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PLEASE SIGN MID RETURP! �DD
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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. __.....-AS1142.5gy6 ,issued to
County af_.Lveld 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
ADDITION NO. NAME POSITION LOCATION AMOUNT PREMIUM
CHARGE
11-29-06 74. Priscilla J. Loew Deputy District $ 5,000.00 $ 25.00AP
Attorney
DEDUCTIONS
DATE OF ITEM
DEDUCTION NO. NAME POSmON LOCATION AMOUNT PREMIUM
CHARGE
11-29-06 39. Dean Beers Coroners 25,000.00 S NRP
Investigator
11-29-06 60. Michael F. Arnail Deputy County 25,000.00 NAP
Coroner
11-29-06 64. Chris Cruz Deputy County 25,000.00 NRp
Coroner
11-29-06 73. Joshua Ritter DgpiltyllPDy strict 5,000.00 NRP
Dated thi 29th day of_ November e� 2006
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By
i�'.• SC A�M.:*tea 1'MP TER S N
N� 'pi;'J+h @•.b 'at be signed by WEST N SURE . OMPANY
P A N Y
the 0lp o-partnership,by
a memb kMRt u'm;if a corporation, By_-_. 4 • t
by a duly authorized officer. PAUL T.BR ,e OR E PRESIDENT
Form 21611-2002
21724-d7a1 61#71d-et
"O?-/S - 61.ODS 2006-3442
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