black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

COLLABORATIVE INSURANCE SOLUTIONS, LLC

NON-RESIDENT PRODUCER AGENCY

License Number:
AGN358232
Status:
Active
First Licensure:
08/06/2020
Cancel Date:
None
Renewal Date:
04/01/2027

Street Location:
91 PROVIDENCE HWY
WESTWOOD, MA 02090-1544
Mailing:
91 PROVIDENCE HWY
WESTWOOD, MA 02090-1544
Phone:
+1 (781) 451-3864
Fax:
+1 (781) 451-3581
Email:
david@collaborative-insurance.com

History
License Type Start Date End Date
NON-RESIDENT PRODUCER AGENCY 08/06/2020 04/01/2027

Alias, DBA or Trade Name
Name
BLACKMER INSURANCE AGENCY

Employer
Name Issue Date License Number Expiration Date Cancel Date
ALLIED INSURANCE COMPANY OF AMERICA
 12/05/2023 PCF216138
GREAT AMERICAN INSURANCE COMPANY
 08/16/2022 PCF764
HARLEYSVILLE INSURANCE COMPANY
 12/05/2023 PCF129870
HARLEYSVILLE PREFERRED INSURANCE COMPANY
 12/05/2023 PCF128998
HARLEYSVILLE WORCESTER INSURANCE COMPANY
 12/05/2023 PCF908
NATIONWIDE ASSURANCE COMPANY
 12/05/2023 PCF38952
NATIONWIDE GENERAL INSURANCE COMPANY
 12/05/2023 PCF30
NATIONWIDE INSURANCE COMPANY OF AMERICA
 12/05/2023 PCF422
NATIONWIDE MUTUAL INSURANCE COMPANY
 12/05/2023 PCF32
NATIONWIDE PROPERTY & CASUALTY INSURANCE COMPANY
 12/05/2023 PCF151089
NORTHERN SECURITY INSURANCE COMPANY INC
 06/01/2021 PCF36
PHILADELPHIA INDEMNITY INSURANCE COMPANY
 01/06/2021 PCF46041
SELECTIVE INSURANCE COMPANY OF NEW YORK
 12/15/2020 PCF437
TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA
 02/04/2021 PCF974
TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA
 08/16/2021 PCF935 08/12/2024
TRAVELERS PERSONAL INSURANCE COMPANY
 11/17/2023 PCF201268
VERMONT MUTUAL INSURANCE COMPANY
 06/01/2021 PCF37

Affiliated Agent
Name Issue Date License Number Expiration Date Cancel Date
DAVID S. DLUGASCH
 08/06/2020 PRN284125

Branch Office

None.

Supervised Entity

None.

Responsible Individual
Name License Number
DAVID S. DLUGASCH PRN284125

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
19474277

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: 05/15/2025 03:00:13 AM