generation Company, LLC
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:NF-0277 02/03/1983 $375 Million
NW-0634 02/03/1983 $375 Million*
N-0093 10/31/1984
N-0101 11/06/1986 *
3. SITE #.3 - DRESDENLOCATION OF NUCLEAR FACILITY: Dresden Nuclear Power Plant in Goose Lake Township, Grundy County, Illinois
NAMED INSURED [LISTED ON POLICY]: Exelon Generation Company, LLCPOLICY NUMBER: POLICY EFFECTIVE: LIMIT OF UABILITY:NF-0043 09/01/1958 $375 MillionNW-0514 09/01/1958 $375 Million•
N-0002 08/01/1977 *N-0003 08/01/1977
4. SITE #4 - LA SALLE
LOCATION OF NUCLEAR FACILITY: La Salle Nuclear Power Plant in Brookfield Township, LaSalle County, Illinois
NAMED iNSURED [LISTED ON POLICY]: Exelon Generation Company, LLCPOLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0253 08/1 0/1 978 $375 Million
NW-0617 08/1 0/1 978 $375 Million**
N-0071 04/1 7/1 982**
N-0083 1 2/18/1983
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: $27339LOC #: Philadelphia
ACO~RDADDITIONAL REMARKS SCHEDULE Page 3 of4
AGENCY NAMED INSUREDMarsh USA Inc. Exelon Corporation
__________________________________________________________ATT__:___i____eATT: eecae xeeeoex orncopcooPOLICY NUMBER 2301 Market Street, $21-1
P.O. Box 8699Philadelphia, PA 19101-8699
CARRIER NAIC CODE
1 EFFECTIVE DATE:
ADDITIONAL REMARKS
[THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance
5. SITE #5 - LIMERICKLOCATION OF NUCLEAR FACILITY: Limerick Nuclear Power Plant in Southeastern PA on the Schuylkill River, 1.7 miles SE of horough of PottstownNAMED INSURED [LISTED ON POLICY]: Exelon Generatisn Company, LLCPOUCY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0284 03/19/1984 $375 Million
NW-0640 03/19/1984 $375 Million"
N-0098 10/26/1984 *
N-01 18 06/22/1989**
6. SITE #6 - PEACH BO'i-IOMLOCATION OF NUCLEAR FACILITY: Peuch Bottom Nuclear Power Plant in Peach Bottom Township, York County, Pennsylvania
NAMED INSURED [LISTED ON POLICY]: Exelon Generation Company, LLC and PSEG Nuclear LLC
POUCY NUMBER: POLICY EFFECTIVE: LIMIT OF UABILITY:
NF-0140 10/05/1964 $375 MillionNW-0544 10/05/1984 $375 Million**
N-0008 08/01/1977 *N-0009 08/01/1 977 •
7. SITE #7 - OUAD-CITIESLOCATION OF NUCLEAR FACILITY: 0usd-Cities Nuclear Power Plant in Rock Island County, IllinoisNAMED INSURED [LISTED ON POLICY]: Exelon Generation Company, LLC and MidAmerican Energy Company
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
NF-0187 10/0111970 $375 Million
NW-0572 10/01/1970 $375 Million**N-0029 08/01/I1977 *N-0030 08/01/1977 *
8. SITE #8 - CLINTON
LOCATION OF NUCLEAR FACILITY: Clinton Nuclear Power Plant East of the city of Clinton in Dewitt County, IllinoisNAMED INSURED [lISTED ON POLICY]: Enelon Generation Company, LLC
POUCY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:NF-0261 09/05/1 980 $375 Million
NW-0621 09/05/1 980 $375 Million"
N-0085 09/29/1 988 *
9. SITE #9 - OYSTER CREEKLOCATION OF NUCLEAR FACILITY: Oyster Creek Nuclear Power Plant in Lacey Township, Ocean County, New Jersey
NAMED INSURED [LISTED ON POLICY]: Exelon Generation Company, LLC
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:NF-0164 10/03/1 967 $375 Million
NW-0558 10/03/1967 $375 Million**
N-0013 08/01/1977
10. SITE #10 - THREE MILE ISLANDLOCATION OF NUCLEAR FACILITY: Three Mile Island Nuclear Power Plant in Londonherry Township, Dauphin County, PennsylvaniaNAMED INSURED [LISTED ON POLICY]: [FOR NF-0220] Exelon Generation Company, LLC, Metropolitan Edison Company, Jersey Central Power & Light Company,
Pennsylvania Electric Company and GPU Nuclear Inc.; [FOR NW-0688[ Enelon Generation Company, LLCPOLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
V. -
AGENCY CUSTOMER ID: $27339LOC #: Philadelphia
ACORD ADDITIONAL REMARKS SCHEDULE Page 4 of 4
AGENCY NAMED INSUREDMarsh USA Inc. Exelon Corporation
__________________________________________________________ATTN_____ic__aeATT: eecae xeleonceonpopccoPOLICY NUMBER 2301 Market Street, $21-1
P.O. Box 8699Philadelphia, PA 19101-8699
CARRIER /NAIC CODE
L EFFECTIVE DATE:
ADDITIONAL REMARKS
[THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
[FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance
NF-0220NW-0688
N-0056
12/03/197312/03/1973
08/01/1 977
$375 Million$375 Million**
11. SITE #11 - CALVERT CLIFFSLOCATION OF NUCLEAR FACILITY: Calvert Cliffs Nuclear Power Plant in Calvert County, Maryland
NAMED INSURED [LISTED ON POLICY]: Calvert Cliffs Nuclear Power Plant, LLC
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:NF-0216 06/27/1 973 $375 MillionNW-0595 06t27/1 973 $375 Million"
N-0052 08/01/1 977
N-0053 08/01/1977 *
12. SITE #12 - NINE MILE POINT
LOCATION OF NUCLEAR FACILITY: Nine Mile Point Nuclear Power Plant on Luke Ontario 8 miles NE of Oswego, Oswego County, New York
NAMED INSURED [LISTED ON POLICY]: Nine Mile Point Nuclear Station, LLC
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
N F-0161 06/1 4/1 967 $375 Million
NW-0557 06/14/1967 $375 Million**
N-0012 08/01/1977 *
N-0105 10/31/1986 *
13. SITE #13 - R. E. GINNA
LOCATION OF NUCLEAR FACILITY: R. E. Ginna Nuclear Power Plant located in Ontario, New York.
NAMED INSURED [LISTED ON POLICY]: R.E. Ginna Nuclear Power Plant, LLCPOLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:N•F-0170 11/01/1968 $375 Million
NW-0561 11/01 /1 968 $375 Million"N-0014 08/01/1977 *
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, condifions 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 Uwit of Uiability shown above way have been reduced by payment of claims
or claims expenses.
COMMENTS/NOTES:
**Maxter Worker Certificate - This limit is shamed 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 raUng plan.
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
ACORDCERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
01/11/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTMars USAInc.NAME:Mas S n.PHONE FAX
2405 Grand Boulevard, #900 IA/C, No, Ext: (A/C, No):Kansas City, MO 64108 E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #t
B22759-OPPD-NRC-16-17 INSURER A : American Nuclear Insurers
INSURED INSURERS :Omaha Public Power DistrictAttn: Uisa Hough INSURER C :444 S 16th Street INSURER D :Mall BE/EP1Omaha, NE 68102 INSURER E2:
_________________________________________________________INSURER F: :_____COVERAGES CERTIFICATE NUMBER: CHI-005941393-02 REVISION NUMBER:4
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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 SUBSR POLICY 2FF POLICY EXPLTR TYPE OF INSURANCE IN• WyP POLICY NUMBER (MMIDD/YYYYI IMM/DDIYYYYI LIMITS
COMMERCIAL GENERAL LIABILITY EACI- OCCURRENCE $
m DAMAGE TO RENTEDCLAIMS-MADE ~JOCCUR PREMISES (Ea occurrence) $
__ __________________MED EXP (Any one peraon) S
_____________________PERSONAL & ADV INJURY $GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
FiIPRO- m--POLICY LiJECT LOC PRODUCTS - COM P/OP AGG $
___OTHER: $AUTOMBILELIABLITYCOMBINED SINGLE LIMIT $AUTOMBILELIABIITYtEa accident)$
ANY AUTO BODILY INJURY (Per person) $ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
__AUTOS AUTOSNON-OWNED PROPERTY DAMAGE $
__HIRED AUTOS AUTOS (Per accident)$
! $
__UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAR I CLAIMS-MADE AGGREGATE $
DEDDED RETENTION $ ______$
WORKERS COMPENSATION STuTPER 0 TH-RAND EMPLOYERS' LIABILITY iYIII N~fANY PRDPRIETORIPARTNER/EXECUTIVE FTF E.L. EACH ACCIDENT $OFFICER/MEMBER EXCLUDED? [jN / A _________
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $If yea, deacribe underDESCRIPTION OF OPERATIONS below __ ___ _E.L. DISEASE - POLICY LIMIT $
A NUCLEAR ENERGY LIABILITY SEE ATTACHED ACORD 101 01/01/2016 01/01/2017 SEE ATTACHED ACORD 101
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarka Schedule, may be attached if more apace Is required)
CERTIFICATE HOLDER CANCELLATION
Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOREU.S. Nuclear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWashington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Mersth USA Inc.
Manashi Mukherjee .3'.,ttaiet •.2tacis.c±
© 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORDACORD 25 (2014101)
AGENCY CUSTOMER ID:" B22759LOC #: Kansas City
.0•A CORD
'4.-. ADDITIONAL REMARKS SCHEDULE Page 2 of2
AGENCY NAMED INSUREDMarsh USA Inc. Omaha Public Power District
___________________________________________________________________Attn: Usa HoughPOLICY NUMBER 444 S316th Street
Mall 8EJEP1Omaha, NE 68102
CARRIER /NAIC CODE
L EFFECTIVE DATE:
ADDITIONAL REMARKSrTHIS 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 certity that there is is force as of the effective date of this Certificate a Nuclear Energy Uability Insurance Policy issued by members ot Aeericen Nacteer 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
soch policy is cancelled or otherwise terminated prior to the end of December 31sat ot the calendar year is 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 ot such December 31st. A Certificate will NOT be issued for any sobsequent
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 & Travsporters], N - [SecondaryFinancial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
1. SITE #1 - FORT CALHOUNLOCATION OF NUCLEAR FACILITY: The Fort Calhoun Station is situated on the southwest bank of the Mississippi River in Washington Cosnty, Nebraska.
NAMED INSURED [LISTED ON POLICY]: Omaha Public Power District
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:
N F- 0207 12/15/1972 $375 Millio nNW-0588 12/15/1972 $375 Million**
N-0046 08/01/1977**
THIS CERTIFICATE IS ISSUED AS A MAT-IER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policy(ies) is subject to the exclusions, conditions sod other provisions of the policy(ies). Neither this Certificate nor any contract or other documentwith respect to which it is issued shall amend, extend or alter the coverage afforded by the policy. The Umit of Uability shown above may have been reduced by payment of claims
or claims espenses.
COMMENTS/NOTES:
**Master Worker Certifi cute - This limit is shared by all Certificates to the Master Worker Policy of which each Certiti cats is a part and is subject to all ot the provisions of such Policy
and Certificate having reference thereto. Such limit may have bees redsced by paymant of claims or claims expenses.
**Secondary Financial Protection Certificafe - Financial protection available under an industry retrospective rating plan.
ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
ACO~RD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY)01/08/2016
THIS CERTIFICATE IS ISSUED-AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTMarsh USA Inc. NAME:
PHONE FAX600 Dallas St, Suite 1500 AIC.No.Ext): AIC, No):Houston, TX 77002 E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
377089-Wolf-Nucle-16-17 INSURER A : American Nuclear Insurers
INSUREDINUEB:Wolf Creek Nuclear Operating Corporation ISRRBAttn: Angela Cool INSURER C :[email protected] INSURER D :818 Kansas AvenueP.O. Box 889 INSURER BTopeka, KS 66601 INSURER F: ______
COVERAGES CERTIFICATE NUMBER: HOU-002496763-02 REVISION NUMBER:4
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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.
LTR - ~TYPE OF INSURANCE NSD WVD POLICY NUMBER MMDYYY(MDDYY)LIMITS
COMMERCIAL GENERAL LIABlUTY EAC-H OCCURRENCE $
F1 DAMAGE TO RENTEDCLAIMS-MADE [] OCCUR PREMISES tEa occurrence) $
___________________________MED EXP (Any one person) $
______________________PERSONAL & ADV INJURY $GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY Li PROCT [ LOC PRODUCTS -COMP/OP AGO $
__OTHER: $AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I
(_ ea accident)ANY AUTO BODILY INJURY (Per person) $ALL OWVNED SCHEDULED BODILY INJURY (Per accident) $AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE__HIRED AUTOS __AUTOS (Per accident)
$
__UMBRELLA LIAB •JOCCUR EACH OCCURRENCE $
EXCESS LIABR ICLAIMS-MADE AGGREGATE $
__DEDI RETENTIONS $WORKERS COMPENSATION PER 0H
STATUTE ERITHAND EMPLOYERS' LIABILITY Y I N E
ANY PROPRIETORJPARTN ER/EXECUTIVE u- E.L. EACH ACCIDENT $OFFICERIMEMBER EXCLUDED? 1 _ N I A(Mandatory In NH) E.L DISEASE - BA EMPLOYEE $If yes, describe underDESCRIPTION OF OPERATIONS below ______E.L DISEASE - POLICY LIMIT $
A Nuclear Energy Liability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101
Insurance
DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mome apace Is required)
CERTIFICATE HOLDER CANCELLATION
Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOREU.S. Nuclear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWashington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh USA Inc.
Manashi Mukherjee -.. ,SY 4., •,-,•o5-~ A-eua~-
0 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORDA CORD 25 (2014101)
AGENCY CUSTOMER ID: 377089LOC #: Houston
ACOIRD ADDITIONAL REMARKS SCHEDULE Page 2 of2
AGENCY NAMED INSUREDMarsh USA Inc. Wolf Creek Nuclear Operating Corporation
______________________________________________________________Attn: Angela CoolPOLICY NUMBER Angela.Cool~westarenergy.comn
818 Kansas AvenueP.O. Box 889
CARRIER NAIC CODE Topeka, KS 66601
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 is force as of the effective date of this Certificate a Nuclear Energy Liability Insurance Policy issued by members of American Nuclear Insurers asindicated (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 in cancelled or otherwise terminated prior to the end of December 31sf of the calendar year in which the Effective Date ot this Certificate occurn, notice will be deliveredin accordance with the policy provisions. Otherwise this Certificete shall terminate as of the end of each December 31sf. A Certificate will NOT be issued for any subsequentcalendar year unless requested in writing.
Types of Insurance: NE - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's & Transporters], FS - [Foreign Suppliers & Transporters], N - [SecondaryFinancial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
1. SITE #1 - WOLF CREEKLOCATION OF NUCLEAR FACILITY: Wolf Creek Generating Station in Burlington, Kansas
NAMED INSURED [LISTED ON POLICY]: Wolf Creek Nuclear Operating Corporation; Kansas Gas and Electric Company (formerly KCA Corporation); Kansas City Power & Light
Company; Kansas Electric Power Cooperative, Inc.; Westemn Resources, Inc.
POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:NF-0283 02/17/198i4 $375 Million
NW-0639 02/17/198i4 $375 Million•
N-0099 03/11/1985**
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS ND RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policylies) is subject to the esclusionu, conditions and other provisions of the policylies). Neither this Certificate nor any contract or other documentwith respect to which it is issued shall amend, extend or alter the coverage afforded by the policy. The Limit ot Uability 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 Policyand 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
AGENCY CUSTOMER ID: J361 05LOG #: Salt Lake City
A•RDADDITIONAL REMARKS SCHEDULE Page 2 of2
SAGENCY NAMED INSURED
Marsh USA Risk & Insurance Services ZionSolutions, LLCand Exelon Generation Company, LLC
POLICY NUMBER Attn: Layne Ashton423 West 300 South, Suite 200Salt Lake City, UT 84101
CARRIER NAIC CODE
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 01 American Nuclear Insurers asindicated (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 of1December 31sat 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 subsequentcalendar 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 STATIONLOCATION 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./'611971 $375 Miiiion*
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(Jes). 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 Umit of Liability shown above may have been reduced by payment of claims
or claims expenses.
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 costsbecause 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, accept 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 ofi such Policy
and Certificate having reference thereto. Such limit may have been reduced by payment of claims or claims expenses.
ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD
ACORDCERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)01107/2016
THIS CERTIFICATE IS ISSUED AS A MA'ITER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTNAME:Marsh USA Risk & Insurance Services PHONE FAX
15 West South Temple, Suite 700 fA/C. No, Ext): A/C, No):Salt Lake City, UT 84101 E-MAILAttn: [email protected];Fax212.948.4373 ADES
INSURER(S) AFFORDING COVERAGE NAIC #J36105-NRC-NEL-16-17 INSURER A : American Nuclear Insurers
INSURED INSURER B :ZionSolutions, LLCand Exelon Generation Company, LLC INSURER C :Attn: Layne Ashton INSURERD :423 West 300 South, Suite 200Salt Lake City, UT 84101 INSURER E :
____________________________________________________ INSURER F: ______
COVERAGES CERTIFICATE NUMBER: SEA-002671181-03 REVISION NUMBER:4
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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 EXPLTR TYPE OF INSURANCE INSD WVfl POLICY NUMBER IMM/DD/YYYYI IMMIDDIYYYYI LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
m DAMAGE TO RENTEDCLAIMS-MADE OCCUR PREMISES (Ea occurrence) $
SMED EXP (Any one person) $
_____________________PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $[• PRO- F7
POLICY JECT L2LOC PRODUCTS - COMP/OP AGG $
__OTHER: _________$AUTOMBILELIABLITYCOMBINED SINGLE LIMIT $AUTOMBILELIABLITY(Ea accident)
ANY AUTO BODILY INJURY (Per person) $ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
__AUTOS __AUTOSNON-OWNED PROPERTY DAMAGE $
HIRED AUTOS __AUTOS (Per accident)
$-- UMBRELLA LIAR OCCUR EACH OCCURRENCE $ "
EXCESS LIABR ICLAIMS-MADFE AGGREGATE $
DEDDED RETENTION $ ____ $WORKERS COMPENSATION PER OH
ERTATUTE_____OTH'E__AND EMPLOYERS' LIABILITY Y INANY PROPRI ETORJPARTNERJEXECUTIVE r1 E.L. EACH ACCIDENT $OFFICER/MEMBER EXCLUDED? [• N I A_________(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $If yes, describe underDESCRIPTION OF OPERATIONS below ______E.L DISEASE - POLICY LIMIT $
A Nuclear Energy Liability NJF-0201 01101/2016 01/01/2017 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 BEFOREU.S. NUCLEAR REGULATORY COMMISSION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INWASHINGTON, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh USA Risk & Insurance Services
Monica Poulsen i:'e/,:.Z,7<2=-,-
© 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01)
ACv R CERTIFICATE OF LIABILITY INSURANCEDATE (MM/DD/YYYY)
01/14/2016
THIS CERTIFICATE IS ISSUED AS A MATT-ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE 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 tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
PRODUCER CONTACTMARSHUSAINC.NAME:MRHUAIN.PHONE FAX
99 HIGH STREET IAIC.No.EXt}: AIC, No):BOSTON, MA 02110 E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
024880-AII-NucI-16-17 INSURER A : American Nuclear Insurers
INSURED INSURER B :General Electric CompanyAttn: Scott McCurdy INSURER C :[email protected] ]NSURER D :3135 Easton Turnpike - W3FFairfield, CT 06828 INSURER E :
INSURER F: :_____
COVERAGES CERTIFICATE NUMBER: NYC-007487487-03 REVISION NUMBER: 12
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWAITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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.
LTR TYPE OF INSURANCE gN•p WVjD POLICY NUMBER IMM/DD/YyyyI 'MMIDDIYyyy1 LIMITS
COMMERCIAL GENERAL LIABILITY EAC-H OCCURRENCE $
m DAMAGE TO RENTEDCLAIMS-MADE L.JOCCUR PREMISES (Ea occurrence) $
___________________________MED EXP (Any one person) $
______________________PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $IIPRO- II]
POLICY LJ JECT LJLOC PRODUCTS -COMP/OP AGG $
__OTI-ER: ___________$
AUTOMBILELIABLITYCOMBINED SINGLE LIMIT $AUTOMBILELIABLITY(Ca accident)$
ANY AUTO BODILY INJURY (Per person) $ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
__AUTOS __AUTOSNON-OWNED PROPERTY DAMAGE
__HIRED AUTOS __AUTOS (Per accident) $
$UMBRELLA LIAB I• OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEDDED RETENTIONS _____ $WORKERS COMPENSATIONSTA TPER 0 RTH-AND EMPLOYERS' LIABILITY YIN N~AUJL& _________
ANY PROPRIETORIPARTNERIEXECUTIVE F7F EL. EACH ACCIDENT $OFFICERJMEMBER EXCLUDED? j N I A(Mandatory in NH) E.L. DISEASE - CA EMPLOYEE $If yes, describe underD)ESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Nuclear Energy Uability See Attached Acord 101 01/01/2016 01/01/2017 See Attached Acord 101
Insurance
DESCRIPTION OF OPERATIONS I 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 BEFOREU.S. Nuclear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Washington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVEof Marsh USA Inc.
© 1988-2014 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01)
AGENCY CUSTOMER ID: 024880LOC #: Boston
ACO~RD ADDITIONAL REMARKS SCHEDULE Page 2 of2
AGENCY NAMED INSURED
MARSH USA, INC. General Electric Company___________________________________________________________Attn: Scott McCurdy
POLICY NUMBER [email protected] Easton Turnpike - W3FFairfield, CT 06828
CARRIER , NAIC CODE
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 ot this Certificate a Nuclear Energy Uahility 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 descnibed herein, If
ouch policy is cancelled or otherwise terminated prior to the end of Decemher 3lstoftthe calendar year in which the Eftective Date of this Certificate occurs, notice will he delivered
in accordance with the policy provisions. Otherwise this Certificate shall terminate assof the end of such December 31st. A Certificate will NOT be issued for any subsequent
calendar year unless requested in writing.
Types of Insurance: NE-- [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's & Transporters], ES - [Foreign Suppliers & Transporters]
COVERAGE FOR NUCLEAR FACILITIES:
1. SITE #1 - VALLECITOS, CA MANUEACTURING EACILITYLOCATION OF NUCLEAR FACILITY: The GE-Hitachi Vallecitos Nuclear Center Facility 6705 Vallecitos Road, Sunol, California
NAMED INSURED [LISTED ON POLICY]: GE-Hitachi Nuclear Energy Americas LLC [NOTE 1]
POLICY NUMBER: POLICY EFEECTIVE: LIMIT OF LIABILITY:
NF-0001 03/22/1957 $25 Million
NW-0500 03/22/1957 $375 Million**
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
The insurance afforded by the policylies) in 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 Umit 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.
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)
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORD