PC326 MDR-1: Certificate of Mold Damage Remediation

Under Property owner and location, enter the Property owner's name, Mailing address, Property address, Lot, Block, Addition or tract and County.

Mold damage has been treated (If Box A and B are filled out, Box C does not need to be filled out.)

Box A: To be filled out by the mold remediation contractor.

"I certify that: I treated the damage caused by mold at this property. Treatment can include removing, cleaning, sanitizing, and preventing mold damage."

I gave this certificate to the property owner within 10 days after completing the work.

In Box A, enter the Certificate number and Date issued, sign the Mold remediation contractor's signature line and enter its Date, Contractor's printed name and address, Date treatment completed, Texas Department of Licensing and Regulation license number and License expiration date.

Box B: To be filled out by the mold assessment consultant.

"I certify that: Damage caused by mold at this property has been treated (remediated). With reasonable certainty, the underlying causes of the mold have been treated so mold will not return. I gave a copy of my report to the property owner."

Per Occupations Code Section 1958.154: Based on visual, procedural, and analytical evaluation, the mold contamination identified for the project has been remediated as outlined in the mold management plan or remediation protocol.

In Box B, sign the Mold assessment consultant's signature line and enter its Date, Consultant's printed name and address, Texas Department of Licensing and Regulation license number and License expiration date.

No mold damage was found (If Box C is filled out, Box A and B do not need to be filled out.)

Box C: To be filled out by the mold assessment consultant or insurance adjuster.

By signing you certify that you inspected this property, that you did not find signs (evidence) of any mold damage, and that you gave a copy of your report to the property owner.

In Box C, enter the Certificate number and Date issued, sign the Mold assessment consultant or insurance adjuster's signature line and enter its Date, Consultant or adjuster's printed name and address, Texas Department of Licensing and Regulation license number, or Texas Department of Insurance license number, and License expiration date.