DEPARTMENT OF INSURANCE

Name	Koosman, Chad David	DOIID	307791	NAIC NPN	7159088

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Inactive	Non Resident	Apprentice Adjuster	Not Applicable	8/16/1999	8/16/2000
Active	Non Resident	Staff Adjuster	Property & Casualty	10/22/2010		7/31/2024	Kentucky

*If a status is Pending, Pending Replacement,or the record displays Affidavit on File, click on them for more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Staff Adjuster	05/15/2024	07/31/2024

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date. Licensees subject to CE must complete CE requirements before Next Compliance Date in order to successfully complete the License Renewal Process.

Address Information

Type	Address
Business / Home Office	6270 East County Rd 1000 South Cloverdale, IN 46120
Residence	Not Public Information
Mailing	6270 East County Rd 1000 South Cloverdale, IN 46120

Internet Information

Type	Address
Business Email	cjbkoosman@gmail.com

Phone Information

Type	Phone
Business / Home Office	(765) 795-5116