HomeMy WebLinkAbout20093196�DfvEC 0 3 2009
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
11-30-09
107.
Natalie Mitchell
Deputy District
Attorney
$ 5,000.00
$
NA
DEDUCTIONS
DATE OF
DEDUCTION
ITEM
NO.
NAME
POSITION
LOCATION
AMOUNT
PREMIUM
CHARGE
11-30-09
104.
Andra K.
Ray
Deputy District
Attorney
$ 5,000.00
$
NR
Dated this 3oth
..119 0,9
M *�
day of
November
2009
N6$E,:This.ferSuttast be signed by
the El i earlb'to-partnership, by
a membE°r Ofitlib"'Firm; if a corporation,
by a duly authorized officer.
Forth 216-11-2L.L 062• �}
(r/9 7lyc'LCZ/7i21
By
WESTE
By
Weld County Human Resources
(EMPLOYER)
MPLOYER'S SIGNATURE)
SURE
COMPANY
PAUL T. DRUFLAT, SENIOR E PR]
P
P
2009-3196
Hello