HomeMy WebLinkAbout000229.tiff Employers Mutual Companies
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wl;.:; .SI.;NE' CHANGES THE POLICY. ''1.. ':A;.;}., READ :I: i s';r;!:t;..Fill..1..Y ,
POLICY CHANG I:..
....I..I:t;Y CHAN0F. NO . 04 y, v,
DATE OF 1.S:CUE:::n (?1/0:I /9:1
.',,t, ,4. 1.,C. 08/01/91
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1 . *INSURED i*'.fa1'1f: (:.HANt:GI::I:? TO:
;'.. INSURED(S) Aof.)ti::L):Kt::NNLI'tl C. ;:3t.1Ftk:N
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ADDRESS (.:i•IAN(3E):) TO:
POLICY rr' ;t:i:1)1) I;lANl:; :k) Ti:}1
6.. COVERAGE FORM ADDED DI::L.L:T 1::T.? CHANGED GED X (1.1 Pi/F)E..D)
INCREASED REASED FROM $431 ,000.00 10 $436,000.
l:. .NOi}ft;•3t:K.it F!+ AI:)I:)ia:) DELETED CHANGED
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;-.in;;} NAME .rl.s:;I Rt:•.1' ATTORNEY -AN-FACT
jut:7:I.TI•I A. 1 FImNton
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TN 11;•;i'iA T rt)N r la1i iU:.() I'I) COMPLETE THIS SCHEDULE, .L NOT SHOWN ON MIS
ENDORSEMENT, 01 Lk i. [E.. CHOWN i.N THE DECLARATIONS.
B. ;•f,ti•)t)1:4i:t(.1ic
1 , APPLICATION OF CllA (YE S.; AFFECTED E:CTE:1.? BY THIS CHANGE i,:ND(:JRS:I: I'tl NT ,:
A. ADDITION OF A DEDUCTIBLE OR INCREASE IN DEDUCTIBLE AMOUNT: i''r11:•:3
1;1.1AR( E 1 I't'l..:1i..:S:; TO L.OS4:; RESULTING FROM ACTS COMMITTED OR EVENI:;
OCCURRING AT ANY TIME, WIfL:.ltf;:;k I3r:;i:t:rt.: OR Ai'I• r:R THE EFFECTIVE DATE
CIF CHANGE.
..
P . DELETION OK RESTRICTION (OTHER l•IER T•I.IAN IN A. ABOVE)) (:if ANY COVERAGE
OR DECREASE IN ANY LIMIT OF INSURANCE y THIS CHANGE APPLIES TO
LOSS RESULTING FROM ACTS S:r C:UMN:I T T I:-:() OR EVENIS OCCURRiNG
I ON OR Al I ER THE t::t•,1 t::1.: I•:(VE I:'' f;:: or CHANGE,, AND ;11...`..:U
2. BEFORE THE LFI 1:.:(::'i':Lvi::. DA11::: OF CHANGE :i-I•' DISCOVERED AFTER ER t:}Nt.:
YEAR FROM THAT DATE.
C. ALL. CHANGES ES OTHER THAN Si N A. AND B . ABOVE 'HIS CHANGE AF'F•t..:1 I:'S.;
TO LOSS ;t;::;;iit.. f 1:NU FROM ni:Tt:; COMMITTED OR t:.VF:NT ; nCI;uR (NI; UN OR
AFTER t:.i THE I.:III:t:;I i'.E DATE OF CHANGE:.
. NO LIMIT OF INSURANCE DURING I:NG ANY PERIOD WII...L. OE CUMULATIVE WITH ANY
01 HER AMOUNT APPLICABLE 1'0 THE SAME t.:(.IVE.SRAGE. DURING ANY OTHER PF.R 1.01)..
229
\ 0A/29'91
(':R i00 l ED. 10-90 0 :16 r; C124b63 9204
FRITTS INSURAN. . AGENCY
1934 EAST 18TH AVENUE
DENVER,CO 802061193
(303)388-4803
TO DATE SPpr__..3,_1991
Canal Mardi ng _ SUBJECT
Weld County Office of Finance and Adm.
P.O. Box 758
Greeley, Colorado 80632
Carol: —
Attached is the_endorsemPnt_adding_ KPnnerh C.. Bitren_to the Public Official Bond.
Please have.Don sign the pink_acreptanee ropy__and_return. to me in the enclosed
envelope. Keep..the white..capy__far._your f 1 PC______
Many thank:_.
ITEM M V 2L The Drawing Board,Dallas,Texas 75266-0429 Fold At(—)To Fit Drawing Board Envelope#EW9DW
Wheeler Group,Inc.1982
(-------mcr DEPARTMENT OF FINANCE AND ADMINISTRATION
PHONE (303)356-4000 EXT.4218
P.O. BOX 758
IGREELEY,COLORADO 80632
C.
COLORADO
August 20, 1991
Roberta Fritts
Fritts Insurance Agency
1934 East 18th Avenue
Denver, CO 80206
Dear Roberta:
Enclosed please find an application for Kenneth C. Buren, who should be
added to our name schedule bond. His is a new position, therefore
coverage will increase by one.
Also enclosed is a list of nine employees from the Sheriff's Office who
need to become notaries. I have given you Social Security numbers, home
addresses and home phone numbers. I have also enclosed a check in the
amount of $450.00 ($50.00 each for Notary Bonds) . Please bill me for the
change in the Name Schedule Bond. If you need further information, please
call me at 356-4000, Ext. 4217.
Thanks for your assistance.
Very truly yours,
4--12-,----LaZze:--r--1!
Carol A. Harding
Office Manager
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