Psb 05 Form PDF Details

In the realm of Texas private security operations, having the right documentation in place is not just a best practice but a regulatory requirement. Among these essential documents, the PSB-05 form stands out as a critical piece, designed specifically for the Texas Department of Public Safety’s Regulatory Services Division under its Private Security Program. This Certificate of Liability Insurance serves not only as evidence of insurance coverage but also as a compliance tool for private security companies. It ensures that the insured's information, from the name to the address, matches exactly what is on file with the Private Security Program, reinforcing the importance of accuracy and consistency. The form outlines specific coverage limits, including a minimum of $100,000 per occurrence for bodily injury and property damage, and $50,000 for personal injury, with an aggregate minimum of $200,000. Additionally, it details the policy's effective dates and any exclusions or endorsements, such as armed coverage or guard dog coverage, emphasizing the tailored nature of insurance needs in the security industry. Alarmingly, insurance binders are explicitly rejected, highlighting the demand for a permanent policy to be in effect. Furthermore, the stipulation that certificates of insurance must remain valid until the insurer terminates liability with notice fortifies the ongoing commitment to safeguarding both the security entities and those they serve. Completing the form involves an insurance agent authorized by the insurance company, reflecting the collaborative effort between insurance providers and the regulatory body to maintain high standards of operation and protection within Texas’s private security sector.

QuestionAnswer
Form NamePsb 05 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesRSD, dps, CURREN, COVERAGES

Form Preview Example

Texas Department of Public Safety www.dps.texas.gov

Regulatory Services Division

PRIVATE SECURITY PROGRAM

CERTIFICATE OF LIABILITY INSURANCE

I NSURED’S I NFORMATI ON

This certificate is issued as a matter of information only and confers no rights upon the certificate holder.

• MUST USE MOST CURREN T FORM

Name of I nsured

(MUST EXACTLY MATCH NAME ON PRI VATE SECURI TY FI LE)

I nsured’s Address

(MUST EXACTLY MATCH ADDRESS ON PRI VATE SECURI TY FI LE)

Private Security

Company

License Number

City

State

(2- Digit Code)

ZI P

REMAI NDER OF FORM MUST BE FI LLED OUT BY THE I NSURANCE AGENT

POLI CY I NFORMATI ON (LI MI TS AND COVERAGES)

The insurance policy must contain minimum limits of $100,000 per occurrence for bodily injury and property damage, and $50,000 per occurrence for personal injury with a minimum total aggregate amount of $200,000 for all occurrences. The below does not amend, extend or alter the coverage afforded by the policies issued.

Limits of ( Commercial General) Liability:

Bodily I njury/

$

Personal

$

 

Aggregate

$

Property Damage

I njury

 

 

 

 

 

 

 

 

 

 

Policy

 

Effective

 

 

Expiration

 

Number

 

Date ( MM/ DD/ YYYY)

Date ( MM/ DD/ YYYY)

 

Exclusions & Endorsements:

Armed Coverage

Bond Forfeiture Apprehension

Liquor Exclusion

(CHECK ALL THAT APPLY)

Guard Dog Coverage

Coverage

Government Housing Exclusion

 

 

All coverage excluded by endorsement and related to the provision of security services. (For this purpose, other forms may be attached and incorporated by reference):

I nsurance Binders are NOT acceptable, as they are a temporary insurance arrangement used until a permanent policy can be issued and that for Department purposes of Certificate of Liability I nsurance a permanent policy must be currently in effect.

Chapter 1702 Occupations Code provides that insurance certificates executed and filed with the Department shall remain in force and effect until the insurer has terminated future liability by a 10 day notice to the Private Security Program.

I NSURANCE COMPANY I NFORMATI ON (AUTHORI ZED REPRESENTATI VE)

Insurance Company

I nsurance Agent/

Agency

Address

City

Texas I nsurance License Number

State

 

ZI P

(2- Digit Code)

 

 

 

 

 

 

 

Phone (

)

I nsurance Agent’s Signature ___________________________________________

Date _____________________

This form and any attachments can be:

•Emailed to: RSD_Customer_Relations@dps.texas.gov

•Faxed to: ( 512) 424 - 5774 ( I nsurance Compliance Section)

•Mailed to: Texas Department of Public Safety

Private Security Program MSC 0242

PO Box 4087

Austin, TX 78773 - 0001

PSB-05 (Rev. 02/ 2012)

Approved by Texas Dept. of I nsurance

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Filling out segment 1 of MSC

2. The next part would be to fill out these fields: I NSURANCE COMPANY I NFORMATI ON, I nsurance Company, I nsurance Agent Agency, Address, City, Texas I nsurance License Number, State Digit Code, ZI P, Phone, I nsurance Agents Signature Date, Faxed to, I nsurance Compliance Section, Emailed to, Mailed to Texas Department of, and PSB Rev Approved by Texas Dept.

Texas I nsurance License Number, ZI P, and I nsurance Company inside MSC

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