R-2001-11 - Laserfiche WebLink

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Page ~ of 2 . e Texas Department of Transportation 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 fo~ce 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. 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. The SIGNATURE of the agent is required. Stamped/typed/printed signatures are not acceptable. 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' <;:ompensation Law. GROUP HEALTH or ACCIDENT INSURANCE is not an acceptable substitute for Workers' Compensation. COMPREHENSIVE GENERAL LIABILITY INSURANCE or COMMERCIAL GENERAL LIABILITY INSURANCE: . If coverages are specified separately. they must be at least these amounts: Bodily, Injury $500,000 each occurrence Property Damage $100,000 each occurrence $100,000 for aggregate MANUFACTURERS' or CONTRACTOR LIABILITY INSURANCE is not an acceptable substitute for Comprehensive General Liability Insurance or Commercial General Liability Insurance. COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE or TEXAS BUSINESS AUTOMOBILE POLICY: The coverage amount for a Texas Business Automobile Policy or Comprehensive Automobile Liability may be shown as a minimum of $600,000 Combined Single Limit by a typed or printed entry and deletion of the specific amounts listed for Bodily Injury and Property Damage. BASIC AUTOMOBILE LIABILITY INSURANCE is not an acceptable substitute for Comprehensive Automobile Liability Insurance or Texas Business Automobile Policy.