HomeMy WebLinkAbout20041712 PLEASE SIGN MID RETURN ® Copy
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 AMOUNT CHARGE
06-10-04 43. William T. Mc Adams Deputy District $ 5, 000. 00 $ 20.00AP
Attorney
DEDUCTIONS
DATE OF ITEM PREMIUM
DEDUCTION NO. NAME POSITION LOCATION AMOUNT CHARGE
06-10-04 12. Rebecca Brunswig Deputy District $ 5, 000.00 $ NRP
Attorney
06-10-04 29. Daniel Wingler Deputy District 5, 000.00 NRP
Attorney
Dated this inuo10th day of June , 2004
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WEST ' N S COMPANY
Nft 'T1us Liget be signed by
the sib -partnership, by - -- r
a membaneflifg irm;if a corporation, By
by a duly authorized officer. PAUL :R T,SENIOR E PRESIDENT
Form 216-11-2002
e.vs, u1 MCAa'iw 2004-1712
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