The Texas 1560 form, also known as the Certificate of Insurance, is a document that certifies the existence of specific insurance policies required by the Texas Department of Transportation (TxDOT). This form serves to inform TxDOT that the insurance policies are in full force and effect, ensuring compliance with state regulations. It is essential for contractors to complete and submit this form to maintain eligibility for state contracts and projects.
The Texas 1560 form, also known as the Certificate of Insurance, plays a crucial role in the relationship between contractors and the Texas Department of Transportation (TxDOT). This form serves as proof that certain insurance policies are in place, which is essential for contractors who wish to perform work for the state. It requires detailed information about the contractor's insurance coverage, including Workers' Compensation, Commercial General Liability, and Business Automobile policies. Each section of the form demands specific data such as policy numbers, effective dates, and limits of liability, ensuring that the contractor meets the minimum insurance requirements set by TxDOT. Notably, the form must be completed accurately and submitted directly to the TxDOT Contract Processing Unit, either by fax or mail, to avoid any interruptions in work. Additionally, the form emphasizes the importance of maintaining active coverage, as insurance must be in force for any work to commence. Agents must be diligent in providing all requested information and adhering to the guidelines outlined in the form, as any inaccuracies or incomplete submissions could lead to delays or complications in the contractor's ability to operate. Ultimately, the Texas 1560 form is not just a bureaucratic requirement; it is a vital document that helps protect both the contractor and the state by ensuring that adequate insurance coverage is in place.
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:
Type of Insurance:
Policy Number:
Effective Date:
Expiration Date:
Commercial General
Not Less Than:
Liability Insurance
$ 600,000 each occurrence
BUSINESS AUTOMOBILE POLICY:
Business Automobile Policy
$ 600,000 combined single limit
Bodily Injury
Property Damage
UMBRELLA POLICY (if applicable):
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.
MANUFACTURERS' or CONTRACTOR LIABILITY INSURANCE is not an acceptable substitute for Comprehensive General Liability Insurance or Commercial General Liability Insurance.
If coverages are specified separately, they must be at least these amounts:
$500,000 each occurrence
$100,000 each occurrence
$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)
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