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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
County of Weld_ Address Greeley, CO -_
subject to all the terms, limitations and conditions therein set forth.
This acceptancenotice 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 NAME POSITION LOCATION AMOUNT PREMIUM
ADDITION NO. CHARGE
12-21-07 9. Christopher Woodruff County Assessor $ 1, 000. 00 $ 6.67AP
12-21-07 91. Graciela Marquez Deputy Coroner 25, 000. 00 6.67AP
12-21-07 92 . Matt Maillaro Deputy District 5, 000.00 6.66AP
Attorney
DEDUCTIONS
DATE OF ITEM NAME POSITION LOCATION AMOUNT PREMIUM
DEDUCTION NO. CHARGE
12-21-07 9. Christopher Woodruff Chief Deputy $ 1, 000.00 $ NRP
Assessor
12-21-07 50. Philip Clark Assistant District 5, 000.00 NRP
Attorney
Dated this 21st day of December 2007
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Ntj'T.liis Est be signed by WESTE S T E N SURE COMPANY
the Safte o-partnership, by
a memb*Nadi`Firm;if a corporation, t 7
by a duly authorized officer. By _
PAUL T.BRUFLAT,SENIOR E PRESIDENT
Form 216-11-2002 ,
11,1 yaGL42GCCL .C 5-71.:iJ
/- 7- , O f 2008-0174
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