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Western Surety Company
CHANGE NOTICE
WESTERN SURETY COMPANY is hereby requested to make the following additions to and-or deductions
from the Schedule of Employees attached to Bond No. 158425466 ,issued to
Weld County Human Resources Address Greeley, CO
subject to all the terms, limitations and conditions therein set forth.
This acceptance notice is issued with the distinct understanding that the liability of WESTERN SURETY
COMPANY shall under no circumstances be cumulative, and shall not exceed the amount of bond in effect as to any
employee or employees when the dishonest act of the employees shall have been committed, and shall in no event
exceed the maximum amount at any time specified as to such employee or employees.
ADDITIONS
DATE OF ITEM PREMIUM
NAME POSITION LOCATION AMOUNT
ADDITION NO. CHARGE
07-16-10 111. Dawn Crespin Deputy District $ 5,000.00 $ 10.OOAP
Attorney
07-16-10 112 . Michael Tipton Deputy District 5, 000.00 10.OOAP
Attorney
DEDUCTIONS
DATE OF ITEM PREMIUMNAME POSITION LOCATION AMOUNT
DEDUCTION NO. CHARGE
$ $
Dated this 16th day of July , 2010
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by a duly authorized officer.
{ ` By PAUL T.BRUFLAT,SENIOR E PRESIDENT
Form 216-11-2002 �rC� +Pvi/Pt.�G(, J
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