HomeMy WebLinkAbout20043550 �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, 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
12-03-04 47. Theron Hope Deputy District $ 5, 000.00 $ NAP
Attorney
12-03-04 48. William Breitigan Deputy District 5, 000.00 NAP
Attorney
DEDUCTIONS
DATE OF ITEM PREMIUM
NAME POSITION LOCATION AMOUNT
DEDUCTION NO. CHARGE
12-03-04 21. Yvette Lewis-Molock Deputy District $ 5, 000.00 $ NRP
Attorney
12-03-04 41. Ann Marie N. Spain Deputy District 5, 000.00 NRP
Attorney
12-03-04 46. Robert C. James Deputy District 5, 000.00 NRP
Attorney
Dated thiA 3rd day of December , 2004
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`ew�`Zr�(2ETp' �,f County of Weld
tin4� 9O,1 �°S (EMPLOYER)
ENic, ire on. By
s MPLOYER'S SIGNATURE)
14 3'-.. AV f A
r '� '' 4is WEST N SURE COMPANY
N r '''-This mat be signed by
the jrin ) gto-partnership, by
a memb`Pfl7**hrrirm;if a corporation, By
by a duly authorized officer. PAUL T.BRUFLAT,SENIOR E PRESIDENT
Form216-11-2002 (*weft/is-ao -CVG E A---2 2004-3550
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