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Fill Your Texas 1560 Form

The Texas 1560 form is a Certificate of Insurance that provides essential information regarding insurance coverage for contractors working with the Texas Department of Transportation (TxDOT). This form ensures that the required insurance policies are in effect and serves as proof of compliance with TxDOT’s insurance requirements. To get started on filling out the Texas 1560 form, please click the button below.

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Dos and Don'ts

When filling out the Texas 1560 form, it is essential to follow specific guidelines to ensure accuracy and compliance. Below is a list of things you should and shouldn't do:

  • Do provide all requested information accurately, including the contractor's legal company name and any applicable DBA (doing business as) names.
  • Do ensure that the Workers' Compensation Insurance policy is endorsed with a Waiver of Subrogation in favor of TxDOT.
  • Do mail or fax the completed form directly to the address specified on the form.
  • Do enter the higher limit amount if your policy provides coverage above the pre-printed limits.
  • Don't use binder numbers as policy numbers; they are not acceptable.
  • Don't make changes to the form that alter its provisions, such as over-stamping or over-typing entries.

Following these guidelines will help ensure that your submission is processed smoothly and without delays. If you have any questions or need further clarification, it is advisable to reach out for assistance.

Sample - Texas 1560 Form

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)

More PDF Templates

Documents used along the form

The Texas 1560 form, also known as the Certificate of Insurance, is a crucial document that provides proof of insurance coverage for contractors working with the Texas Department of Transportation (TxDOT). Alongside this form, several other documents are often required to ensure compliance with state regulations and to protect all parties involved. Below is a list of documents commonly used in conjunction with the Texas 1560 form.

  • Workers' Compensation Policy: This document outlines the specific terms and conditions of the workers' compensation insurance coverage. It is essential for contractors with employees, as it provides benefits for work-related injuries.
  • Commercial General Liability Policy: This policy details the coverage for claims related to bodily injury and property damage that may arise during the contractor's operations. It protects against various liabilities that could occur on the job site.
  • Business Automobile Policy: This document provides coverage for vehicles used in the course of business. It includes details about bodily injury and property damage limits, ensuring that contractors are protected while operating vehicles for work purposes.
  • Umbrella Policy: An umbrella policy offers additional liability coverage beyond the limits of the primary insurance policies. It serves as a safety net for contractors, covering unexpected large claims that may exceed standard policy limits.
  • Endorsements: These are amendments or additions to existing insurance policies that may be required to meet specific contractual obligations. For example, a waiver of subrogation in favor of TxDOT is often needed in workers' compensation policies.
  • Certificate of Insurance Holder: This document lists the individuals or entities that are entitled to receive proof of insurance coverage. It ensures that all relevant parties are informed of the contractor's insurance status.
  • Insurance Binder: An insurance binder is a temporary document that provides proof of insurance coverage until the formal policy is issued. It is often used in the interim to meet immediate contractual requirements.

These documents collectively contribute to a comprehensive understanding of the insurance landscape for contractors working with TxDOT. They help ensure that all parties are adequately protected and that contractual obligations are met. Proper management of these forms is essential for maintaining compliance and safeguarding against potential liabilities.

Common mistakes

Filling out the Texas 1560 form can be straightforward, but many people make common mistakes that can lead to delays or complications. One frequent error is failing to provide the correct insured name. The insured's legal company name must be listed, including any DBA (doing business as) names. Omitting this detail can result in the form being rejected.

Another common mistake is not including the complete contact information for the insurance carriers. Each carrier's name, phone number, and address must be fully detailed. Incomplete information can cause confusion and may lead to the form being considered invalid.

People often forget to indicate the effective and expiration dates of the insurance policies. These dates are crucial, as they confirm that the coverage is active and will remain so throughout the contract period. Missing these dates can lead to unnecessary work stoppages.

Some individuals mistakenly use binder numbers instead of actual policy numbers. Binder numbers are not acceptable on this form. Always ensure that the actual policy number is provided to avoid complications with the insurance verification process.

Additionally, many fail to strike through or cross out the pre-printed limits on the form when higher limits apply. If the policy provides coverage above the stated minimums, it is essential to indicate this correctly. Otherwise, the form may not meet the required standards.

Another mistake involves the signature of the agent. This signature is mandatory. Without it, the form is incomplete and will not be processed. Agents should double-check that their signature is present before submission.

People also often neglect to confirm that the Workers' Compensation policy includes a waiver of subrogation in favor of TxDOT. This endorsement is necessary for compliance, and failing to include it can lead to rejection of the form.

Some individuals mistakenly include over-stamped or over-typed entries that change the provisions of the certificate. Such alterations are not acceptable. The form must be filled out clearly and accurately without any modifications that could alter its meaning.

Lastly, many overlook the requirement to submit the form one business day prior to the expiration date of the insurance. This deadline is critical to ensure that there is no lapse in coverage and that work can continue without interruption.

Misconceptions

Understanding the Texas 1560 form can be challenging due to several misconceptions. Here are six common misunderstandings:

  • The Texas 1560 form guarantees insurance coverage. This form does not provide insurance coverage itself. It serves only as a certificate of insurance, indicating that certain policies are in effect.
  • All endorsements must be attached to the form. In fact, copies of endorsements listed on the form are not required as attachments. The form itself suffices for documentation purposes.
  • Submitting the form is optional. It is mandatory to submit the Texas 1560 form for work to commence. The insurance must be in force, and the form must be submitted at least one business day before the expiration date of any existing coverage.
  • The form can include project-specific details. The Texas 1560 form should not reference specific projects or contracts. It is meant to be a general certificate of insurance for the contractor.
  • Any type of insurance can be listed. Only specific types of insurance are acceptable. For example, Group Health or Accident Insurance cannot substitute for Workers' Compensation Insurance.
  • Faxed forms are not valid. Faxed submissions are acceptable. When sent via fax, the sender adopts the received document as a duplicate original.

Key takeaways

When filling out and using the Texas 1560 form, it is essential to follow specific guidelines to ensure compliance with the Texas Department of Transportation (TxDOT) requirements. Here are some key takeaways:

  • Complete All Sections: Agents must fill out every section of the form accurately, including the insured’s name, address, and contact information.
  • Submit Promptly: To avoid work suspension, submit the completed form via fax or mail at least one business day before any insurance expiration date.
  • Waiver of Subrogation: Ensure that the Workers' Compensation policy is endorsed with a Waiver of Subrogation in favor of TxDOT, as this is a mandatory requirement.
  • Correct Policy Numbers: Use actual policy numbers instead of binder numbers. This is crucial for the form to be valid.
  • Minimum Coverage Limits: Adhere to the minimum coverage limits specified in the form. If higher limits are available, list those and strike through the pre-printed amounts.
  • Legal Company Name: Always use the contractor's legal company name, including any DBA (doing business as) names, when identifying the insured.
  • No Alterations: Avoid any over-stamping or over-typing on the form, as changes that modify the original provisions are not acceptable.
  • Reproduction Allowed: The Texas 1560 form can be reproduced, but ensure that it remains unchanged and follows the required format.

By adhering to these guidelines, agents can facilitate a smoother process for obtaining and maintaining the necessary insurance coverage for TxDOT contracts.

File Characteristics

Fact Name Details
Form Title Certificate of Insurance Form 1560 (Rev. 01/12)
Governing Law Texas Workers' Compensation Law
Submission Method Agents must fax or mail the completed form to the specified address.
Coverage Requirements Workers' Compensation Insurance is mandatory if the contractor has employees.
Minimum Liability Limits Commercial General Liability Insurance: $600,000 each occurrence.
Cancellation Notice Notice of cancellation must follow the policy provisions.
Contact Information Completed forms should be sent to TxDOT at 125 E. 11th Street, Austin, TX 78701-2483.

How to Use Texas 1560

Completing the Texas 1560 form requires careful attention to detail. After filling out the form, it must be sent directly to the Texas Department of Transportation. Ensure all necessary information is accurate and complete to avoid any delays in processing.

  1. Obtain the Texas 1560 form. Ensure you have the most recent version.
  2. Fill in the Insured section with the legal company name, including any DBA (doing business as) name.
  3. Provide the Street/Mailing Address, City/State/Zip, and Phone Number of the insured.
  4. Complete the Workers' Compensation Insurance Coverage section. Include the carrier name, phone number, and address.
  5. Fill in the Type of Insurance, Policy Number, Effective Date, Expiration Date, and Limits of Liability for Workers' Compensation.
  6. Repeat the above step for the Commercial General Liability Insurance section.
  7. Complete the Business Automobile Policy section with the required details.
  8. If applicable, fill in the Umbrella Policy section.
  9. Ensure that the form is signed by an authorized agent, including the date of signing.
  10. Fax or mail the completed form to the Texas Department of Transportation at the address provided on the form.