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aSlaul ENDORSEMENT No . 11 Lrl
IProperN&LiabliN For use with Fidelity Schedule Bonds (Position Form or Name Form) to�,40 an r4educ,t 1987 l�!
nsunince
Employees and to increase and/or decrease the amount of coverage on q'pi7yled yee
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ATTACHED TO AND FORMING PART DATE ENDORSEMENT EXECUTED EFFECTIVE TIME OF ENDORSEMENT EFFECTIVE DATE 6i`ENBORSE MENT
OF BOND NO.
400 GJ 7043 12/3/87 12 : 01 AM 12/1/87
ISSUED TO
Weld County
It is agreed that the following amendments are made in the Schedule of the Bond:
NAME FORM ONLY POSITION FORM ONLY
POSITION OF ADDRESS NUMBER IN EACH TOTAL
POSITION AMOUNT OF
NAME OF EMPLOYEE EMPLOYEE WHERE EMPLOYED
I AMOUNT OF COV. COVERAGE
I EACH POSITION
I
DEDUCTIONS FROM SCHEDULE:
$
Martin West I-busing Authority Commissioner 25 ,000 .00
Greeley, CO
ADDITIONS TO SCHEDULE:
$ $
Richard Zambri Housing Authority Commissioner 25 ,000 .00
Greeley, CO
Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions, provisions,
agreements or limitations of the above mentioned Bond, other than as above stated.
Accepted: SL FIRE AND , ARINE INSURANCE COMPANY
PCo By rc- �FY.
003 A torn y-in- ac 1-17-722240 Ed. 7-73 Printed in U.S.A. 234 1-17-7
INSURED 4-37
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