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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 Gf4*iey, 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
$ $
4-28-03 36 Stephanie Frangeila Deputy District 5,000.00 20.00AP
Attorney
DEDUCTIONS
DATE OF ITEM RETURN
DEDUCTION NO. NAME POSITION LOCATION AMOUNT PREMIUM
$ $
4-28-03 17 Jams hartnan Deputy District 5,000.00
Attorney
Ded 7th day of May , 2003
minty of Weld
P OY R)
15TO`fE�This form mustwbe signed by By
the+mploy f. If,a Cgartnership, by a (EMPLOYER'S S NATURE)
meal ier of the't'irm,ifa corporation,by a WESTERN S R T Y C PAN Y
dulyaorile¢fit` T
Form 2A6 idle t..=x By
Censeirt a qt. ec, 2003-1598 S PHEN T.PATE,PRESIDENT
6-if_`eJ 3
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