HomeMy WebLinkAbout20050856.tiff �Df
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 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
11-14-05 65. Mathew Pring Deputy District $ 5, 000.00 $ NAP
Attorney
11-14-05 66. Richard Wetmore Deputy District 5,000.00 NAP
Attorney
11-14-05 67. Christopher Estoll Deputy District 5, 000.00 NAP
Attorney
DEDUCTIONS
DATE OF O. NAME POSITION LOCATION AMOUNT PREMIUM
DEDUCTION IN
NO. CHARGE
11-14-05 58. Rebekah Melnick Deputy District $ 5,000.00 $ NRP
Attorney
Dated thiss; 14th day of November , 2005 otoe amoso
County of Weld
t .";"444
�; Q'Q C}�,41 . -. .(EMPLOYER)
ydr� eon.
'-= By MPLOYER'S SIGNATURE)
Div '1?Y``
N!§ v a`¢a This, stbesignedby WESTE N SURE COMPANY
the l > q7. o-partnership, by /
a memb4i'W*l1 firm;if a corporation, By
by a duly authorized officer. PAUL T.BRUFLAT,SENIOR E PRESIDENT
Form 216-11-2002
6,N5eevt s-eTrr>{I 2005-0856
/�-Os-br
Hello