Sample Certificate of Liability Insurance~31.pdf

PDF 812 KB Posted

Attached to
26AL2518 Kinkaid Lake S. F. W. A. Farm Lease
Solicitation number
26-422DNR-REALT-B-49025
Issued by
Jefferson County, Illinois

About this file

Written by GovTribe AI ·

This document is a Sample Certificate of Liability Insurance issued by an insurance broker for a Tenant Farmer, with the Illinois Department of Natural Resources (IDNR) listed as the certificate holder. The form is an ACORD 25 standard insurance certificate template, demonstrating coverage for commercial general liability and automobile liability insurance. The policy includes a $1,000,000 each occurrence limit and a $2,000,000 general aggregate limit, with specific provisions for property damage and bodily injury coverage.

The certificate serves as an informational document for a farm lease agreement between the tenant farmer and the IDNR, located in Springfield, Illinois. It provides proof of insurance coverage but does not supersede the requirements of the executed farm lease. The document is marked as a sample and includes placeholder fields for policy numbers, effective dates, and specific insurance details. The bottom of the form includes a disclaimer emphasizing that the document is intended for informational purposes only and is meant to be part of the contractual terms between the tenant farmer and the IDNR control.

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SAMPLE CERTIFICATE OF LIABILITY INSURANCE.

POLICY NUMBER START

DATE

END DATE

POLICY NUMBER START

DATE

END DATE

POLICY NUMBER

(IF APPLICABLE)

START

DATE

END DATE

nicole.thomas Line nicole.thomas Text Box This box MUST be completed, even if the response is "N".

nicole.thomas Text Box Minimum amount required by law, if applicable.

nicole.thomas Line nicole.thomas Line nicole.thomas Line nicole.thomas Text Box IDNR should be listed as additional insured.

nicole.thomas Line nicole.thomas Line nicole.thomas Text Box Minimum contract requirement. Additional coverage/info may be included.

nicole.thomas Line nicole.thomas Line nicole.thomas Line nicole.thomas Text Box This document does not supersede the requirements of any executed farm lease. This document is intended for informational purposes only. Contractual terms of an executed farm lease between the tenant farmer and the IDNR control.

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File details come from the government source that posted it. Updated .