Acumen Solutions Group Logo

35 Pinelawn Road, Suite 112
Melville, NY 11747
Phone: 516-986-3425
Fax: 866-594-9689
Email: [email protected]

SCHEDULE OF INSURANCE:

Please provide a list of ALL your insurance policies. Even if the policies are with another broker or you use a payroll/ PEO provider for your health benefits, disability, or workers compensation insurance. Our aim is to prevent any overlaps or gaps in your coverage and ensure that all your insurance needs are being fully met.

    Insured Name*:

    Insured Address*:

    Address Continued:

    City*:

    State*:

    Zip*:

    Date Prepared:

    Coverage

    Insurance Company

    Policy #

    Expiration Date

    Broker Name

    General Liability

    Commercial Property

    Workers Compensation

    E&O

    D&O

    EPLI

    Crime

    Cyber

    Health Benefits

    Voluntary Benefits

    Excess/Umbrella

    Additional