HomeMy WebLinkAbout20091312.tiffPLEASE SIGN AND RETURN
DOj®
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
Weld County Human Resources
158425466 , issued to
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
ADDITION
ITEM
NO.
NAME
POSITION
LOCATION
AMOUNT
PREMIUM
CHARGE
05-18-09
05-18-09
33.
105.
Mat t Ward
Kristen Maurer
Chief Deputy
Coronor
Deputy District
Attorney
$ 25,000.00
5,000.00
$
10.OOAP
10.OOAP
DEDUCTIONS
DATE OF
ITEM
NO.
NAME
POSITION
LOCATION
AMOUNT
FM]
CHAT
05-18-09
32.
Thomas Shimp
Deputy Coronor
$ 25,000.00
$
05-18-09
33.
Mast Ward
Deputy Coronor
25,000.00
05-18-09
68.
Jason M. Eergevin
Deputy District
5,000.00
Attorney
Dated this 18th day of
NCIB.rr 3',his.Jor ixZtii t be signed by
the I°inploi$>r„'f'+Oopa rtnership, by
a memlieileSeiti?Eirm; if a corporation,
by a duly authorized officer_
Farm 61
c9
UM
GE
NRP
NRP
NRP
WESTEOMPANY
2009-1312
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