Sample Certificate of Liability Insurance~45.pdf

PDF 812 KB Posted

Attached to
26AL2198 Washington County S. R. A. Farm Lease
Solicitation number
26-422DNR-REALT-B-49460
Issued by
Washington County, Illinois

About this file

This document is a Sample Certificate of Liability Insurance for the Illinois Department of Natural Resources (IDNR), located in Springfield, Illinois. The certificate is an ACORD standard form designed to provide proof of insurance coverage for a tenant farmer, with the IDNR listed as the certificate holder. The form outlines various insurance policy details, including commercial general liability coverage with a $1,000,000 per occurrence limit and a $2,000,000 general aggregate limit.

The insurance certificate covers key liability protections, specifically commercial general liability and automobile liability. The policy appears to be a standard risk management document for agricultural land use, with explicit notation that the document does not supersede executed farm lease requirements and is intended for informational purposes only. The certificate is structured to provide transparency about insurance coverage, listing potential insurers, policy periods, and specific coverage limits, which are critical for maintaining appropriate risk protection for both the tenant farmer and the state department overseeing the land use.

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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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