Fillable NOTICE OF BAIL RECOVERY AGENT UTILIZATION Instructions for (Arizona)

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NOTICE OF BAIL RECOVERY AGENT UTILIZATION Instructions for (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-BRA (v. 20180618)
Instructions for FORM L-BRA
NOTICE OF BAIL RECOVERY AGENT UTILIZATION
PURPOSE
Arizona Revised Statutes (“A.R.S.”) § 13-3885(C) states,
The surety or bail bond agent employing, hiring as an independent contractor or otherwise utilizing a
bail recovery agent shall advise the Department of Insurance in writing that the bail recovery agent is
providing the services to the surety or bail bond agent on a given case or cases. The written notice to
the Department of Insurance must be given within twenty-four hours after the retention and shall
include the name, date of birth, home and business address, and telephone number of the bail recovery
agent. The bail recovery agent identified in the written notice shall certify on the written notice, under
penalty of perjury, that the bail recovery agent has never been convicted in any jurisdiction of theft or of
any felony or any crime involving carrying or the illegal use or possession of a deadly weapon or
dangerous instrument and that the bail recovery agent has complied with ARS § 20-340.04.
The purpose of this form is to help bail bond agents and bail recovery agents comply with the reporting and
certification requirements of ARS §§ 13-3885(C) and 20-340.04.
INSTRUCTIONS
Form L-BRA Time Frame: The bail bond agent must have this form completed, notarized and received by
the Department within 24 hours of utilizing a bail recovery agent. In order to accommodate our industry
customers, we will consider Form L-BRA to be timely received if either
The Bail Recovery Agent Team receives the original of Form L-BRA within 24 hours after the surety
or bail bond agent utilizes the bail recovery agent; OR
The Bail Recovery Agent Team receives an email of Form L-BRA within 24 hours after the surety or
bail bond agent utilizes the bail recovery agent.
Photograph: If you have not submitted a photograph of a bail recovery agent in an annual report pursuant
to ARS § 13-3885(D), submit a two-inch wide by three-inch high photograph of the face of the bail recovery
agent with Form L-BRA. Write the full name of the bail recovery agent on the back of the photograph.
QUESTIONS: The Bail Recovery Agent Team is part of our Insurance Licensing Section.
Visit the PRODUCERS page on the Department of Insurance web site (https://insurance.az.gov)
Send a question by e-mail to Licensing@azinsurance.gov.
If you are unable to obtain answers to questions from other information sources, call the Insurance
Licensing Section at (602) 364-4457.
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-BRA (v. 20180618)
FORM L-BRA: NOTICE OF BAIL RECOVERY AGENT UTILIZATION
Section 1: Bail Bond Agent information
Full Last Name Full First Name Full Middle Name AZ Insurance License #
E-mail Address Business Phone
In accordance with ARS § 13-3885, I hereby advise the Department of Insurance that I have employed, hired
as an independent contractor, or otherwise utilized the bail recovery agent identified below. I hereby certify
that to the best of my knowledge the bail recovery agent has never been convicted in any jurisdiction of theft,
or of any felony, or of any crime involving carrying or the illegal use or possession of a deadly weapon or
dangerous instrument.
__________________________________________ _____________________
FULL SIGNATURE OF BAIL BOND AGENT DATE
Section 2: Bail Recovery Agent information
Full Last Name Full First Name Full Middle Name Date of Birth
Home Street Address City State Zip Code Home Phone
Business Street Address City State Zip Code Business Phone
Section 3: Attestation (pursuant to Arizona Revised Statutes §§ 13-3885 and 20-340.04)
By my signature below, I hereby certify, under penalty of perjury, that I have NEVER been convicted in any
jurisdiction of ►theft, ► any crime involving carrying or the illegal use or possession of a deadly weapon or
dangerous instrument, or ► any felony.
For the purposes of this attestation, “convicted” includes, but is not limited to, having been found guilty by
judge or jury or pled guilty or no contest to any felony charge, regardless of whether
the conviction was dismissed, expunged, pardoned, appealed, set aside or reversed;
civil rights were restored;
a plea was withdrawn;
probation, a suspended sentence or a fine was given; or
a diversion program was successfully completed.
__________________________________________
FULL signature of bail recovery agent
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NOTICE OF BAIL RECOVERY AGENT UTILIZATION Instructions for (Arizona)

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Completed 12 August 2020

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