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Download Texas 1560 Template

The Texas 1560 form, officially known as the Certificate of Insurance Form 1560, is a critical document for contractors and agents conducting business with the Texas Department of Transportation (TxDOT). It certifies that insurance policies are in place and meet the state's requirements, detailing specific coverages such as Workers' Compensation, Commercial General Liability Insurance, Business Automobile Policy, and potentially an Umbrella Policy. Ensure your compliance and smooth operations by accurately completing and submitting this form as required. Click the button below to fill out your Texas 1560 form.

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In the vast and intricate world of insurance and legal compliance, the Texas 1560 form plays a critical role, especially for contractors and businesses engaged in projects with the Texas Department of Transportation (TxDOT). This Certificate of Insurance, last revised in January 2012, goes beyond a mere procedural formality; it is a testament to a business's adherence to the stringent insurance requirements set forth by TxDOT. By providing comprehensive details regarding Workers' Compensation, Commercial General Liability, Business Automobile Policy, and, if applicable, Umbrella Policy, the form ensures that all parties involved are adequately protected. Not only does it specify the minimum required limits of liability but it also mandates the inclusion of a Waiver of Subrogation in favor of TxDOT under the Workers' Compensation Insurance Coverage. The directive that the certificate must be faxed or mailed directly before the expiration of the preceding coverage underscores its importance in maintaining continuous protection. Furthermore, the form uniquely binds the sender to the authenticity of the faxed signature, thereby streamlining the process while upholding its legitimacy. Insights into the form’s stipulations reveal a meticulous approach towards ensuring that the contractual obligations regarding insurance are not only met but clearly documented and accessible to the Texas Department of Transportation, thereby safeguarding all parties involved in state projects.

Document Example

CERTIFICATE OF INSURANCE

Form 1560 (Rev. 01/12)

Previous editions of this form may not be used. Page 1 of 2

Agents should complete the form providing all requested information then either fax or mail this form directly to the address listed on page two of this form. Copies of endorsements listed below are not required as attachments to this certificate.

This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not confer any rights or obligations other than the rights and obligations conveyed by the policies referenced on this certificate. The terms of the policies referenced in this certificate control over the terms of the certificate.

Insured:

Street/Mailing Address:

City/State/Zip:

Phone Number: (

)

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WORKERS' COMPENSATION INSURANCE COVERAGE:

 

 

 

 

Endorsed with a Waiver of Subrogation in favor of TxDOT.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Carrier Name:

 

 

 

 

 

Carrier Phone #: (

)

-

 

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

 

City, State, Zip:

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of Insurance

 

Policy Number

 

Effective Date

Expiration Date

 

Limits of Liability:

 

 

 

 

 

 

 

 

 

Workers' Compensation

 

 

 

 

 

 

Not Less Than: Statutory - Texas

 

 

 

 

 

 

 

 

 

COMMERCIAL GENERAL LIABILITY INSURANCE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Carrier Name:

 

 

 

 

 

Carrier Phone #: (

)

-

 

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

 

City, State, Zip:

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of Insurance:

 

Policy Number:

 

Effective Date:

Expiration Date:

 

Limits of Liability:

 

 

 

 

 

 

 

 

 

Commercial General

 

 

 

 

 

 

Not Less Than:

Liability Insurance

 

 

 

 

 

 

$ 600,000 each occurrence

 

 

 

 

 

 

 

 

 

BUSINESS AUTOMOBILE POLICY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Carrier Name:

 

 

 

 

 

Carrier Phone #: (

)

-

 

Address:

 

 

 

 

 

City, State, Zip:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of Insurance:

 

Policy Number:

 

Effective Date:

Expiration Date:

 

Limits of Liability:

 

Business Automobile Policy

 

 

 

 

 

 

Not Less Than:

 

 

 

 

 

 

 

$ 600,000 combined single limit

 

Bodily Injury

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Property Damage

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UMBRELLA POLICY (if applicable):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Carrier Name:

 

 

 

 

 

Carrier Phone #: (

)

-

 

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

 

City, State, Zip:

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of Insurance:

 

Policy Number:

 

Effective Date:

Expiration Date:

 

Limits of Liability:

 

 

 

 

 

 

 

 

 

 

 

Umbrella Policy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Should any of the above described policies be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions.

THIS IS TO CERTIFY to the Texas Department of Transportation acting on behalf of the State of Texas that the insurance policies named are in full force and effect. If this form is sent by facsimile machine (fax), the sender adopts the document received by TxDOT as a duplicate original and adopts the signature produced by the receiving fax machine as the sender's original signature.

Agency Name

Address

City, State, Zip Code

 

 

 

 

 

 

 

 

(

)

-

 

 

 

 

 

 

 

 

 

Authorized Agent's Phone Number

Authorized Agent Original Signature

 

Date

The Texas Department of Transportation maintains the information collected through this form. With few exceptions, you are entitled on request to be informed about the information that we collect about you. Under §§552.021 and 552.023 of the Texas Government Code, you also are entitled to receive and review the information. Under §559.004 of the Government Code, you are also entitled to have us correct information about you that is incorrect.

Fax completed form to: 512/416-2536

Form 1560 (Rev. 01/12) Page 2 of 2

NOTES TO AGENTS:

Agents must provide all requested information then either fax or mail this form directly to the address listed below.

Pre-printed limits are the minimum required; if higher limits are provided by the policy, enter the higher limit amount and strike-through or cross-out the pre-printed limit.

To avoid work suspension, an updated insurance form must reach the address listed below one business day prior to the expiration date. Insurance must be in force in order to perform any work.

Binder numbers are not acceptable for policy numbers.

The certificate of insurance, once on file with the department, is adequate for subsequent department contracts provided adequate coverage is still in effect. Do not refer to specific projects/contracts on this form.

List the contractor's legal company name, including the DBA (doing business as) name as the insured. If a staff leasing service is providing insurance to the contractor/client company, list the staff leasing service as the insured and show the contractor/client company in parenthesis.

The TxDOT certificate of insurance form is the only acceptable proof of insurance for department contracts.

List the contractor's legal company name, including the DBA (doing business as) name as the insured or list both the contractor and staff leasing service as insured when a staff leasing service is providing insurance.

Over-stamping and/or over-typing entries on the certificate of insurance are not acceptable if such entries change the provisions of the certificate in any manner.

This form may be reproduced.

DO NOT COMPLETE THIS FORM UNLESS THE WORKERS' COMPENSATION POLICY IS ENDORSED WITH A WAIVER OF SUBROGATION IN FAVOR OF TXDOT.

The SIGNATURE of the agent is required.

CERTIFICATE OF INSURANCE REQUIREMENTS:

WORKERS' COMPENSATION INSURANCE:

The contractor is required to have Workers' Compensation Insurance if the contractor has any employees including relatives.

The word STATUTORY, under limits of liability, means that the insurer would pay benefits allowed under the Texas Workers' Compensation Law.

GROUP HEALTH or ACCIDENT INSURANCE is not an acceptable substitute for Workers' Compensation.

COMMERCIAL GENERAL LIABILITY INSURANCE:

MANUFACTURERS' or CONTRACTOR LIABILITY INSURANCE is not an acceptable substitute for Comprehensive General Liability Insurance or Commercial General Liability Insurance.

BUSINESS AUTOMOBILE POLICY:

If coverages are specified separately, they must be at least these amounts:

Bodily Injury

$500,000 each occurrence

 

$100,000 each occurrence

Property Damage

$100,000 for aggregate

PRIVATE AUTOMOBILE LIABILITY INSURANCE is not an acceptable substitute for a Business Automobile Policy.

MAIL ALL CERTIFICATES TO:

Texas Department of Transportation

CST Contract Processing Unit (RA/200 1st Fl.) 125 E. 11th Street

Austin, TX 78701-2483 512/416-2540 (Voice), 512/416-2536 (Fax)

Form Information

Fact Name Fact Detail
Form Revision and Usage The Texas 1560 form was revised in January 2012. Previous editions of this form are not permitted.
Transmission Methods Agents must complete and then either fax or mail this form directly to the specified address listed on the form.
Insurance Policy Requirements The certificate of insurance is valid as long as the referred policies are effective, and its terms are controlled by the policies themselves.
Workers' Compensation Endorsement The Workers' Compensation Insurance must include a Waiver of Subrogation in favor of TxDOT.
Notification of Cancellation If any policy is cancelled before its expiration date, notice will be delivered in accordance with the policy provisions.
Governing Law This form and the insurance requirements are governed by the Texas Workers' Compensation Law and other relevant state laws.

How to Use Texas 1560

Completing the Texas 1560 form is essential for ensuring your compliance with requirements set by the Texas Department of Transportation (TxDOT) regarding insurance policies for contractors. It serves as a verification of the insurance coverage you hold or offer. The filling process is straightforward and requires attention to detail to ensure all the information provided is accurate and matches the insurance policies exactly.

  1. Start by entering the legal company name of the insured, including the DBA (doing business as) name if applicable, in the "Insured" field.
  2. Provide the street or mailing address, city, state, and ZIP code for the insured.
  3. Fill in the phone number of the insured, including the area code.
  4. Under the WORKERS' COMPENSATION INSURANCE COVERAGE section, ensure the policy includes a Waiver of Subrogation in favor of TxDOT. Enter the carrier's name, phone number, address, policy number, effective date, expiration date, and verify that the limits of liability meet the statutory requirement for Texas.
  5. In the COMMERCIAL GENERAL LIABILITY INSURANCE section, input the carrier's name, phone number, address, type of insurance, policy number, effective date, expiration date, and ensure the limits of liability are not less than $600,000 each occurrence.
  6. For the BUSINESS AUTOMOBILE POLICY portion, include the carrier's name, phone number, address, type of insurance, policy number, effective date, expiration date, and confirm the limits of liability are at least $600,000 combined single limit for Bodily Injury and Property Damage.
  7. If you have an UMBRELLA POLICY, fill in the carrier's name, phone number, address, type of insurance, policy number, effective date, expiration date, and limits of liability as applicable.
  8. Signify that you understand cancellation notices will be delivered in accordance with policy provisions by reviewing the appropriate section.
  9. Under the agency information, enter the agency name, address, city, state, and zip code. Provide the authorized agent's phone number.
  10. Ensure the authorized agent signs and dates the form in the designated fields.
  11. Fax the completed form to 512/416-2536 or mail it to the Texas Department of Transportation CST Contract Processing Unit as listed on the form.

After submitting the form, it's crucial to monitor the expiration dates of the policies and update the information with TxDOT accordingly. This proactive approach ensures there's no work suspension due to insurance coverage lapses. Remember, maintaining accurate and current insurance documentation with TxDOT is not just a compliance issue but also a matter of professional integrity and responsibility towards the projects undertaken.

Listed Questions and Answers

What is a Texas 1560 form?

The Texas 1560 form is a Certificate of Insurance required by the Texas Department of Transportation (TxDOT). It serves as proof that an insurance policy is in place and complies with the minimum requirements set by TxDOT for contractors working on state projects. This form outlines the limits of liability and types of coverage, including Workers' Compensation, Commercial General Liability, Business Automobile Policy, and Umbrella Policy (if applicable).

Who needs to complete the Texas 1560 form?

This form must be completed by insurance agents representing contractors who intend to undertake work for the Texas Department of Transportation. It is the agent's responsibility to provide all requested information accurately and to ensure the form is submitted properly, either by fax or mail, directly to TxDOT.

What are the insurance requirements listed on the Texas 1560 form?

The form outlines several insurance requirements, which include:

  1. Workers' Compensation Insurance: Mandatory if the contractor has any employees, including relatives. Coverage must meet Texas statutory requirements.
  2. Commercial General Liability Insurance: Minimum limits of $600,000 per occurrence.
  3. Business Automobile Policy: Minimum combined single limit of $600,000 for bodily injury and property damage.
  4. Umbrella Policy: If applicable, should provide additional coverage beyond the limits of the primary policies.

Can a Group Health or Accident Insurance policy substitute for Workers' Compensation Insurance?

No, Group Health or Accident Insurance policies are not acceptable substitutes for Workers' Compensation Insurance. The Texas 1560 form specifically requires Workers' Compensation Insurance to cover benefits allowed under the Texas Workers' Compensation Law for any employees of the contractor, including relatives.

What happens if an insurance policy is cancelled before its expiration date?

If any of the insurance policies listed on the Texas 1560 form are cancelled before the expiration date noted on the certificate, notice of cancellation will be delivered in accordance with the policy provisions. It is essential for contractors to maintain continuous coverage to avoid work suspension or termination of their contract with TxDOT.

How should the form be submitted and when is it considered adequately filed with TxDOT?

The completed Texas 1560 form must be either faxed or mailed directly to the address provided by TxDOT. To avoid any work suspension, updated insurance information must reach TxDOT one business day before the insurance coverage's expiration date. Once on file, the certificate of insurance is considered adequate for subsequent contracts as long as the coverage remains in effect and meets TxDOT's requirements.

Common mistakes

When filling out the Texas 1560 form, a Certificate of Insurance, individuals often make common errors that can lead to delays or complications. Being aware of these mistakes can help ensure the process is completed smoothly. Here are nine frequent mistakes:

  1. Not providing all requested information. Each section of the form has specific requirements that must be meticulously filled out to avoid processing delays.
  2. Failing to ensure the Workers' Compensation Insurance section is correctly endorsed with a Waiver of Subrogation in favor of TxDOT. This specific endorsement is a requirement and must be clearly indicated on the form.
  3. Using binder numbers instead of policy numbers. The form explicitly requires the policy number, as binders are not considered acceptable for this documentation.
  4. Not updating insurance information before the expiration date. To avoid work suspension, updated insurance forms must be sent and received by TxDOT one business day before the policy expires.
  5. Incorrect identification of the insured. It is crucial to list the contractor’s legal company name and include the DBA (doing business as) name where applicable. This mistake can lead to confusion regarding the coverage parties.
  6. Overlapping staff leasing services incorrectly. If staff leasing services provide insurance, they must be listed as the insured, with the contractor/client company shown in parenthesis.
  7. Altering pre-printed limits without authorization. While it’s permissible to indicate higher limits than those pre-printed, the original figures should be clearly striked through or crossed out, not obscured or overwritten without clarity.
  8. Not adhering to the specific requirements for Commercial General Liability Insurance and Business Automobile Policy. Substitutes like Manufacturers' or Contractor Liability Insurance, or Private Automobile Liability Insurance, are not acceptable.
  9. Failure to mail the completed form to the correct address or use the recommended fax number can result in documents not being processed in time or at all.

Avoiding these common mistakes can streamline the process of submitting the Texas 1560 form, ensuring compliance with TxDOT’s requirements and avoiding unnecessary delays or complications in your contract fulfilment.

Documents used along the form

When working with the Texas 1560 form, which serves as a certificate of insurance, it's essential to ensure that all necessary documentation is in order to maintain compliance and facilitate smooth operations. Alongside the Texas 1560 form, several other forms and documents are often required to provide a comprehensive view of the insured party's coverage and to meet regulatory or contract-specific requirements. Understanding each of these documents can assist individuals and businesses in navigating the complexities of insurance verification and compliance.

  • ACORD 25 Certificate of Liability Insurance: This is a standard certificate of insurance form that provides evidence of general liability coverage. It summarizes the key elements of the policy, including the insured's name, the policy effective date, the type of coverage, and the limits of liability. It is widely used across various industries to confirm insurance coverage.
  • Waiver of Subrogation: This document is an endorsement that can be added to an insurance policy, allowing the insured to waive the insurer's right to seek recovery from a third party that may have caused an insurance loss to the insured. It is crucial in contracts where the parties agree to limit each other's liability for losses covered by insurance.
  • Additional Insured Endorsement: An essential document for many contractual relationships, this endorsement modifies the policy to include an additional party (or parties) as insured under the policy. It provides coverage to other individuals or entities that were not originally named in the policy, typically required in various contracts and agreements.
  • Proof of Workers' Compensation Coverage: This document serves as proof that the employer has workers' compensation insurance, as required by law. It shows the policy number, effective dates, and coverage limits. It is necessary for businesses to prove they have coverage that protects their employees in case of work-related injuries.
  • Business Automobile Liability Insurance Proof: This form verifies that a business has the required automobile liability insurance coverage for its vehicles. It provides details on the policy number, insured vehicles, coverage types, and limits of liability. This document is important for companies that use vehicles for business purposes, ensuring that they meet legal requirements and financial responsibilities in the event of an auto accident.

Collectively, these documents support the Texas 1560 form in painting a complete picture of an entity's insurance landscape. They are instrumental in ensuring that all contractual and legal requirements are met, providing peace of mind and protection to all parties involved in a contractual relationship. By understanding and properly managing these forms, individuals and businesses can better navigate the intricacies of insurance requirements, ensuring compliance and fostering trust among partners.

Similar forms

The ACORD 25 Certificate of Liability Insurance is similar to the Texas 1560 form as both serve as proof of insurance coverage for businesses. Like the 1560 form, the ACORD 25 enables organizations to provide information on various coverages, such as general liability and automobile policies, along with the insured's details, the insurance company's details, coverage limits, and policy effective dates. However, the ACORD 25 is more widely recognized across various states and sectors, providing a standardized format for evidencing insurance information.

The Workers' Compensation Certificate of Insurance closely aligns with the 1560 form's section dedicated to Workers' Compensation Insurance. This document also confirms an employer's compliance with state laws requiring coverage for employee work-related injuries or illnesses. It specifies the policy number, effective dates, and coverage limits, ensuring the policy adheres to statutory requirements. Both documents act to verify that an entity is carrying the necessary workers' compensation insurance, with distinctions primarily in format and specific informational requirements.

The Automobile Insurance Identification Card shares similarities with the Business Automobile Policy section of the Texas 1560 form. Both identify the insured party, the insurance provider, and policy specifics such as policy numbers, effective dates, and types of covered autos. Additionally, they detail coverage amounts, specifically minimum liability limits required by law, ensuring that the entity possesses adequate insurance for its vehicles. The primary purpose of both documents is to provide proof of insurance coverage for vehicles used in business operations.

An Umbrella Policy Certificate of Insurance is analogous to the Umbrella Policy section on the Texas 1560 form, as both document the existence of umbrella liability coverage over and above the limits of the underlying liability policies. They specify the insurer, the policy's effective and expiration dates, and importantly, the coverage limits that serve to protect the insured against significant claims. While detailing comprehensive liability coverage, both seek to confirm that an entity has sufficient insurance protection beyond standard policy limits.

Dos and Don'ts

Completing the Texas 1560 form accurately is crucial for ensuring your insurance documentation meets the Texas Department of Transportation's requirements. Here are nine important dos and don'ts to keep in mind:

  • Do provide all requested information thoroughly to avoid any delays or issues with your submission.
  • Do ensure the Worker's Compensation Policy includes a Waiver of Subrogation in favor of TxDOT, as this is a mandatory requirement.
  • Do fax or mail the completed form directly to the address listed on the form, confirming the delivery method preferred by the department.
  • Do list the contractor's legal company name as the insured, including the DBA name if applicable, for clear identification.
  • Do make sure the insurance is active and will not expire before the work’s completion. Update the certificate at least one business day before expiration to avoid work suspension.
  • Don't use binder numbers as substitutes for policy numbers. Real policy numbers must be provided.
  • Don't refer to specific projects or contracts on this form to ensure the form’s proper processing and adherence to guidelines.
  • Don't over-stamp or over-type entries on the certificate in a manner that changes its provisions. Ensure all entries remain clear and accurate to the original document.
  • Don't complete this form unless you have ensured the Worker's Compensation coverage includes a Waiver of Subrogation in favor of TxDOT, as without it, the form cannot be processed.

Following these guidelines will help ensure that your form 1560 submission is compliant, accurate, and processed efficiently by the Texas Department of Transportation.

Misconceptions

When navigating the requirements and implications of the Texas 1560 form, several misconceptions commonly arise. Understanding these misconceptions is crucial for ensuring compliance and accurately managing expectations regarding insurance coverage and requirements for projects involving the Texas Department of Transportation (TxDOT).

  • Misconception 1: Copies of endorsements are needed when submitting the form.

    The form clearly states that copies of endorsements listed are not required as attachments to this certificate, focusing instead on the accurate completion of information on the form itself.

  • Misconception 2: The certificate grants additional rights to the certificate holder.

    Contrary to what some might assume, the certificate is issued as a matter of information only and does not confer any rights upon the certificate holder beyond the policies referenced.

  • Misconception 3: The terms of the certificate override the policies referenced.

    In fact, the policies referenced in the certificate control over the terms of the certificate itself, ensuring that existing policy terms remain paramount.

  • Misconception 4: Binder numbers can be used for policy numbers.

    The instructions specifically state that binder numbers are not acceptable for policy numbers, emphasizing the need for actual policy details.

  • Misconception 5: Specific projects or contracts should be referred to on the form.

    There is a clear directive not to refer to specific projects/contracts on this form, aligning with the requirement for general applicability.

  • Misconception 6: The certificate alone is sufficient for all TxDOT contracts indefinitely.

    While the certificate, once on file, is adequate for subsequent department contracts, this is predicated on the coverage being in effect and relevant to the specific work being conducted.

  • Misconception 7: Staff leasing services cannot be listed as the insured.

    If a staff leasing service is providing insurance to the contractor/client company, it can be listed as the insured, correctly showing the relationship between parties.

  • Misconception 8: Over-stamping and/or over-typing entries on the certificate is allowed for corrections.

    Such modifications are not acceptable if they change the provisions of the certificate in any manner, ensuring the integrity of the originally provided information.

  • Misconception 9: Group health or accident insurance can substitute for Workers' Compensation Insurance.

    Group health or accident insurance is explicitly not an acceptable substitute for Workers' Compensation Insurance, underscoring the specific insurance requirements for contractors working with TxDOT.

Clearing up these misconceptions helps facilitate smoother interactions with TxDOT, ensuring that contractors are adequately insured and compliant with state requirements. Always refer to the most current guidance from TxDOT and consult with a professional if in doubt about specific insurance requirements or form instructions.

Key takeaways

Filing the Texas 1560 form correctly is crucial for contractors and agents to ensure compliance with insurance requirements for projects involving the Texas Department of Transportation (TxDOT). Here are key takeaways to consider:

  • All requested information must be provided by the agent, confirming that the insurance policies listed are in full force.
  • The certificate of insurance is considered adequate proof of insurance for TxDOT contracts, provided it shows the policies are still active.
  • Workers' Compensation Insurance must include a Waiver of Subrogation in favor of TxDOT, emphasizing the form's importance in contract compliance.
  • Commercial General Liability and Business Automobile Policy limits are set at no less than $600,000 each occurrence and $600,000 combined single limit for Bodily Injury and Property Damage, respectively, indicating minimum coverage amounts.
  • The certificate needs to be faxed or mailed to TxDOT one business day before the existing coverage expiration date to avoid work suspension, which underscores the importance of timely submissions.
  • Specific instructions are given regarding how to list the insured, addressing both contractors and staff leasing services, to ensure clarity and accuracy.

Ensuring all conditions and requirements are met on the Texas 1560 form is vital for contractors to maintain eligibility and compliance with TxDOT's insurance requirements. Accurate and timely submission of this form helps in the seamless continuation of contracted work.

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