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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
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 ITEM NAME POSITION LOCATION AMOUNT PREMIUM
ADDITION NO. CHARGE
02-18-08 93 . Brenda Dones Chief Deputy $ 1, 000. 00 $ 10.OOAP
Assessor
02-18-08 94 . Jason Wolfe Deputy District 5, 000. 00 10.00AP
Attorney
DEDUCTIONS
DATE OF ITEM NAME POSITION LOCATION AMOUNT PREMIUM
DEDUCTION NO. CHARGE
Dated this..,.. 18th day of February _ , 2008
Weld County Human Resources
4.4 _- :•:y,
(EMPLOYER)
_
By
MPLOYER'S SIGNATURE)
N&TE='This for h6stbesignedby WESTE N SURE per COMPANY
the tmbgi'yf 'Firno-parcorporati by ���t��^` �a memb�r�eYftiHp'Firm; if a corporation,
by a duly authorized officer. By - PAUL T.BRUFLAT,SENIOR E PRESIDENT
Form 216-11-2002 .
L'414/ 'Lee /it/tie etiC
V--Wc9QQ, 2008-1269
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