DeLand (386) 734-0800
Edgewater (386) 427-5201

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OUR BUSINESS IS PEOPLE, NOT POLICIES

We strive to provide affordable, comprehensive coverage and look forward to building a long-term relationship with our clients.

There's no business exactly like yours; so you can't afford to waste money on one size fits all insurance.

We offer health & disability coverage for all your insurance needs.

Request a Certificate
Date of Request

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Insured's Name

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Contact Name

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Contact Phone

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Contact Fax

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Contact Email

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Relationship to Insured

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NOTE:If you have received written insurance requirements or a contract, please forward a copy with this request to: denise@lanelennon.com or phone 386-734-0800 so we may issue the certificates correctly.
Certificate Holder's Name

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Attention

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Address

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City/State/Zip

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Email

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Contact Fax

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Contact Phone

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Does the certificate holder need to be shown as an additional insured?

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Does the certificate holder require a Waiver of Subrogation?

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Please be advised that we CANNOT send out a certificate of insurance with Certificate Holder added as Additional Insured or if a Waiver of Subrogation is required unless you send us a copy of the Contract Insurance Requirements information. Please send it to denise@lanelennon.com; or phone her at (386) 734-0800 ext. 203.
Additional Information

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Our Carriers

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