Blank Texas 1560 PDF Form Get Texas 1560 Here

Blank Texas 1560 PDF Form

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.

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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.

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Agents should complete this form by providing all requested information, then either email, fax, or mail this form as noted at the bottom of page two. 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.
WORKERS' COMPENSATION INSURANCE COVERAGE:
Endorsed with a Waiver of Subrogation in favor of TxDOT.
COMMERCIAL GENERAL LIABILITY INSURANCE:
BUSINESS AUTOMOBILE POLICY:
UMBRELLA POLICY (if applicable):
Agency Name Address City, State, Zip Code
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.
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.
Phone Number:
City/State/Zip:
Street/Mailing Address:
Insured:
Address:
Carrier Name:
City, State, Zip:
Carrier Phone #:
Workers' Compensation
Type of Insurance Policy Number Effective Date Expiration Date Limits of Liability:
Not Less Than: Statutory - Texas
Carrier Name:
Address:
Type of Insurance:
Commercial General
Liability Insurance
Not Less Than:
$ 600,000 each occurrence
Policy Number: Effective Date: Expiration Date:
City, State, Zip:
Carrier Phone #:
Limits of Liability:
Carrier Name:
Address:
Type of Insurance:
Business Automobile Policy
Not Less Than:
$ 600,000 combined single limit
Policy Number:
Effective Date: Expiration Date:
City, State, Zip:
Carrier Phone #:
Limits of Liability:
Carrier Name:
Address:
Type of Insurance:
Umbrella Policy
Policy Number: Effective Date:
Expiration Date: Limits of Liability:
City, State, Zip:
Carrier Phone #:
Authorized Agent's Phone Number Authorized Agent Original Signature Date
( ) -
( ) -
( ) -
( ) -
( ) -
( ) -
CERTIFICATE OF INSURANCE
Form 1560
(Rev. 07/24)
Previous editions of this form may not be used.
Page 1 of 2
NOTES TO AGENTS:
Agents must provide all requested information then either email, fax, or mail this form as noted below.
Pre-printed limits are the minimum required; if higher limits are provided by the policy, enter the higher limit amount on
an Acord Form.
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 Texas Department of Insurance (TDI) approved forms are the only acceptable proof of insurance for department
contracts. The preferred Certificate of Insurance (COI) is on a 1560 or Acord form.
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.
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 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:
If coverages are specified separately, they must be at least these amounts:
Bodily Injury $500,000 each occurrence
$100,000 each occurrence
$100,000 for aggregate
Property Damage
MANUFACTURERS' or CONTRACTOR LIABILITY INSURANCE is not an acceptable substitute for Comprehensive
General Liability Insurance or Commercial General Liability Insurance.
BUSINESS AUTOMOBILE POLICY:
PRIVATE AUTOMOBILE LIABILITY INSURANCE is not an acceptable substitute for a Business Automobile Policy.
Form 1560 (Rev. 07/24)
Page 2 of 2
Completed forms may be submitted by any of the following methods:
Email: CST_Insurance@txdot.gov
Fax: (512) 416-2536
Mail: Texas Department of Transportation
CST – Contract Processing
125 E. 11th Street
Austin, TX 78701-2483
⇓ Texas 1560 PDF

Document Specs

Fact Name Description
Form Purpose The Texas 1560 form serves as a Certificate of Insurance for contractors working with the Texas Department of Transportation (TxDOT).
Governing Law This form is governed by the Texas Workers' Compensation Law and other applicable Texas insurance regulations.
Submission Method Agents must complete and submit the form via fax or mail to the address specified on the second page.
Coverage Requirements Contractors must have Workers' Compensation Insurance, Commercial General Liability Insurance, and Business Automobile Policy, each with specified minimum limits.
Signature Requirement An authorized agent's signature is mandatory on the form for it to be valid.
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