`(“:%Q affordbgipbfl}s & UNPAID PREMIUM AGREEMENT
`
`90 BRAINARD ROAD, SUITE 203, HARTFORD CT 06114 ¢ (860) 244-0373
`
`. . CHaT (g
`PAYMENT TERMS: I (We) having obtained a surety bond release for (Defendant’s
`Name) and having an unpaid balance hereby agree to Afford-A-Bail Bonds Bondsman:
`
`¢ Premium Amount: $ i 1 00O
`e Down Payment: $ EES _
`e Amount Owed: $ | Z 39
`
`A surety bail bond agent may enter into a premium financing arrangement with a defendant or any co-signer(s) in which such agent extends credit to such defendant
`or co-signer(s). If a surety bail bond agent enters into a premium financing arrangement, such agent shall require (1) the defendant on the bail bond or any
`co-signer(s) to make a minimum down payment of thirty five percent of the premium due, and (2) the defendant and any co-signer(s) to execute a promissory note
`for the balance of the premium due. Such promissory note shall provide that such balance shall be paid not later than fifteen months after the date of the execution
`of the bail bond. In the event that payments against the premium become 60 days delinquent, or if such balance has not been paid in full to the surety bail bond
`agent by the due date, Afford-A-Bail Bonds reserves the right to revoke bail and the agent shall file a civil action seeking appropriate relief with the court.
`
`This note is due and gayable as follows: The first such payment is due and payable on the I3 day of oCHober , 2024, and like
`installments of $_7 on a weekly/biweekly/or monthly payment thereafter until the total amount of $.j22% _ ispaidin full.
`
`Pursuant to Connecticut General Statute section 36a-660c, all outstanding balances must be paid IN FULL no later than 15 months
`after the execution of this bond. If the principal or indemnitor on this note is more than sixty days in arrears, all outstanding balances
`must be paid IN FULL immediately. Pursuant to Connecticut General Statute section 36a-660c, if payment due under this
`
`note is more than sixty days in arrears regardless of outcome of case, this agent must file a civil action seeking appropriate relief
`with the court. No Exceptions. May be collected jointly or individually.
`
`FORMS OF PAYMENT: Check, credit card or money order may be accepted. Some fees apply.
`
`Verification of Current or Previous Employment and/or Compensation for:
`Employee Name:
`
`I authorize Afford-A-Bail Bonds on behalf of my employer to release information relative to my employment.
`1 authorize the release of the following information (Please check one):
`
`O Dates of employment, employment type, employment status, position and compensation information.
`
`ATTORNEY’S FEES: If this note is given to an attorney for collection or enforcement, or if suit is brought for collection or enforcement, or if it
`is collected or enforced through probate, bankruptcy, or other judicial proceeding then payer(s) shall pay Afford-A-Bail Bond all costs of
`collection and enforcement, including reasonable Attorney’s fees and court costs in addition to other amounts due.
`
`EXECUTED this___ 1 S day of __ ,zo&"f
`
`By signing I agree to pay any cost that may be incurred for late payments. For monthly invoice check box [:]
`Payer #1: CVaz GW?“! Current Employer PLAS f)'T‘qFfini-)
`
`Payer’s Address W% 5 Lifewfieid Towe 4 Position Wawre iv S¥
`
`City, State Nwd)’”d‘:’)\é L CT_bphHt 5 Supervisor Name Meart
`
`Phone (26% ) 59% ¥%% “ Phone # ext
`
`,i/ % Employer address 55 Marsn il Rd Ovange . CT
`& rd
`Signature |, ,L[/u/ % 14/ Current banking institution C)’NVV[‘P
`
`v iy = -+
`
`3
`SS# . — . Mail payments to:
`
`Any questions regarding payments please call: Afford-A-Bail
`
`860-244-0373 P.O. Box 2192
`Hartford, CT 06145
`
`PLEASE READ BEFORE SIGNING THIS DOCUMENT =™
`
`
`
`
`
`
`
`
`
`Invoice & Account Statement
`
`Statement Date: Thursday, September 25, 202 Afford-A-Bail
`90 Brainard Road
`
`Hartford, CT 06114
`Ph: (860) 244-0373
`
`Defendant: Gray, Chaz
`1685 Litchfield Turnpike
`Woodbridge, CT 06525
`
`Balance
`
`Bond/Power No.: UFC025-88007006 Posted Date: 9/15/2024
`
`Amount of Bond: $25000.00 Premium:
`
`Indemnitor(s): Heyward, Joy
`09/15/24 Bond Charges - $1,900.00 $1,900.00 $1,900.00
`09/15/24 Payment $665.00 Cash $1,235.00
`11/16/24 Payment payment $75.00 Credit Card $1,160.00
`11/23/24 Payment payment $75.00 Cash $1,085.00
`07/23/25 - POSTAGE $16.80 $1,101.80
`
`Send Payments to: Afford-A-Bail
`90 Brainard Road
`Hartford, CT 06114
`(860) 244-0373
`10of 1
`
`
`
`
`
`
`
`
`Indemnitor O_é\ll ITN\!CUOV‘d
`
`Date -
`of Bir... - Sex F
`
`Race. -9 79CKL. * & g
`
`Relationship C"F"‘hch‘evz Ql'
`
`-
`Address V95 l_"“f’chfi‘eld Tpm al EE ‘;ghy WOOdeidg%
`
`Renting Home Landlord Name
`
`How
`
`O Buying Home Long Value
`
`Dan d
`
`Mortgage
`
`DL &
`How
`stCY 7, 0052 5 Long
`Phone
`Name(s)
`On Deed
`
`Employer DN CYIrTYa Medical CaaTey o 4, Medical S vt
`
`Holc[er
`
`How
`Long
`
`2
`
`Supervisorsaswa Sv vdhav
`
`Employer vt Phone,
`Address_ D 10 U—CLWI‘efi T Extension/ Dspt. 20% 509 b492
`Vehicle(s) Description I
`Spouse / Partner Phone(s) Employer
`Indemnitor Total
`Income Source(s) Monthly [ncome
`Abllity to How
`Pay Forfeiture Quickly
`Type / Value Receipt
`Signature Only ______ Collateral Also _» of Collateral Provided
`Indemnitor ; I Relationship Phone(s)
`Date R
`of Birth Sex Race SS# DL #
`How
`Address City St Zip Long
`[ Renting Home Landlord Name Phone
`How Mortgage Name(s)
`[ Buying Home Long Value Holder On Deed,
`How
`Employer Position Long Supervisor,
`Employer Phone,
`Address Extenslon/Dept.
`Vehicle(s) Description
`PN
`Spouse/ Partner Phone(s) Employer
`Indemnitor Total
`Income Source(s) Monthly Income
`Abllity to How
`Pay Forfeiturs Quickly
`Type / Value Recelpt
`Signature Only Collateral Also of Collateral Provided
`Indemnitor Relationship Phone(s)
`Date
`of Birth Sex Race SS # DL #
`How
`Address City St Zip Long
`[ Renting Horme Landlord Name Phone
`How Mortgage Name(s)
`I Buying Home Long Value Holder On Deed
`How
`Employer Position Long Supervisor,
`Employer Phone,
`Address Extension/Dept.
`Vehicle(s) Description
`Spouse / Partner Phone(s) Employer
`Indemnitor Total
`Income Source(s) Monthly Income
`Ability to How
`Pay Forfeiture Quickly
`Type / Value Recelpt
`Signature Only Collateral Also of Collateral Provided
`
`
`
`
`
`
`
`
`
`TERMS AND CONDITIONS FOR DEFENDANT AND EACH AND ALL INDEMNITORS
`
`The premium paid for this sursty ball bond Is non-refundable regardless If charges are dismissed or the ball Is reduced, or canceled.
`Should the cases, connected with this bond, remain open 12 months from today’s date, a renewal premium Is due sursty agency, providing
`
`state law allows, This Contract shall be construed and enforced under the laws of the State of .
`By my true and accurate application attached and signature hereunder, I/We acknowledge understanding of, and obligation for all Gontract
`responsibilitles, terms and conditions, Including the provisions entltled Promise for Court Appearances, Promise to Pay and Consumer
`Authorization to Release Information. Promlise for Court Appsarances: In accardance with ths terms and conditlons of this Surety Bond
`Application and Contract For Court Appearance I/We promise that the Defendant shall appear at each and every Court required
`appearance, In the correct Gourt locatlon at the time designated, until case(s) conclusion and bond(s) exoneration. Promise to Pay: In
`accordance with the terms and conditions of this Surety Bond Application and Contract For Court Appearance 1/We promise to pay the full
`amount of the bond(s) plus costs and expenses if the Defendant fails to appear as required by the Court(s). Consumer Authorization to Release
`Information and Confidential Location Services Agreement: I/We hereby authorize all current and previous employers, [abor unions,
`landlords, nelghbors, co-inhabitants, merchants, credit reporting companles, banks, credlt unlons, mortgage, title, financs, private
`investigators, computer or credit card companles, physicians, hosplials, clinics, schools, universities, churches, utliity or telephone
`companies (spscifically for lists of Incoming and outgoing telephone calls, phone numbers, names and addresses) and all governmental
`agencles, employment, military, natural resources, motor vehicle, law enforcement and judiclal agencles, courts and dstention facliitiss at
`the Federal, State, County/Parish, City and/or Township levels and any other persons or organizations having Information, documents or
`photographs concerning me/our and/or my immediate family with regard to credit history, property or vehicle ownership, medical,
`employment, health, arrest, conviction, detention or arrest records to release Information about me/our and/or my immediate famlly to
`Unlversal Fire & Casualty Insurance Company and Its assigns and/or duly authorized representatives. [/We heraby glve speclfic permission
`for release of information, documents or photographs In connection with, or contained In N.C.I.C., C.C.H., LEE.LLN. and D.M.V. records. The
`
`undersigned does hereby agree that the (Agency), wlill act as Principal’s ball bond
`and as part of that agreement, they will be able to use location technologles to locate my wireless device at any time during the period of
`Principal's ball. The following privacy/terms and conditions are an Integral part of this agresment and bond(s) is condltloned upon full
`compliance by the principal of all sald terms and condltions and Is a part of sald bond(s) and application thersfore: The Agency will use
`network-based location technologles to find me solely at their discretlon. This agreement wlill serve as the sole notice for the collection
`of location Information for me untll the Princlpal’s bond liabllity is fully discharged. The Agency will only retaln location data while the ball
`bond s actively in force. The Agency will only disclose locatlon Informatlon to the courts as required by court order. The Agency will have
`exclusive rights to access the locatlon Information for me. | WILL NOT have the option to OPT-OUT of location use during the perod of ball, All
`questions relating to location capabillity should be directed to the Agency. By my/our signaturs(s) below, I/We hereby walve my/our rights
`under the Privacy Act and authorize the use of coples of this document by Universal Fire & Casualty Insurance Company and [ts assigns
`and/or duly authorlzed representatives.
`
`Power of Attorney: CPNI Location Information /Ping Cell Phone. | hereby name Universal Firs & Casualty Insurance Company as my
`Attorney-in-fact In relation to all wireless telephone subscriber accounts | may hold during the duration of this Agreement, | expressly
`consent and grant to Unlversal Fire & Casualty Insurance Company, or its agents, full access to any and all location Information of my
`handhsld wirsless telephones and/or devices that constitutes or may constitute Customer Proprietary Information (CPNI) 47 U.8.C. § 222(a}.
`This shall Include Real-Time Geo-locational Pings with CDR Service Records. As a material term and condition of the ball bond posted
`through Universal Fire & Casualty Insurance Company and my pre-rial releass by and through thelr underwriting of a ball bond for my beneflt,
`and, In the avent [ breach the bail bond and fail to appsar for a mandated court appearancs, | hereln expressly consent to the disclosure of
`my locatlon information to Universal Fire & Casualty Insurance Company (or its agents) by wireless carrlers servicing my wirsless device or
`moblle phone account for purposss of compllance with any court order, arrest order or warrant dus to my fallure to appear In person before
`the court. | understand that [ cannot withdraw this power of attornsy until all ball bonds are exonerated by the court holding jurisdiction over
`my criminal case and all ball bonds are released by the court with regard to my criminal cass, and herein expressly represent the same to any
`
`. Wwireless or moblle carrler serving my celiular telephone, mabille device, or prepaid mobile telepho
`Coslgners.can be held responsible for any and-allunpald balances and fesse- 2 Z
`Signed this /b ay of S('H{M bt( ; 207!-’ Agent Wi
`
`Csll Phone
`Cell Phone 208 599 B-129
`
`Cell Phone
`
`Defandant
`
`Indemnitor
`
`Indemnitor
`
`Indemnitor Csll Phone
`
`
`
`
`
`
`
`
`
`



