Psb 05 Form PDF Details

Are you looking to fill out a PSB 05 form? If so, then this blog post is for you. Here we'll explain exactly what a PSB 05 form is and why it's important. We'll take a deep dive into what information needs to be included on the form, where to find it, how to submit it correctly, and any other relevant details that may come up during your process of filling out the form. You can trust us here - with our years of expertise in the field, we're sure that by following along with this guide step-by-step will make the entire process easier than ever before!

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

How to Edit Psb 05 Form Online for Free

Texas can be filled in in no time. Simply open FormsPal PDF editor to complete the task promptly. Our tool is consistently evolving to deliver the very best user experience achievable, and that's thanks to our dedication to constant enhancement and listening closely to customer feedback. To get started on your journey, consider these simple steps:

Step 1: Access the PDF doc inside our editor by hitting the "Get Form Button" above on this page.

Step 2: Once you open the online editor, you will see the form prepared to be filled in. Besides filling in different blanks, you can also do some other things with the Document, that is putting on any textual content, editing the initial textual content, adding illustrations or photos, placing your signature to the document, and a lot more.

Completing this PDF usually requires thoroughness. Make sure all mandatory fields are filled in accurately.

1. Start filling out your Texas with a group of essential blanks. Note all of the required information and ensure there is nothing omitted!

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

It is easy to make an error when completing your Texas I nsurance License Number, therefore you'll want to reread it before you'll finalize the form.

Step 3: Glance through the details you've inserted in the form fields and hit the "Done" button. Right after getting afree trial account here, you'll be able to download Texas or email it immediately. The PDF file will also be easily accessible via your personal account page with all your edits. FormsPal is dedicated to the confidentiality of our users; we always make sure that all information put into our system stays protected.

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