Sample Certificate of Liability Insurance~34.pdf
PDF 812 KB Posted
- Attached to
- 26AL2013 Rend Lake S. F. W. A. Farm Lease
- Solicitation number
- 26-422DNR-REALT-B-48985
- Issued by
- Jefferson County, Illinois
About this file
This document is a Sample Certificate of Liability Insurance form issued by ACORD for the Illinois Department of Natural Resources (IDNR) located in Springfield, Illinois. The certificate is a standard insurance document designed to provide proof of insurance coverage for a tenant farmer, with key insurance details outlined across multiple sections including types of coverage, policy numbers, and insurance limits.
The insurance certificate includes Commercial General Liability coverage with a $1,000,000 per occurrence limit and a $2,000,000 general aggregate limit. The document specifically notes that it is intended for informational purposes only and does not supersede the requirements of any executed farm lease between the tenant farmer and the IDNR. The certificate holder is identified as the Illinois Department of Natural Resources, and the form includes spaces for policy numbers, start and end dates, and various insurance coverage details such as automobile liability and workers' compensation information. The document is marked as a sample and uses the standard ACORD 25 (2016/03) form template.
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Text version
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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