Ensuring that structural pest control businesses maintain appropriate levels of insurance is critical for safeguarding both the service providers and their clients from potential liabilities. The ALS 1101 form, issued by the Texas Department of Agriculture, plays an essential role in this process. This form serves as a certificate of insurance for structural pest control businesses in Texas, verifying that a specific policy has been put in place to cover damages or injuries that could occur during pest control operations. It outlines the insurer's details, the policy number, effective dates, and the coverage amounts - with a minimum requirement of $200,000 for bodily injury and property damage and a total aggregate of $300,000 for all occurrences. The form requires certification and signature by an authorized insurance agent or insurer's representative, confirming the accuracy of the provided information and the insurer's authorization to conduct business in Texas. This document, therefore requiring careful completion and submission to the Texas Department of Agriculture, is a fundamental step for pest control businesses aiming to operate legally and responsibly within the state.
| Question | Answer |
|---|---|
| Form Name | Form Als 1101 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | texas form 1101, texas form als 1101, texas department of agriculture form als 1101, form als 1101 |
P.O. BOX 12847 AUSTIN, TEXAS 78711 (877)
HEARING IMPAIRED: (800)
TEXAS DEPARTMENT OF AGRICULTURE
|
STRUCTURAL PEST CONTROL SERVICE |
COM M ISSIONER SID M ILLER |
CERTIFICATE OF INSURANCE |
|
The policy identified in Section C has been issued by the insurer identified in Section B and insures the structural pest control business licensee identified in Section A against liability for damage to persons or property occurring as a result of operations performed in the course of the business of structural pest control on premises or any other property under the applicant's care, custody, or control in an amount not less than $200,000 for bodily injury and property damage coverage, with a minimum total aggregate of $300,000 for all occurrences.
SECTION A
SECTION B
SEC. C
D
STRUCTURAL PEST CONTROL BUSINESS LICENSEE
Full Legal Business Name
DBA (if applicable)
TDA License No. |
OR |
TPCL No. |
|
|
|
|
|
|
|
Physical Address |
|
|
|
|
|
|
|
|
|
City |
|
|
State |
Zip |
|
|
|
|
|
INSURER INFORMATION
Name of Insurance Company
Mailing Address
City |
|
|
|
State |
|
|
Zip |
|
|
|
|
|
|
|
|
|
|
|
|
Phone ( |
) |
- |
|
Email Address |
|
|
|
|
|
|
|
|
|
|
|
|
|
||
POLICY INFORMATION |
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|
|
|
|
Policy No. |
|
|
Policy Effective Date |
Policy Expiration Date |
|||||
|
|
|
/ |
/ |
(mm/dd/yyyy) |
/ |
/ |
(mm/dd/yyyy) |
|
CERTIFICATION AND SIGNATURE
I hereby certify that (1) the statements and information on this form are true and accurate to the best of my knowledge, (2) I am a licensed Texas insurance agent or the insurer’s representative authorized to sign on behalf of the insurer identified above, and (3) the insurer identified above is authorized to do business in the State of Texas.
SECTION
Name of Insurer’s Representative or Agent
Texas License Number (if agent signs)
Signature of Insurer’s Representative or Agent and Date
____________________________________ |
/ |
/ |
|
|
(mm/dd/yyyy)
Please email the completed and signed form to
insurance@texasagriculture.gov
This Certificate of Insurance is issued for informational purposes only, does not confer any rights or obligations other than the rights and obligations conveyed by the policy referenced herein, and the terms of said policy shall control over the terms herein.
REVISED 1/1/2015