Revised August 2017 Approved by TDI 09/26/2017, Filing Link No. S644091
TEXAS STATE BOARD OF PLUMBING EXAMINERS
PO BOX 4200
AUSTIN, TX 78765-4200
(512) 936-5200
Scan and Email to: insurance@tsbpe.texas.gov
Allow up to 10 days for processing before contacting this
office for confirmation of receipt of certificate.
CERTIFICATE OF INSURANCE (COI)
A Master Plumber shall furnish the Texas State Board of Plumbing Examiners (Board) with a current Certificate of
Insurance (COI) before acting as a Responsible Master Plumber (RMP). This COI expires on the date that the
insurance policy specified herein expires. The RMP shall furnish the Board with a current COI immediately upon or
prior to the expiration of this COI. At least the minimum insurance coverage specified in (1) and (2) below shall be
maintained at all times during which the Master Plumber acts as a RMP. The insurance coverage must include all
types of plumbing that will be performed under the RMP’s license, including if applicable, liquefied petroleum gas
plumbing, medical gas plumbing, and multipurpose residential fire protection sprinkler plumbing. The Certificate
Holder does not guarantee the accuracy of any information provided in this COI. This COI neither affirmatively or
negatively amends, extends, or alters the coverage afforded by the insurance policy specified herein. The terms of
the policy control over the terms of this certificate.
Responsible Master Plumber (RMP) Name: License #: M‒____________
Business Name: _______________________________________________ Telephone: (_______)_____________________
RMP Email Address: ___________________________________________________________________________________
RMP Address: _________________________________________________________________________________________
Street City State Zip
Business Owner Name: _________________________________________________________________________________
Insurance Company: ___________________________________________________________________________________
Policy Number: Effective Date: ______________ Expire Date: ______________
Name of Insurance Agency: ___________________________________________ Agent Phone: (______)_______________
Insurance Agent Email Address:
Insurance Agency Address:
Street City State Zip
By my signature below, as an agent for an insurer authorized to engage in the business of insurance in this state
or an eligible surplus lines insurer, as defined by Section 981.002, Insurance Code, I hereby sign this Certificate of
Insurance (COI) stating that the above policy meets at least the following minimum standards:
(1) provides for commercial general liability insurance for the above named Responsible Master Plumber
for claims for property damage or bodily injury, regardless of whether the claim arises from a negligence
claim or on a contract claim; and
(2) is in a coverage amount of not less than $300,000 for all claims arising in any one-year period.
__________________________________ ____________________________________ ___________________________
Signature of Agent Printed Name of Agent Date
CERTIFICATE HOLDER ADDRESS:
TEXAS STATE BOARD OF PLUMBING EXAMINERS
PO BOX 4200
AUSTIN, TX 78765-4200
PHONE: (512) 936-5200 EXT. 65203
www.tsbpe.texas.gov
CANCELLATION:
Should any of the above described policies be
cancelled, non-renewed, or otherwise modified, the
Texas State Board of Plumbing Examiners (Certificate
Holder) will be notified in accordance with the terms of
the underlying policy.
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