Fillable Form 1: BOND OF BAIL BOND AGENT (Arizona)

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Form 1: BOND OF BAIL BOND AGENT (Arizona)

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100 North 15 Avenue, Suite 261 | Phoenix, Arizona 85007-2630
Page 1 of 1
FORM L-195 20220601
FORM L-195
BOND OF BAIL BOND AGENT
LICENSING
602-364-4457 |
insurancelicensing@difi.az.gov
BOND NUMBER:
FULL NAME OF SURETY INSURER
CASUALTY INSURANCE PRODUCER LICENSE NUMBER
I, ___________________________________________________, as Principal
1
for an Arizona Bail Bond Agent License,
and ____________________________________________________, as an Arizona-admitted surety insurer
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.
Dated: ___________________________
SIGNATURES
PRINCIPAL (Bail Bond Agent, or for a Business Entity, a Member,
Officer or Director
TYPE OR PRINT NAME
ATTORNEY-IN-FACT
TYPE OR PRINT NAME
SURETY INSURER’S ARIZONA-LICENSED CASUALTY PRODUCER
TYPE OR PRINT NAME
(AFFIX SURETY COMPANY SEAL)
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 1: BOND OF BAIL BOND AGENT (Arizona)

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Completed 1 July 2022

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