Department of Insurance Mailing Address PO Box 1139 Sacramento CA 95812-1139 916-492-3035
Pursuant to Sections 1802 and 1802.1 of the Insurance Code
The Insurance Commissioner of the State of California:
Notice is hereby given that effective from the date of filing of this notice, the designated insurer hereby: APPOINTS the person named herein, who is the holder of a bail fugitive recovery agent's license, as its agent in California to perform the activities of a bail fugitive recovery agent. Such appointment shall remain in force until terminated as provided in Section 1802.1 of the Insurance orCode. TERMINATES the agency of the licensee named herein.
Are you terminating this appointment because you have reason to believe the agent may have violated the California Insurance Code? If yes, please explain (attach separate sheet if necessary)
NAIC ID or Bail Agent license #, full name and address of office must be typed in the box below.
License number (if applicable), full legal name (as it appears on the license or application) and address of the agent must be typed in the box below.