TEXAS DEPT. OF INSURANCE · AUSTIN, TEXAS

. APPROVED

JUL 07 2016 P.O. BoK 12847AusnN, TirXAs)8711 *t877J 542·2474 •(512)463;7476 •

H£1RING IMPAIR£~: (800)735-2988 VOJCB *IVWW,AGR.STATE.1X:us

TEXAS DEPARTMENT OF AGRICULTURE . STRUCTURAL P~TCONTROL SERVICE

:;.· ····· · ' CERTtFtci\re·o~r&su~tANca ·. "· ··

ALS-1101 . coWiMtss'toN'E~>§io.MILi:iiR' ·:··: · .. , ·· .,.

·.. ·· ·: been inSectiori·B.and insures the structural pest · . · .control busin~s$ Iiceij~~e identified in Section A against liability for datnage to personsor property occurring as a · ·· · · result of operatfOns perfonned in the course of the business Of stru~tural pest control on premises or any other property · .:. · :, unqer the applicant's care~ custody, pr contra~ in an not than $200,000for bodily injury and property

~e ~li~y ;denti~~~inSe~~ion· ~ ~~s i~suedby. th~ · ihs.urer. ide~tifi~d .; .·

·· .. · . .damage · wit~ a minimumtotal aggregate · · :·: ., . .. . ' ,! '·

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State .

I hereby certify that ( i) the statements and information on this form are true and accurate to the best of my knowledge, (2) I am a licensed Texas insurance agent or the insurer's representative authorized to sign on behalf of the insurer identified above, and (3) the insurer identified above is authorized to do business in the State of Texas.

Name of Insurer's Representative or Agent Signature of Insurer's Representative or Agent and Date

Texas License Number (if agent signs)

I I

Please email the completed and signed form to

insurance@texasagriculture.gov

Tllis Certificate ofl11Surance is issued for informational purposes only, does not confer any rights or obligations other than the rights atrd obligations conveyed by the policy referenced herein, and the tenns ofsaid policy shall control over the terms herein.

REVISED J/J/2015