HomeMy WebLinkAbout20081909.tiff PLEASE SIGN AND RETURN ® Copy
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 C_ounty_Human_. Resources __. Address Greeley, CO
subject to all the terms, limitations and conditions therein set forth.
This acceptance notice is issued with the distinct unde standing 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
ADDITION NO. NAME POSITION LOCATION AMOUNT CHARGE
06-23-08 96. James Wilkerson, IV Deputy County $ 25, 000. 00 20. OOAP
Coroner
DEDUCTIONS
DATE OF ITEM PREMIUM
DEDUCTION NO NAME POSITION LOCATION AMOUNT CHARGE
06-23-08 37. Amanda J. Mashin Deputy District $ 5, 000. 00 NRP
Attorney
06-23-08 80. John Carver Cororner 25, 000.00 NRP
Dated this 23rd day of _ June , 2008.
Weld County Human Resources .
(EMPLOYER)
- ; /.1 By
'MPLOYERS SIGNATURE)
NOTE'- This formmust be signed by WESTE S T E N SURE COMPANY
the Employer "FTato-partnership, by
a membditifthatirm; if a corporation,
by a duly authorized officer. By
PAUL.T.BRUFLAT,SENIOR ,E PRESIDENT
Form 216-11-2062
!6C-it Le.‘",/,/(_,C.61.___ /`/e ri
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