Texas Certificate Insurance PDF Details

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.

QuestionAnswer
Form NameTexas Certificate Insurance
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namestx coi plumbing examiners, tx coi, texas state board of plumbing examiners coi, texas certificate insurance

Form Preview Example

TEXAS STATE BOARD OF PLUMBING EXAMINERS

PO BOX 4200 • AUSTIN, TX 78765-4200 • (512) 936-5200 Scan and Email to: insurance@tsbpe.texas.gov

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: _________________________________________________________________________________________

StreetCityState Zip

Business Owner Name: _________________________________________________________________________________

Insurance Company: ___________________________________________________________________________________

Policy Number:Effective Date: ______________ Expire Date: ______________

Name of Insurance Agency: ___________________________________________ Agent Phone: (______)_______________

Insurance Agent Email Address:

Insurance Agency Address:

Street

City

State

Zip

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 one-year period.

__________________________________

____________________________________

___________________________

Signature of Agent

Printed Name of Agent

Date

CERTIFICATE HOLDER ADDRESS:

TEXAS STATE BOARD OF PLUMBING EXAMINERS PO BOX 4200

AUSTIN, TX 78765-4200

PHONE: (512) 936-5200 EXT. 65203 www.tsbpe.texas.gov

Revised August 2017

CANCELLATION:

Should any of the above described policies be cancelled, non-renewed, or otherwise modified, the Texas State Board of Plumbing Examiners (Certificate Holder) will be notified in accordance with the terms of the underlying policy.

Approved by TDI 09/26/2017, Filing Link No. S644091

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