Texas Certificate Insurance Form is a form that you can use to provide proof of insurance to someone. The form provides specific information about the policy and the insured. It is important to complete the form correctly so that it accurately reflects the policy information. If you have any questions about how to complete the form, be sure to contact your insurance agent.
If you need to first find out how much time you will need to prepare the texas certificate insurance and the number of pages it's got, here is some basic data that could be helpful.
|Form Name||Texas Certificate Insurance|
|Form Length||1 pages|
|Avg. time to fill out||15 sec|
|Other names||tx coi plumbing examiners, tx coi, texas state board of plumbing examiners coi, texas certificate insurance|
TEXAS STATE BOARD OF PLUMBING EXAMINERS
PO BOX 4200 • AUSTIN, TX
Allow up to 10 days for processing before contacting this office for confirmation of receipt of certificate.
CERTIFICATE OF INSURANCE (COI)
A Master Plumber shall furnish the Texas State Board of Plumbing Examiners (Board) with a current Certificate of Insurance (COI) before acting as a Responsible Master Plumber (RMP). This COI expires on the date that the insurance policy specified herein expires. The RMP shall furnish the Board with a current COI immediately upon or prior to the expiration of this COI. At least the minimum insurance coverage specified in (1) and (2) below shall be maintained at all times during which the Master Plumber acts as a RMP. The insurance coverage must include all types of plumbing that will be performed under the RMP’s license, including if applicable, liquefied petroleum gas plumbing, medical gas plumbing, and multipurpose residential fire protection sprinkler plumbing. The Certificate Holder does not guarantee the accuracy of any information provided in this COI. This COI neither affirmatively or negatively amends, extends, or alters the coverage afforded by the insurance policy specified herein. The terms of the policy control over the terms of this certificate.
Responsible Master Plumber (RMP) Name:License #: M‒____________
Business Name: _______________________________________________ Telephone: (_______)_____________________
RMP Email Address: ___________________________________________________________________________________
RMP Address: _________________________________________________________________________________________
Business Owner Name: _________________________________________________________________________________
Insurance Company: ___________________________________________________________________________________
Policy Number:Effective Date: ______________ Expire Date: ______________
Name of Insurance Agency: ___________________________________________ Agent Phone: (______)_______________
Insurance Agent Email Address:
Insurance Agency Address:
By my signature below, as an agent for an insurer authorized to engage in the business of insurance in this state or an eligible surplus lines insurer, as defined by Section 981.002, Insurance Code, I hereby sign this Certificate of Insurance (COI) stating that the above policy meets at least the following minimum standards:
(1)provides for commercial general liability insurance for the above named Responsible Master Plumber for claims for property damage or bodily injury, regardless of whether the claim arises from a negligence claim or on a contract claim; and
(2)is in a coverage amount of not less than $300,000 for all claims arising in any
Signature of Agent
Printed Name of Agent
CERTIFICATE HOLDER ADDRESS:
TEXAS STATE BOARD OF PLUMBING EXAMINERS PO BOX 4200
Revised August 2017
Should any of the above described policies be cancelled,
Approved by TDI 09/26/2017, Filing Link No. S644091