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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
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 AMOUNTCHARGE
08-10-05 61. Steve Wrenn Deputy District $ 5, 000.00 $ 5.OOAP
Attorney
08-10-05 62 . Brandi Nieto Deputy District 5,000.00 5.OOAP
Attorney
08-10-05 63 . Amy Broughton Deputy District 5,000. 00 5.OOAP
Attorney
08-10-05 64. Chris Crux Deputy County 25, 000.00 5.OOAP
DEDUCTIONS
DATE OF ITEM PREMIUM
DEDUCTION NO. NAME POSITION LOCATION AMOUNT CHARGE
08-10-05 16. Mark Gonzales Deputy District $ 5, 000.00 $ NRP
Attorney
08-10-05 18. Thomas J. Joaquin Deputy District 5, 000.00 NRP
Attorney
08-10-05 28 . Robert A. Weist Deputy District 5, 000.00 NRP
Attorney
08-10-05 42. David M. Goddard Deputy District 5, 000.00 NRP
Dated this 10th day of___.. August 2.0.05_
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County of Weld _
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By -MPLOYER'S SIGNATURE)
NiVih,This mast be signed byt WESTE S T E ' N SURE COMPANY
ahe ��?1e 'm;if
byn, / �'�� % /--
a memb€YidY'thg`):'irm;if a corporation, By
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by a duly authorized officer. PAUL T.BRUFLAT,SENIOR Y.PRESIDENT
Form ese -P-Vi C 216-11-2002 l)
-,.'`ma � 2005-2508
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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
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
NAME POSITION LOCATION AMOUNT
ADDITION NO. CHARGE
Coroner $ $
DEDUCTIONS
DATE OF ITEM PREMIUM
NAME POSITION LOCATION AMOUNT
DEDUCTION NO. CHARGE
Attorney $ $
08-10-05 44. Kimberly Duke Coroner 25,000.00 NRP
Investigator
08-10-05 51. Steve Bernard Chief Deputy 5, 000.00 NRP
District Attorney
Dated thi@,E.-, 10th _ day of__. ___August , 2005 . _.
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Y7 BSI r
county of Weld
.s 1,3 ,x₹ '1,4>
(EMPLOYER)
fty By --
s
MPLOYER'S SIGNATURE)
NC#T$.�zmTh1sfr,it'ihstbe signed by WESTE N SURE COMPANY
the mbRWtoftrillTi`m; if arcorporati by 4-2
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a membdf:�?tliLi firm; if a corporation, By
by a duly authorized officer. PAUL T.BRUFLAT,SENIOR E PRESIDENT
Form 216-11-2002
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