All information on this form is on YOU, Not the person in Jail. (Please note, When asked for the bond amount, it is the total amount of all bonds. (Not The 10% Fee)

This section will ask for 3 references and MUST be completed:

Please Read then Sign and Date on Bottom.  ( PROMISSORY NOTE )
1. FOR VALUE RECEIVED, I (we), the undersigned Debtor(s), jointly and severally (together and separately), promise to pay to the order
of Engel Bail Bonds and USFIC (“Bail Producer”) the principal sum of _____________________
___________ ($_________) owed for the bail bond (“Bond”) of ______________________________ (“Defendant”) at the address
shown above in the Bail Producer Stamp box or at such other place as Bail Producer may from time to time designate in writing
2. The entire amount of the then outstanding balance under this note shall become due and payable immediately under any one or
more of the following events: (i) upon Defendant’s failure to appear in the court for which the Bond was posted at any time required
by such court; (ii) upon forfeiture of the Bond; or (iii) if any payment is not received by Bail Producer within ten days following its
due date or is returned for insufficient funds, stopped or refused for any reason upon presentment to a financial institution.
3. I (we), jointly and severally (together and separately), hereby waive presentment, protest and demand, notice of protest, dishonor
and nonpayment of this note, and expressly agree that, without in any way affecting my (our) liability under this note, Bail Producer
may (i) extend the due date or the time of payment of any payment due under this note, (ii) accept security or partial payments, (iii)
release any party liable under this note or any guarantee of this note and (iv) release any security now or later securing this note.
The failure of the Bail Producer to enforce any provision of this note, or to declare a default under this note, shall not be construed
as a waiver of the Bail Producer’s entitlement to payment, shall not be construed as a waiver or modification of the terms of this
note, and shall not impair the right of the Bail Producer to declare a default or to strictly enforce the terms of this note.
4. All obligations under this note remain in full force and are not terminated, modified or otherwise affected: (i) by revocation of
the Bond; (ii) by any change in the status of the Bond or the surety’s liability under the Bond; (iii) by any change in the status of
court proceedings for which the Bond was posted; or (iv) by any change in whereabouts or status of the Defendant. This note shall
become null and void only if all premium amounts and obligations under the Bond have been paid or satisfied, and otherwise, this
note shall remain in full force and effect.
5. If any portion of this note or any application of such provision shall be declared by a court of competent jurisdiction to be invalid
or unenforceable, such invalidity or unenforceability shall not affect any other applications of such provision or the remaining
provisions which shall, to the fullest extent, remain in full force and effect. Any amendment or modification of this note must be in
writing and signed by both Bail Producer and me (us).
6. I (we) agree to all terms and conditions of this note and acknowledge receipt of a copy of this note. I (we) also agree to pay all
collection costs including, without limitation, court costs, reasonable and actual attorneys’ fees and expenses, and any other fees
permitted by applicable law.

FLORIDA ADDENDUM TO INDEMNITOR APPLICATION AND AGREEMENT
This Florida Addendum (“Addendum”) is attached to and forms part of the Indemnitor Application and Agreement signed, sealed
and delivered by you as Indemnitor (“Agreement”) and is incorporated into the Agreement by this reference. Any capitalized terms used in
this Addendum without definition shall have the meanings assigned to these terms by the Agreement.
A. For good and valuable consideration, you agree to indemnify and hold harmless the Surety or its agent for all losses not
otherwise prohibited by law or by rules of the Department of Financial Services.
B. You acknowledge receipt of copies of the Terms and Conditions of the Bail Bond Application and Agreement and the Florida
Addendum thereto, which include statements as to (1) the restrictions placed on Defendant as a condition of the Bond and (2) the
agent’s powers relating to the cancellation of the Bond and recommitment of Defendant.
C. The specific fees for which you are required to indemnify Surety and its agent in accordance with the Agreement are
as follows:
(i) Costs necessary to apprehend Defendant in the event Defendant attempts to flee the jurisdiction of the courts;
(ii) Attorneys’ fees and court costs associated with filing of motions;
(iii) Documented transportation and lodging expenses outside the jurisdiction of the court;
(iv) Law enforcement costs for housing, re‐arrest, transportation and extradition; and
(v) A maximum fee of $100 for a surrender allowed by law when there has been no forfeiture of the Bond.
D. Collateral will be returned to the person whose name appears as Depositor on the Collateral Receipt within 21 days after
proof of final termination of liability on the Bond has been provided to the Surety.
E. Surety shall be entitled to deduct from collateral held or any return premium all fees, expenses, and charges authorized
by applicable law, including Florida Administrative Code 69B‐221.105.
F. For any complaints or inquiries, you may contact the Department of Financial Services, Bail Bond Section, 200 E. Gaines
Street, Tallahassee, FL 32399‐0320, (850) 413‐5660.
G. Except as expressly provided in this Addendum, all terms and conditions of the Agreement remain in full force and effect.
In the event of a conflict between the terms and conditions of the Agreement and this Addendum, this Addendum shall control.
H. This Addendum shall be attached to every Indemnitor Application and Agreement entered into in the State of Florida.
Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application
containing any false, incomplete, or misleading information is guilty of a felony of the third degree. United States Fire Insurance Company
11490 Westheimer Rd., Suite 300 • Houston, TX 77077
P.O. Box 2807 • Houston, Texas 77252-2807
(713) 954-8100 • (713) 954-8389 FAX
Email: CourtNotices@cfins.com

PRIVACY NOTICE
As required by law, we keep the financial information of our current and former customers private. This notice describes how we collect, use and
share your personal information and also explains your rights. It also explains our legal duties and privacy practices. Personal information means
information that allows someone to identify or contact you (“Information”). We are required by state laws to give you this notice.
THE INFORMATION WE COLLECT AND DISCLOSE
We collect Information about you from the following sources:
• From you through applications and other forms (e.g. your name, address, social security number, family member information, assets, income, and
property locations and values);
• From your transactions and experiences with us and others, (e.g. your account balance, insurance coverage, payment history, the premium you
pay, and claims information); and
• From consumer reporting agencies, medical providers, or others (e.g. your credit score and medical and employment information).
We may disclose this Information as described in this notice.
PARTIES TO WHOM WE MAY DISCLOSE INFORMATION
We keep your Information in our files. Your Information will only be disclosed as authorized by you or as required or allowed by law. We do not
disclose your Information to any affiliates or unrelated third parties for marketing purposes. We use your Information to process your application,
post your bond, and resolve bond claims or breaches of contract. We may give your Information to our producers, agents, investigators, attorneys and
others for these purposes. We may also disclose it to persons to perform transactions you request or authorize. When we use service providers to
help us service your account, your Information stays confidential. Our service providers agree to keep your Information private and not use it for any
other purpose. We may also share your Information for other reasons such as:
• with state insurance departments or other governmental or law enforcement authorities in the event of a bond forfeiture or breach of contract;
• with state insurance departments or other governmental or law enforcement authorities if required by law or to protect our legal interests or in
cases of suspected fraud or illegal activities;
• if ordered by a subpoena, search warrant or other court order; or
• business activities that we may legally undertake.
We may also share your Information with insurance support organizations that maintain information to, among other things, detect or prevent fraud
or criminal activity in connection with insurance underwriting or claims. Information disclosed to or obtained from such entities may be kept by them
and given to other persons.
We may also share your Information with insurance support organizations that maintain information to, among other things, detect or prevent fraud
or criminal activity in connection with insurance underwriting or claims. Information disclosed to or obtained from such entities may be kept by them
and given to other persons.
CONFIDENTIALITY AND SECURITY
We maintain administrative, technical and physical safeguards to protect your Information. We ensure that your Information is treated responsibly
and in line with our privacy policy. We also restrict access to your Information within our organization to those persons who must have the Information
to provide services to you, or to conduct our business. Persons who have access to your Information may use it only for our business purposes. We
safeguard Information in accordance with applicable laws.
YOUR RIGHT TO ACCESS AND AMEND YOUR INFORMATION
If you believe any of your Information that we have is inaccurate, you can send us a written request to review certain recorded information that we
can reasonably locate and provide to you. You can request that we amend, correct or delete anything that you believe to be wrong. If we agree with
you, we will amend, correct or delete the Information in question, unless otherwise required by law. We are not required to agree to your request.
If we do not agree with your request, we will notify you of our reasons. We may charge a small fee to collect and send the Information to you. Please
send your request to the address provided below and include your name, address, telephone number and bond number.
INVESTIGATIVE CONSUMER REPORT
We may prepare or request an investigative consumer report about you (the “Report”) in connection with your application or agreement with us.
You can request to be interviewed in connection with the preparation of the Report. You are entitled to receive a copy of the Report if you submit a
written request to us. Please send your request to the address provided below and include your name, address, telephone number and bond number. United States Fire Insurance Company
11490 Westheimer Rd., Suite 300 • Houston, TX 77077
P.O. Box 2807 • Houston, Texas 77252-2807
(713) 954-8100 • (713) 954-8389 FAX
Email: CourtNotices@cfins.com

INDEMNITOR APPLICATION AND AGREEMENT
You, the undersigned indemnitor (“Indemnitor” or “you”), hereby represent and warrant that the following declarations made and answers given
are true, complete and correct and are made for the purpose of inducing United States Fire Insurance Company (“Surety”) to issue, or cause to
be issued, a bail bond or undertaking for ______________See Above_____________________________ (“Defendant”), using power of attorney number(s)
(if known), _________________________________________ in the total amount of _______________ Dollars ($ ) in the Court of
____________________(“Bond”).THIS INDEMNITY AGREEMENT (“Agreement”) is entered into between you, the undersigned Indemnitor, and Surety through Surety’s duly appointed
independent bail producer referenced below (“Producer”).
1. You will have Defendant appear in any court required in connection with the bond(s) at the times stated in the bond(s) and all other times as may
be ordered by the court.
2. You, jointly and severally (together and separately) with any other indemnitor, shall indemnify the Surety and keep the Surety indemnified
and hold it harmless from and against any and all losses, demands, liabilities, fees and expenses relating to, or arising out of, Surety’s issuance
or procurement of the Bond, including, but not limited to the following: (a) the principal amount of any forfeiture of, or judgment on, the
Bond, plus any related court costs, interest and legal fees incurred, (b) a fugitive recovery fee if there is a forfeiture of the Bond (which fee is
typically ten percent of the amount of the Bond for an in-state recovery, plus any out of pocket expenses) (c) any and all extradition costs that
may be incurred to apprehend and return the Defendant, and (d) if a collection action is required, reasonable and actual attorneys’ fees plus
any and all other costs, expenses and/or assessments that may be incurred as a result of any forfeiture of the Bond subject to applicable law
(if any) as stated in an attached addendum. The voucher, check or other evidence of any payment made by Surety or Producer, by reason of
such suretyship, shall be conclusive evidence of such payment in any lawsuit against you both as to the propriety of such payment and as to
the extent of your liability to Surety for such payment. Further, you will, upon demand, place with Surety the requisite funds to meet any such
claim, demand, liability, attorneys’ fees, expense or judgment, whether that demand is made before or after Surety has paid or advanced such
funds.
3. Will collateral be used to secure this agreement? q Y q N If using Collateral, will it be a lien on real property? q Y q N
4. Unless otherwise provided by applicable law (if any) as stated in an attached addendum, the following events shall constitute a breach of
the obligations to the Surety, and the Surety shall have the right to immediately apprehend, arrest and surrender the defendant, and you,
as indemnitor, shall have no right to any refund of premium whatsoever: (a) the defendant departs the jurisdiction of the court without the
prior written consent of the court and the Surety; (b) the defendant moves from current address without prior written consent of the Surety
or fails to notify Surety of any material information; (c) the defendant commits any act that constitutes reasonable evidence of the intention
to cause a forfeiture of the Bond; (d) the defendant is arrested and incarcerated for any other offense (other than a minor traffic violation);
(e) the defendant makes any materially false statement in this application; (f) any indemnitor that makes any materially false statement in the
Indemnitor Application and Agreement; (g) the bail is increased; (h) any indemnitor requests that the defendant be surrendered; (i) there is a
material increase in the risk assumed by the Surety (as determined by the Surety in its sole and absolute discretion) including, by way of example
but not limitation, any collateral or security given for the Bond depreciates in value or becomes impaired.
5. Subject to applicable law (if any) as stated in an attached addendum: (a) any property or collateral you deposit is deposited as security for the
payment of any and all monies and sums due to Surety or Producer, including all liability, demands, debts (including promissory notes), damages,
judgments, interest, premiums, services charges, attorneys’ fees and costs suffered, sustained, made or incurred by Surety or Producer on account
of, arising out of or relating to the Bond and transactions contemplated thereby (including, without limitation, the items referenced in paragraph
2 above), your failure to comply with the terms and conditions of this Agreement, and any and all debt or other obligations arising out of or
evidenced by any agreement executed by Defendant, you or any other indemnitor for the benefit of Surety or Producer (“Liabilities”); and (b) if you
grant the Surety a lien or a security interest in any property or collateral to enforce the obligations contained in this Agreement, and if you do not perform all of your obligations in this Agreement, you authorize the Surety to (i) apply or sell any collateral security you deposited to reimburse the
Surety for any and all Liabilities of any kind or nature, (ii) hold, apply or sell the collateral, or any part thereof, to protect or reimburse the
Surety by reason of the execution at any time of any other bond for or on behalf of you or Defendant, and (iii) apply and sell the collateral for
the purpose of placing the Surety in cash funds or protecting the Surety against any claim, demand or loss under the Bond or any other bond
executed on your or Defendant’s behalf. Subject to applicable law (if any) as stated in an attached addendum, the Surety may make any such sale,
at its discretion, at public or private sales, and without demand, notice or advertisement of the time and place of said sale, and also with the right
to purchase said collateral at such sale or sales, freed and discharged from any equity or redemption.
6. The Surety shall not be liable for the depreciation of any collateral or for any interest thereon. In the event of depreciation of the collateral, or
any part thereof, or of any collateral which may be hereafter deposited with the Surety for its protection, upon request of the Surety, you shall
provide the Surety with additional and satisfactory collateral so that the total market value of the collateral shall, at all times, be equal to the
market value of the collateral at the time of its initial deposit. Subject to applicable law (if any) as stated in an attached addendum, if you fail
to deposit such additional collateral, the Surety shall have the full right, power and authority, without further demand or notice, to sell, assign
and deliver the whole or any part of such collateral, substituted collateral, or additional collateral, at public or private sale, at its option, and
without demand, notice or advertisement, and also with the right to purchase said collateral at any such sale, freed and discharged from any
equity or redemption.
7. If a confession of judgment is taken in connection with the Bond, the Surety shall have the right to enter and file the same at any time, and
such judgment shall be a lien and entitled to a preference against any of your property, whether or not the Surety is indemnified at the time of
the filing or entry of such judgment. In case a confession of judgment is filed by the Surety against you, the judgment entered shall be effective
and available to the Surety against you not only in connection with the Bond but also in connection with any other bond that may have been
written by the Surety in which you are either the indemnitor or defendant.
8. You acknowledge and agree that the Surety may foreclose any or all of the liens and security interests arising out of the transactions relating to
the Bond or this Agreement, or exercise any of its rights or remedies under this Agreement, or take any combination of such actions, without
waiving any other right or remedy. Failure to exercise any rights or remedies of the Surety at any one time shall not constitute a waiver of the
right to exercise them at any other time. Any security or collateral you give may be substituted, subordinated, or released by the Surety without
affecting any other rights. The Surety shall not be obligated to enforce its rights against any security or collateral prior to enforcing its rights
against you or any other indemnitor.
9. Subject to applicable law (if any) as stated in an attached addendum, the Surety will return the collateral to you when all of the following are
satisfied: (i) the Surety receives competent written legal evidence satisfactory to the Surety (for example, written notice from the court) of the
Surety’s discharge or release from all liability under the Bond; (ii) there are no outstanding Liabilities of any kind including, without limitation,
premium, arising out of or relating to the Bond; (iii) there are no other outstanding bonds or obligations executed by, for or on behalf of you
or Defendant in connection with which the Surety may deem it advisable to retain such collateral for its protection; and (iv) upon the Surety’s
request, you shall have executed and delivered to the Surety a general release upon the Surety’s return of the collateral to you. If the Surety
deems it necessary to make any outlay to protect any collateral or security in its possession, whether the same be real or personal property,
you authorize the Surety to do so, and you agree to indemnify and reimburse the Surety for any such outlay as in the judgment of the Surety
may be necessary to protect its collateral or security, including payment of taxes or liens or mortgages and any attorneys’ fees or service fees
for time spent and/or special services rendered.
10. The Surety shall have the right to transfer and/or assign, in whole or in part, its rights and obligations in this Agreement, and/or in the Bond
to the Producer or any other person or entity (“Assignee”) without notice to or consent from you. Subject to any limitations imposed upon
Assignee by the Surety, Assignee shall have the right to enforce in any action, proceeding or otherwise any of the Surety’s rights herein or
arising out of any of the transactions contemplated hereby, and you shall not, and expressly waive any right to, assert the claim or defense that
Assignee does not have the right to enforce such rights in any such action, proceeding or otherwise. If more than one bond is made or has been
made for the Defendant, then this Agreement shall extend to and cover all those bonds and the terms of this Agreement shall apply to each
bond individually or as a group.
11. This Agreement and all documents that are executed in connection with this Agreement set forth all the terms of the agreement between the
Surety and you. All statements, representations, promises, agreements, and affirmations made by the Surety and its producers and employees
prior to or contemporaneously with the execution of this Agreement are contained within this document, and unless they are specifically set
forth in this Agreement are of no force or effect whatsoever in determining the rights and liabilities of the Surety and you. You further agree to
execute and be bound by any other future documents necessary to carry out and effectuate this Agreement.
12 You hereby acknowledge and agree that neither the Surety nor its Producer has recommended or suggested any specific attorney or firm of
attorneys to represent the Defendant in any capacity.
13. This Agreement may not be terminated or modified orally. All modifications and terminations of this Agreement, including any release of your
liability hereunder, must be in writing and signed by the Surety and you.
14. To the maximum extent permitted by applicable law, you hereby waive any and all rights you may have under federal law (including, but not
limited to, Title 28 Privacy Act-Freedom of Information Act, Title 6, Fair Credit Reporting Act) and any local or State law relating to Surety’s
obtaining, and you consent to and authorize Surety to obtain, any and all private or public information and/or records concerning you from any
party or agency, private or governmental (local, state, federal), including, but not limited to, credit reports, Social Security Records, criminal
records, civil records, driving records, tax records, telephone records, medical records, school records, worker compensation records, and
employment records. You further authorize, without reservation, any party or agency, private or governmental (local, state, federal), contacted
by Surety to furnish in accordance with applicable law any and all private and public information and records in their possession concerning
you to the Surety and direct that a copy of this document shall serve as evidence of said authorization. You irrevocably grants to surety and
its producers, agents and representatives the right to enter your residence or other property owned or occupied by you or Defendant without
notice, at any time, for the purpose of locating, arresting, and returning to custody the Defendant, and subject to applicable law, you waive any
and all causes of action in connection therewith including, without limitation, torts of trespass and false imprisonment. 15. You agree that Surety may attach a location tracking device on any vehicle owned or driven by you, at any time, without notice, and monitor
the location of the vehicle through any available technology. You further agree that Surety may use location technologies to locate your wireless
device at any time during the period of Defendant’s bail and any applicable remission period, and the Bond is conditioned upon your full
compliance with the following terms and conditions: (i) Surety, at its discretion, will use network-based location technologies to find you; (ii) this
is the only notice you will receive for the collection of your location information; (iii) Surety will retain location data only while the Bond is in
force and during any applicable remission period; (iv) Surety will disclose location information only to the courts as required by court order; (v)
Surety and its licensed producers, designees and representatives will be the only persons with access to your location information; (vi) YOU WILL
NOT HAVE THE OPTION TO OPT-OUT OF LOCATION USE DURING THE BAIL PERIOD; and (vii) all questions relating to location capability should be
directed to Surety.
16. In the event any provision herein shall be deemed to exceed any applicable state or federal law, then such provision shall automatically be
deemed to have been revised to comply with such law so as to provide the Surety with the maximum protection from any loss or liability. The
invalidity or unenforceability of any provision herein (or portion thereof) shall in no way effect the validity or enforceability of any other provision
(or portion thereof).
17. You have not been paid to sign this Agreement. You have read the above contract, understand it and agree to fulfill ALL of the provisions therein.
18. Other Bond Conditions, not included above: ________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
I have read, understand, and agree to all of the terms and conditions set forth in this document, including all terms set forth on each page. United States Fire Insurance Company
11490 Westheimer Rd., Suite 300 • Houston, TX 77077
P.O. Box 2807 • Houston, Texas 77252-2807
(713) 954-8100 • (713) 954-8389 FAX
Email: CourtNotices@cfins.com

PLEASE READ BEFORE SIGNING: Informational Notice: it is understood and agreed that the happening of any one of the following events shall constitute a breach of principals obligations to USFIC shall have the right to apprehend, arrest and surrender principal and principal shall have no right to refund of premium whatsoever. Informational Notice: Conditions of Defendant Per (Fl. Statute 648.4425) Constitutes Breach Of Bond If Any Conditions Violated: (1) If principal shall depart the jurisdiction of the court without written consent of the court and the Surety Company or it's Agents. (2)If principal shall move without notifying the Surety Company or it's Agents. (3) If principal shall commit any act which shall constitue reasonable evidence of principal's intention to cause a forfeiture of said bond. (4) Principal is arrested and incarcerated for any offence other than a minor traffic violation. (5) If principal shall make any material false statements in the appearance bond.   

United States Fire Ins. Company, 11490 Westheimer Rd. Ste 300, houston Texas, 77252. (713) 954-8100. For any inquiries or complaints you can contact the Florida Dept. of Financial Services at 877-693-5236.

USFIC as the Surety Company through its duly appointed agents shall have control and jurisdiction over the principal during the bond term shall have the right to apprehend, arrest and surrender princible to the proper officials.

In the event surrender of princible is made prior to the principals appearances and for reasons other than listed above, the principal shall be entitled to a refund of premium. By signing below you declare that all information is true and correct and that any person knowingly defraud, deceive, mislead or falseify any information may be found guilty of a felony.

What happens now? First you may save and print this form. Call us and we will email, text or mail you a copy. Also you will receive a collateral and premium receipt from us by email, text or mail. (Please be advised the 10% is a fee and not refundable unless otherwise stated in above conditions). We will as soon as possible go over to the jail and post bond. From here, normal release time can be from 2 to 8 hours depending on time of day and jail procedures. Thank You.