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Western S?refir®
ty Company
CHANGE NOTICE
1
WESTERN SURETY COMPANY is hereby requested to make the following additions to and-ot 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.
s.y; L 'tk! at'Co phante:notice is issued with the (distinct understanding that the liability bf WESTERN SURETY
O• 'Alqrslia11 underno circumstances be cdnvulative, and.shall not exceed the amount of bond in effebt as to any
employee or employees when'the dishonest act St iie—employees shall have been committed, and shall in no event
exceed the maximum amount at any time specif\ud,as to such employee or employees: tii c.
; ,ADDITIONS
DATE OF ITEM NAME POSITION ` LOCATION AMOUNT PREMIUM
ADDITION NO. - CHARGE
11-08-07 88. Anthony. Perea Deputyr'Disttict $ 5,000.00 $ 6.66AF
¢1,a.
1.''''''''.' Attorney '
. ' 11 ,08-07 89. Melissa Fox Deputy District 5, 000.00 . 6:67A1
Attorney
11-08-07 90. Chad Zito Deputy District 5, 000.01( 6.67AF
Attorney
DEDUCTIONS
DATE OF ITEM PREMIUM
DEDUCTION NO. NAME MO
: , ,! , POSITION LOCATION AUNT CHARGE
11-08-07 22. Michele ;Meyer ; .,.., ;, peputy„DaS.t,rict•. , . . (I. $ 5, 000.00 $ NF
' .. _.._
yn
11-08-07 72. Nigel Lush Deputy District . :. 15,000.00 NR
Attorney
4.',I= i.
Dated the 8th day of November 2007 •
on unrryrp -- -- , (. .
at�.•4/ .•0°C.
•41:" QOR '�^ _ County of Weld -
-' 0Q`:. . qr�:y� (EMPLOYER)
4 :r I BY ___
�3\Sc Av *- MPLOYERSSIGNATURE) .. ----
N tip'T.lyic stbesignedby' WESTE 'N SURE COMPANY
the jflsanti -partnership, by : . -
a mem if a corporation, G_--//`
by a duly authorized officer. By PAUL T.BRUFLAT,SENIOR V .F PRESIDENT
Form 218.,11.2002
(0 -- . 2 ? 2007-3736
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