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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
02-17-10 108. Matthew Canaga Coroner's Medicolegal $ 25,000.00 $ 87.50AP
Investigator
02-17-10 109. Gerald Gunderson Coroner's Medicolegal 25,000.00 87.50AP
Investigator
02-17-10 110. Anthea Carrasco Deputy District 5, 000.00 17.50AP
Attorney
DEDUCTIONS
DATE OF ITEM PREMIUM
NAME POSITION LOCATION AMOUNT
DEDUCTION NO. CHARGE
Dated this 17th day of February , 2010
ants - ,t tin-4)'. .. Weld County Human Resources
84c:' . ,}„ (EMPLOYER)a.
By
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.'. �^a By ANe MPLOYER'S SIGNATURE)
N6T This,foria st be signed by WESTE S T E ' N SURE COMPANY
the bf a'Lo-partnership, by
a membfiaMtli9}' irm;if a corporation, B
by a duly authorized officer. By
PAUL T.BRUFLAT,SENIOR E PRESIDENT
3-/-‘27C070 2010-0449
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