HomeMy WebLinkAbout20091646.tiffoRRECraD D�f,
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
ADDITION
ITEM
NO.
NAME
POSITION
LOCATION
AMOUNT
PREMIUM
CHARGE
07-02-09
106.
David
Skarka
Deputy District
Attorney
5,000.00
°
NA
DEDUCTIONS
DATE OF
DEDUCTION
ITEM
NO.
NAME
POSITION
LOCATION
AMOUNT
PREMIUM
CHARGE
07-02-09
106.
David
Sharkaa
Deputy District
Attorney
'
5,000.00
fi
NR
Dated this 2nd day of
tia`
„fnrp$ utust be signed by
the Es $tl$t@ Jfltato-partnership, by
a memo P'bfthe`tirm; if a corporation,
by a duly authorized officer.
July
Fnrm916-11-2002- - [j (j,
e011 -)4124t, O 9
2009
Weld County Human Resources
By
MPL0YEWS SIGNATURE)
WESTESURE COMPANY
ByT
PAUL T. I3RUFLAT. SENIOR v
2009-1646
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