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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, C0_
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
02-25-05 57. Brandon Luna Deputy District $ 5,000.00 $ 17.50AP
Attorney
DEDUCTIONS
DATE OF ITEM PRENAME POSITION LOCATION AMOUNT CHARGE
DEDUCTION NO. CHARGEGE
$ $
Dated this 25th_ day of February — 2005 .
�i\iiti iiui'r,l�Y:tc.,: '•; O County of Weld
tuu: i Oft4 •.\ • ^a (EMPLOYER)
2
' MPLOYER'S SIGNATURE)
f ' e' fir, WEST N SURE COMPANY
NOTickThis,,fOittiiist be signed by
the at$ .rto-partnership, by w�
a membe'VM'thtttirm; if a corporation, By _
by a duly authorized officer. PAUL T.BRUFLAT,SENIOR
Form 216-11-2002 ,E�G�1'1 tZ` CZ � 2005-0747
..3- 2- =.,?FDA
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