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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. ____?58425466 , 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 PREMIUM
ADDITION NO. NAME POSITION LOCATION AMOUNT CHARGE
07-20-05 60. Michael F. Arnall Deputy County $ 25, 000.00 $ 40.10AP
Coroner
DEDUCTIONS
DATE OF ITEM NAME POSITION LOCATION AMOUNT PREMIUM
DEDUCTION NO. CHARGE
Dated thi§ _20th day of July , 2005
,'
p. County of Weld
r td J{�fA (EMPLOYER)
{
Mmeto: By MPLOYER'S SIGNATURE)
NCiT ? This, "st be signed by WEST ' N SURE COMPANY
the j'7b'¢eL ato-partnership, by
a membgt`i ftlid firm;if a corporation, By / _
by a duly authorized officer. PAUL T.BRUFLAT,SENIOR E PRESIDENT
I. i27 >11-202
�� 2005-2129
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