Fillable FORM L-195: BOND OF BAIL BOND AGENT: (Arizona)

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FORM L-195: BOND OF BAIL BOND AGENT: (Arizona)

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Licensing Section
Arizona Department of Insurance
100 North 15
th
Avenue, Suite 102, Phoenix, Arizona 85007-2624
Phone: (602) 364-4457 | Toll-free: (877) 660-0964
Web: https://insurance.az.gov | E-mail: Licensing@azinsurance.gov
Form L-195 (v. 20180618)
FORM L-195: BOND OF BAIL BOND AGENT
BOND NUMBER: ____________________
I, ___________________________________________________, as Principal0F
1
for an Arizona
Bail Bond Agent License, and ______________________________________________, as an
Arizona-admitted surety insurer1F
2
(“Surety”), bind ourselves to the penal sum of ten thousand
dollars ($10,000.00) to the people of the State of Arizona. The total aggregate liability under
this bond is limited to ten thousand dollars ($10,000.00).
This conditions of this obligation are such that if the Principal is granted an Arizona Bail Bond
Agent License, Principal shall make full accounting and due payment to the person entitled to
this bond of monies and collateral coming into the Principal’s possession as an incident to bail
bond transactions under the license.
This bond shall remain in force as prescribed by Arizona Revised Statutes § 20-340.02 until
released by the Director of Insurance or until canceled by Surety. Without prejudice to any
liability previously incurred thereunder, Surety may cancel the bond upon thirty (30) days
advanced written notice filed with the Director of Insurance.
(Affix Surety company seal)
Dated this _______ day of ____________________, 20_____,
Signature of Principal (bail bond agent, or for a business entity, a member, officer, or director)
Full Name of Surety Insurer Signature of Attorney-in-fact
Signature of Surety’s Arizona-licensed Casualty Producer
Casualty Insurance Producer License Number
1
The “Principal” is the bail bond agent if the bail bond agent is an individual; OR, a member, officer or
director of the bail bond agent if the bail bond agent is a business entity.
2
Any surety company duly authorized to transact casualty insurance business in the State of Arizona
may act as Surety on this bond.
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FORM L-195: BOND OF BAIL BOND AGENT: (Arizona)

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Completed 12 August 2020

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