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{{#Wiki_filter:0005230 SP 0043-C01-P05232-1 Document.Control Desk U.S. Nuclear Regulatory Comriission Washington, DC 20555-0001 M 6 61 ACCR" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 02/06/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.IMPORTANT:
{{#Wiki_filter:0005230       SP         0043       -C01-P05232-1 Document.Control Desk U.S. Nuclear Regulatory Comriission Washington, DC 20555-0001 M 661
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed.
 
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement.
DATE (MMIDDIYYYY)
A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
ACCR"                                   CERTIFICATE OF LIABILITY INSURANCE                                                                                     02/06/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
PRODUCER Marsh Risk & Insurance Services CA License #0437153 777 South Figueroa Street Los Angeles, CA 90017 Attn: LosAngeles.CertRequest@marshcom  
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
/F: 212-948-0535 08819 -DRI-AII-15-16 CONTACT NAME: PHONE FAX IA/C. No. Ext):A/ No): E-MAIL Annppqq.INSURER(S)
PRODUCER                                                                                 CONTACT NAME:
AFFORDING COVERAGE INSURER A: American Nuclear Insurers INSURED Dominion Resources, Inc.ATTN: Leslie D. Garber Leslie.Garber@dom.com 701 East Cary Street, 20th Floor Richmond, VA 23219 INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
Marsh Risk & Insurance Services                                                       PHONE                                                    FAX CA License #0437153                                                                   IA/C. No. Ext):A/                                              No):
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.INSR IADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE N POLICY NUMBER (MMIDD/YyyyJ IMMiDD/Yyyy)
777 South Figueroa Street                                                             E-MAIL Annppqq.
LIMITS GENERAL UABIUTY EACH OCCURRENCE  
Los Angeles, CA 90017 Attn: LosAngeles.CertRequest@marshcom /F: 212-948-0535                                                   INSURER(S) AFFORDING COVERAGE 08819 -DRI-AII-15-16                                                                     INSURER A: American Nuclear Insurers INSURED INSURER B:
$DAMAGE TO RENTED MMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)  
Dominion Resources, Inc.
$CLAIMS-MADE D OCCUR MED EXP (Any one person) $0 _ _ PERSONAL & ADV INJURY $GENERAL AGGREGATE  
ATTN: Leslie D.Garber                                                               INSURER C:
$GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOP AGG $"- POLICY --ROJECT '-]LOC $COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accidentO  
Leslie.Garber@dom.com                                                               INSURER D:
$ANY AUTO _BODILY INJURY (Per person) $ALL OWVNED SCHEDULED BODILY INJURY (Per accident)  
701 East Cary Street, 20th Floor Richmond, VA 23219                                                                   INSURER E:
$AUTOS __AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident)_$
COVERAGES                                       CERTIFICATE NUMBER:
$UMBRELLA LIAB OCCUR EACH OCCURRENCE  
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
$EXCESS LIAB CLAIMS-MADE AGGREGATE  
INSR IADDL                                                 SUBR                                     POLICY EFF     POLICY EXP LTR                   TYPE OF INSURANCE             N                   POLICY NUMBER           (MMIDD/YyyyJ   IMMiDD/Yyyy)                         LIMITS GENERAL UABIUTY                                                                                                       EACH OCCURRENCE                 $
$SDED I RETENTION$  
DAMAGE TO RENTED MMERCIAL GENERAL LIABILITY                                                                               PREMISES (Ea occurrence)       $
$WORKERS COMPENSATION WC STATU- OTH-AND EMPLOYERS' LIABIUTY YIN TORY LIMITS NR ANY PROPRIETORIPARTNER/EXECUTIVE r E.L EACH ACCIDENT $OFFICER/MEMBER EXCLUDED?
CLAIMS-MADE   D   OCCUR                                                                                 MED EXP (Any one person)       $
L.j N INA (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $A Nuclear Energy Liability See Attached 01/01/2015 01/01/2016 See Attached Acord Insurance "Acord 101" 101 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)CERTIFICATE HOLDER CANCELLATION Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE U.S. Nudear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Washington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.
0         _           _                                                                                     PERSONAL & ADV INJURY           $
AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services Shannon Moyer© 1988-2010 ACORD CORPORATION.
GENERAL AGGREGATE               $
All rights reserved.The ACORD name and logo are registered marks of ACORD ACORD 25 (2010105)
GEN'L AGGREGATE LIMIT APPLIES PER:                                                                                     PRODUCTS - COMPIOP AGG         $
AGENCY CUSTOMER ID: 08819 LOC #: Los Angeles ACC>R0 ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED Marsh Risk & Insurance Services Dominion Resources, Inc.ATTN: Leslie D. Garber POUCY NUMBER Leslie.Garber@dom.com 701 East Cary Street, 20th Floor Richmond, 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 I CERTIFICATE OF NUCLEAR ENERGY LIABILITY INSURANCE EFFECTIVE DATE OF THIS CERTIFICATE:
POLICY -
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 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.
                "-         -   ROJECT '-]LOC                                                                                                                   $
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:
COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY                                                                                                   (Ea accidentO                   $
NF -[Facility Form], NW- [Master Worker Certificate], NS -[US Domestic Supplier's  
ANY AUTO           _BODILY                                                                                               INJURY (Per person)   $
& Transporters], FS -[Foreign Suppliers  
ALL OWVNED             SCHEDULED                                                                                 BODILY INJURY (Per accident)   $
& Transporters], N -[Secondary Financial Protection Certificate]
AUTOS               __AUTOS NON-OWNED                                                                                 PROPERTY DAMAGE HIRED AUTOS           AUTOS                                                                                     (Per accident)_$
                                                                                                                                                                $
UMBRELLA LIAB             OCCUR                                                                                 EACH OCCURRENCE                 $
EXCESS LIAB               CLAIMS-MADE                                                                           AGGREGATE                       $
SDED     I RETENTION$                                                                                                                          $
WORKERS COMPENSATION                                                                                                         WC STATU-         OTH-AND EMPLOYERS' LIABIUTY                   NR YIN                                                                               TORY LIMITS ANY PROPRIETORIPARTNER/EXECUTIVE r                                                                                     E.L EACH ACCIDENT             $
OFFICER/MEMBER EXCLUDED?               L.j N INA (Mandatory in NH)                                                                                                     E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below                                                                                       E.L. DISEASE - POLICY LIMIT     $
A Nuclear Energy Liability                                   See Attached                       01/01/2015     01/01/2016   See Attached Acord Insurance                                               "Acord 101"                                                     101 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
CERTIFICATE HOLDER                                                                       CANCELLATION Document Control Desk                                                                     SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE U.S. Nudear Regulatory Commission                                                         THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Washington, DC 20555-0001                                                                 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE of Marsh Risk & InsuranceServices Shannon Moyer
                                                                                                            © 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105)                                      The ACORD name and logo are registered marks of ACORD
 
AGENCY CUSTOMER ID: 08819 LOC #: Los Angeles ACC>R0 ADDITIONAL REMARKS SCHEDULE                                                                                                         Page         2     of     3 AGENCY                                                                                                                   NAMED INSURED Marsh Risk &Insurance Services                                                                                       Dominion Resources, Inc.
ATTN: Leslie D. Garber POUCY NUMBER                                                                                                                   Leslie.Garber@dom.com 701 East Cary Street, 20th Floor Richmond, 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                                                                                                               I 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. Ifsuch 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 willbe delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate as of the end of such December 31st. A Certificate willNOT be issued for any subsequent calendar year unless requested in writing.
Types of Insurance: NF - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's &Transporters], FS - [Foreign Suppliers & Transporters], N - [Secondary Financial Protection Certificate]
COVERAGE FOR NUCLEAR FACILITIES:
COVERAGE FOR NUCLEAR FACILITIES:
: 1. SITE #1 -NORTH ANNA LOCATION OF NUCLEAR FACILITY:
: 1. SITE #1 - NORTH ANNA LOCATION OF NUCLEAR FACILITY: North Anna Nuclear Power Plant 40 MINW of Richmond, VA NAMED INSURED [LISTED ON POLICY]: Virginia Electric &Power Company POLICY NUMBER:                                   POLICY EFFECTIVE:                               LIMIT OF LIABILITY:
North Anna Nuclear Power Plant 40 MI NW of Richmond, VA NAMED INSURED [LISTED ON POLICY]: Virginia Electric & Power Company POLICY NUMBER: POLICY EFFECTIVE:
NF-0240                                             03/26/1976                                         $375 Million NW-0610                                             03/26/1976                                         $375 Million-N-0063                                             11/26/1977                                           -
LIMIT OF LIABILITY:
N-0070                                             04/11/1980
NF-0240 03/26/1976  
: 2. SITE #2 - SURRY LOCATION OF NUCLEAR FACILITY: Surry Nuclear Power Plant 17 MINW of Newport News, VA NAMED INSURED [LISTED ON POLICY]: Virginia Electric & Power Company POLICY NUMBER:                                   POLICY EFFECTIVE:                               LIMITOF LIABILITY:
$375 Million NW-0610 03/26/1976  
NF-0186                                             06/15/1970                                         $375 Million NW-0571                                             06/1511970                                         $375 Million-N-0027                                             08/01/1977                                         ...
$375 Million-N-0063 11/26/1977  
N-0028                                             08/01/1977                                           ...
-N-0070 04/11/1980
: 3. SITE #3 - MILLSTONE LOCATION OF NUCLEAR FACILITY: Millstone Nuclear Power Plant 3.2 MIWSW of New London, CT NAMED INSURED [LISTED ON POLICY]: Dominion Nuclear Connecticut, Inc.
: 2. SITE #2 -SURRY LOCATION OF NUCLEAR FACILITY:
POLICY NUMBER:                                   POLICY EFFECTIVE:                               LIMITOF LIABILITY:
Surry Nuclear Power Plant 17 MI NW of Newport News, VA NAMED INSURED [LISTED ON POLICY]: Virginia Electric & Power Company POLICY NUMBER: POLICY EFFECTIVE:
NF-0173                                             05/01/1969                                         $375 Million NW-0563                                             05/0111969                                         $375 Million-N-0016                                             08/0111977
LIMIT OF LIABILITY:
* N-0103                                             11/25/1985
NF-0186 06/15/1970  
: 4. SITE #4 - KEWAUNEE LOCATION OF NUCLEAR FACILITY: Kewaunee Nuclear Power Plant in the Town of Carlton, Kewaunee County, Wisconsin NAMED INSURED [LISTED ON POLICY]: Dominion Energy Kewaunee, Inc.
$375 Million NW-0571 06/1511970  
POLICY NUMBER:                                   POLICY EFFECTIVE:                               LIMITOF LIABILITY:
$375 Million-N-0027 08/01/1977  
NF-0204                                             01/01/1972                                         $375 Million NW-0586                                             01/01/1972                                         $375 Million-N-0044                                             08/01/1977
...N-0028 08/01/1977  
* ACORD 101 (2008/01)                                                                                                                                 © 2008 ACORD CORPORATION. All rights reserved.
...3. SITE #3 -MILLSTONE LOCATION OF NUCLEAR FACILITY:
The ACORD name and logo are registered marks of ACORD
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:
AGENCY CUSTOMER ID: 08819 LOC #: Los Angeles AC40RD                                                       ADDITIONAL REMARKS SCHEDULE                                                                                                               Page         3     of   3 AGENCY                                                                                                             NAMED INSURED Marsh Risk & Insurance Services                                                                                 Dominion Resources, Inc.
NF-0173 05/01/1969  
ATTN: Leslie D. Garber POLICY NUMBER                                                                                                           Leslie.Garber@dom.com 701 East Cary Street, 20th Floor Richmond, VA 23219 CARRIER                                                                                       NAIC CODE EFFECTIVE DATE:
$375 Million NW-0563 05/0111969  
ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:                 25             FORM TITLE: Certificate of Liability Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
$375 Million-N-0016 08/0111977  
The insurance afforded by the policy(ies) is subject to the exclusions, conditions and other provisions of the policy(ies). Neither this Certificate nor any contract or other document with respect to which it is issued shall amend, extend or alter the coverage afforded by the policy. The Limit of Liability shown above may have been reduced by payment of claims or claims expenses.
*N-0103 11/25/1985
COMMENTS/NOTES:
: 4. SITE #4 -KEWAUNEE LOCATION OF NUCLEAR FACILITY:
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.
Kewaunee Nuclear Power Plant in the Town of Carlton, Kewaunee County, Wisconsin NAMED INSURED [LISTED ON POLICY]: Dominion Energy Kewaunee, Inc.POLICY NUMBER: POLICY EFFECTIVE:
    - Secondary Financial Protection Certificate -Financial protection available under an industry retrospective rating plan.
LIMIT OF LIABILITY:
ACORD 101 (2008101)                                                                                                                               © 2008 ACORD CORPORATION. All rights reserved.
NF-0204 01/01/1972  
The ACORD name and logo are registered marks of ACORD}}
$375 Million NW-0586 01/01/1972  
$375 Million-N-0044 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: 08819 LOC #: Los Angeles AC40RD ADDITIONAL REMARKS SCHEDULE Page 3 of 3 AGENCY NAMED INSURED Marsh Risk & Insurance Services Dominion Resources, Inc.ATTN: Leslie D. Garber POLICY NUMBER Leslie.Garber@dom.com 701 East Cary Street, 20th Floor Richmond, 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 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.The insurance afforded by the policy(ies) is subject to the exclusions, conditions and other provisions of the policy(ies).
Neither this Certificate nor any contract or other document with respect to which it is issued shall amend, extend or alter the coverage afforded by the policy. The Limit of Liability shown above may have been reduced by payment of claims or claims expenses.COMMENTS/NOTES:
Master Worker Certificate  
-This limit is shared by all Certificates to 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}}

Revision as of 14:31, 31 October 2019

Acord Certificate of Liability Insurance
ML15065A238
Person / Time
Site: Millstone, Kewaunee, Surry, North Anna  Dominion icon.png
Issue date: 02/06/2015
From:
Acord Corporation
To:
Document Control Desk, Office of Nuclear Reactor Regulation
References
Download: ML15065A238 (4)
v • d • e


Text

0005230 SP 0043 -C01-P05232-1 Document.Control Desk U.S. Nuclear Regulatory Comriission Washington, DC 20555-0001 M 661

DATE (MMIDDIYYYY)

ACCR" CERTIFICATE OF LIABILITY INSURANCE 02/06/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

PRODUCER CONTACT NAME:

Marsh Risk & Insurance Services PHONE FAX CA License #0437153 IA/C. No. Ext):A/ No):

777 South Figueroa Street E-MAIL Annppqq.

Los Angeles, CA 90017 Attn: LosAngeles.CertRequest@marshcom /F: 212-948-0535 INSURER(S) AFFORDING COVERAGE 08819 -DRI-AII-15-16 INSURER A: American Nuclear Insurers INSURED INSURER B:

Dominion Resources, Inc.

ATTN: Leslie D.Garber INSURER C:

Leslie.Garber@dom.com INSURER D:

701 East Cary Street, 20th Floor Richmond, VA 23219 INSURER E:

COVERAGES CERTIFICATE NUMBER:

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

INSR IADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE N POLICY NUMBER (MMIDD/YyyyJ IMMiDD/Yyyy) LIMITS GENERAL UABIUTY EACH OCCURRENCE $

DAMAGE TO RENTED MMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $

CLAIMS-MADE D OCCUR MED EXP (Any one person) $

0 _ _ PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $

POLICY -

"- - ROJECT '-]LOC $

COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accidentO $

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 OCCUR EACH OCCURRENCE $

EXCESS LIAB CLAIMS-MADE AGGREGATE $

SDED I RETENTION$ $

WORKERS COMPENSATION WC STATU- OTH-AND EMPLOYERS' LIABIUTY NR YIN TORY LIMITS ANY PROPRIETORIPARTNER/EXECUTIVE r E.L EACH ACCIDENT $

OFFICER/MEMBER EXCLUDED? L.j N INA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $

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

A Nuclear Energy Liability See Attached 01/01/2015 01/01/2016 See Attached Acord Insurance "Acord 101" 101 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)

CERTIFICATE HOLDER CANCELLATION Document Control Desk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE U.S. Nudear Regulatory Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Washington, DC 20555-0001 ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE of Marsh Risk & InsuranceServices Shannon Moyer

© 1988-2010 ACORD CORPORATION. All rights reserved.

ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD

AGENCY CUSTOMER ID: 08819 LOC #: Los Angeles ACC>R0 ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED Marsh Risk &Insurance Services Dominion Resources, Inc.

ATTN: Leslie D. Garber POUCY NUMBER Leslie.Garber@dom.com 701 East Cary Street, 20th Floor Richmond, 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 I 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. Ifsuch 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 willbe delivered in accordance with the policy provisions. Otherwise this Certificate shall terminate as of the end of such December 31st. A Certificate willNOT be issued for any subsequent calendar year unless requested in writing.

Types of Insurance: NF - [Facility Form], NW- [Master Worker Certificate], NS - [US Domestic Supplier's &Transporters], FS - [Foreign Suppliers & Transporters], N - [Secondary Financial Protection Certificate]

COVERAGE FOR NUCLEAR FACILITIES:

1. SITE #1 - NORTH ANNA LOCATION OF NUCLEAR FACILITY: North Anna Nuclear Power Plant 40 MINW of Richmond, VA NAMED INSURED [LISTED ON POLICY]: Virginia Electric &Power Company POLICY NUMBER: POLICY EFFECTIVE: LIMIT OF LIABILITY:

NF-0240 03/26/1976 $375 Million NW-0610 03/26/1976 $375 Million-N-0063 11/26/1977 -

N-0070 04/11/1980

2. SITE #2 - SURRY LOCATION OF NUCLEAR FACILITY: Surry Nuclear Power Plant 17 MINW of Newport News, VA NAMED INSURED [LISTED ON POLICY]: Virginia Electric & Power Company POLICY NUMBER: POLICY EFFECTIVE: LIMITOF LIABILITY:

NF-0186 06/15/1970 $375 Million NW-0571 06/1511970 $375 Million-N-0027 08/01/1977 ...

N-0028 08/01/1977 ...

3. SITE #3 - MILLSTONE LOCATION OF NUCLEAR FACILITY: Millstone Nuclear Power Plant 3.2 MIWSW of New London, CT NAMED INSURED [LISTED ON POLICY]: Dominion Nuclear Connecticut, Inc.

POLICY NUMBER: POLICY EFFECTIVE: LIMITOF LIABILITY:

NF-0173 05/01/1969 $375 Million NW-0563 05/0111969 $375 Million-N-0016 08/0111977

  • N-0103 11/25/1985
4. SITE #4 - KEWAUNEE LOCATION OF NUCLEAR FACILITY: Kewaunee Nuclear Power Plant in the Town of Carlton, Kewaunee County, Wisconsin NAMED INSURED [LISTED ON POLICY]: Dominion Energy Kewaunee, Inc.

POLICY NUMBER: POLICY EFFECTIVE: LIMITOF LIABILITY:

NF-0204 01/01/1972 $375 Million NW-0586 01/01/1972 $375 Million-N-0044 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: 08819 LOC #: Los Angeles AC40RD ADDITIONAL REMARKS SCHEDULE Page 3 of 3 AGENCY NAMED INSURED Marsh Risk & Insurance Services Dominion Resources, Inc.

ATTN: Leslie D. Garber POLICY NUMBER Leslie.Garber@dom.com 701 East Cary Street, 20th Floor Richmond, 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 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.

The insurance afforded by the policy(ies) is subject to the exclusions, conditions and other provisions of the policy(ies). Neither this Certificate nor any contract or other document with respect to which it is issued shall amend, extend or alter the coverage afforded by the policy. The Limit of Liability shown above may have been reduced by payment of claims or claims expenses.

COMMENTS/NOTES:

Master Worker Certificate - This limit is shared by all Certificates to 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

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