Sample Certificate of Liability Insurance~39.pdf

812 KB Posted

Attached to
26AL2118 Eldon Hazlet State Park - Farm Lease
Solicitation number
26-422DNR-REALT-B-48916
Issued by
Clinton County, Illinois

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This document is a Sample Certificate of Liability Insurance form for the Illinois Department of Natural Resources (IDNR) located in Springfield, Illinois. The form is an ACORD standard template designed to provide proof of insurance coverage for a tenant farmer, with the certificate serving as informational documentation only and not constituting a binding contract.

The certificate outlines commercial general liability insurance with coverage limits of $1,000,000 per occurrence and $2,000,000 general aggregate. The form indicates that the policy covers various liability aspects including commercial general liability and automobile liability. A key notation at the bottom of the document emphasizes that this certificate does not supersede requirements of any executed farm lease and is intended solely for informational purposes, with the actual terms governed by the contractual agreement between the tenant farmer and the IDNR.

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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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