black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

CLUB AGENCY INSURANCE BROKERAGE LLC

NON-RESIDENT PRODUCER AGENCY

License Number:
AGN111679
Status:
Active
First Licensure:
03/16/2005
Cancel Date:
None
Renewal Date:
04/01/2027

Street Location:
CLUB AGENCY INSURANCE BROKERAGE LLC
100 RING RD W UNIT 200
GARDEN CITY, NY 11530-3217
Mailing:
CLUB AGENCY INSURANCE BROKERAGE LLC
100 RING RD W UNIT 200
GARDEN CITY, NY 11530-3217
Phone:
+1 (516) 873-2361
Fax:
+1 (516) 742-0541
Email:
pventrelli@rmshg.com

History
License Type Start Date End Date
NON-RESIDENT PRODUCER AGENCY 07/27/2019 04/01/2027
*** NOT ACTIVE *** 02/13/2009 07/26/2019
NON-RESIDENT PRODUCER AGENCY 03/16/2005 02/12/2009

Employer
Name Issue Date License Number Expiration Date Cancel Date
21ST CENTURY CENTENNIAL INSURANCE COMPANY
 09/19/2008 PCF880 02/13/2009
AIU INSURANCE COMPANY
 03/02/2006 PCF308 02/13/2009
AMERICAN HOME ASSURANCE COMPANY
 03/02/2006 PCF367 02/13/2009
CRUM & FORSTER INDEMNITY COMPANY
 08/26/2019 PCF169608
DRIVERS EDGE INSURANCE COMPANY
 09/19/2008 PCF364 02/13/2009
FEDERAL INSURANCE COMPANY
 06/15/2005 PCF439 02/13/2009
HARTFORD ACCIDENT & INDEMNITY COMPANY
 08/23/2006 PCF462 07/03/2008
HARTFORD CASUALTY INSURANCE COMPANY
 08/23/2006 PCF967 07/03/2008
HARTFORD FIRE INSURANCE COMPANY
 08/23/2006 PCF464 07/03/2008
HARTFORD INSURANCE COMPANY OF THE MIDWEST
 08/23/2006 PCF1021 07/03/2008
HARTFORD UNDERWRITERS INSURANCE COMPANY
 08/23/2006 PCF992 07/03/2008
NORTH RIVER INSURANCE COMPANY
 08/26/2019 PCF698
SENTINEL INSURANCE COMPANY LTD
 08/23/2006 PCF84269 07/03/2008
TRAVELERS COMMERCIAL INSURANCE COMPANY
 06/18/2007 PCF31811 02/13/2009
TRAVELERS PERSONAL INSURANCE COMPANY
 10/28/2021 PCF201268
TWIN CITY FIRE INSURANCE COMPANY
 08/23/2006 PCF963 07/03/2008
UNITED STATES FIRE INSURANCE COMPANY
 08/26/2019 PCF101256

Affiliated Agent
Name Issue Date License Number Expiration Date Cancel Date
MARK D. DERRENBERGER
 07/27/2019 PRN44836

Branch Office

None.

Supervised Entity

None.

Responsible Individual
Name License Number
MARK D. DERRENBERGER PRN44836

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
7268180

An active license/permit may still be subject to limitations and restrictions as a result of disciplinary action imposed. Please contact the specific licensing board about specific disciplinary actions.

Date: 11/25/2025 11:49:01 PM