Notes to Use: Please attach certified copies of the following with this Order: (1) Appearance bond, (2) Power of attorney (if any), (3) Notice of bail forfeiture, (4) Proof of service, (5) Order of judgment, (6) Notice to cure forfeiture judgment. ___________________County, Colorado ! County Court ! District Court _____________________________________Municipal Court, Colorado Court address: Phone Number : VS. COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: FAX Number: BOND POSTED FOR: Case Number: Arrest Number: Warrant Number: Bond Number: Division Courtroom E-mail: Atty. Reg #.: ORDER TO DIVISION OF INSURANCE ! Defendant ! Respondent ! Plaintiff ! Petitioner ! Child NAME OF PARTY (print or type): ________________________________________________________________________________ First Middle Last DOB RE: POWER OF ATTORNEY # ________________________ THE COURT FINDS that: 1. The bail bond posted on (date) ________________________________, in the amount of $ ______________________, was executed and posted in this action by _______________________________________________________________________, a licensed Colorado bail bonding agent, as agent for, a bail insurance company *. 2. Said compensated surety or sureties were placed on the board pursuant to C.R.S. 16-4-112, and the subject bail forfeiture judgment remains unpaid. 3. Check one: ! As to Cash Bonding Agent. Thirty days have expired since the cash bonding agent was placed on the board pursuant to C.R.S. C.R.S. 16-4-112(5)(e). ! As to a Bail Bonding Agent writing through a Bail Insurance Company. Forty-five days have expired since the bail bonding agent was placed on the board pursuant to C.R.S. 16-4-112(5)(e) and (f). ! As to a Bail Insurance Company. Fifteen days have expired since the Bail Insurance Company was placed on the board pursuant to C.R.S. 16-4-112(5)(f). IT IS ORDERED that in accordance with C.R.S. 12-7-103(3), the Colorado Division of Insurance shall suspend the license of the above named bail bonding agent, after hearing pursuant to C.R.S. 10-2-801, until such time as all forfeitures and judgments ordered and entered against the bail bonding agent have been certified as paid or vacated by a court of record, AND FURTHER ORDERS that if the above named bail bonding agent is a cash bonding agent, the Colorado Division of Insurance shall declare the qualification bond of such cash bonding agent to be forfeited after a hearing as provided in C.R.S. 12-7-106(2), AND FURTHER ORDERS that administrative action be taken against the bail insurance company, if the box, “As to a Bail Insurance Company”, is checked. BY THE COURT DATE: _____________________________________________ * Strike if inapplicable ________________________________________________ Judge CERTIFICATE OF SERVICE I certify that on (date) ___________________________________, I served a copy of the ORDER TO DIVISION OF INSURANCE by personal service or regular mail, postage prepaid, to the Colorado Division of Insurance and one of the following: __________________________________________________ ________________________________________________ (Bail Bonding Agent) (Bail Insurance Company) Address: ____________________________________________ City & State: __________________________________________ Division of Insurance c/o Bail Bond Investigations Department of Regulatory Agencies 1560 Broadway, Suite 850, Denver, CO 80202 Address: __________________________________________ City & State: ________________________________________ CLERK OF THE COURT ________________________________________________ Deputy Clerk JDF 380 R1/00 ORDER TO DIVISION OF INSURANCE 2001 © American LegalNet, Inc.