HomeMy WebLinkAbout000237.tiff ASlaid ENDORSEMENT No. 3
Property&Lobilay For use with Fidelity Schedule Bonds (Position Form or Name Form) to add and/or deduct
Insurance
Employees and to increase and/or decrease the amount of coverage on bonded Employees.
ATTACHED TO AND FORMING PART DATE ENDORSEMENT EXECUTED EFFECTIVE TIME Of ENDORSEMENT EFFECTIVE DATE OF ENDORSEMENT
OF BOND NO.
400 GJ 7043 8/9/84 8/1/84 #11/84
ISSUED TO RR ri.''"^r
.t (!pdB!•.^n.
Weld County ^-7
Ir i
It is agreed that the following amendments are made in the Schedule of the Bond: AUG i 3 1984 `);
NAME FORM ONLY POSITION'F(f, . I
POSITION OF ADDRESS rNUMBER IN EACftt •' COCA
11I POSITION AMOUNT OF
NAME OF EMPLOYEE EMPLOYEE WHERE EMPLOYED r
I AMOUNT OF IOV. COVERAGE
I EAC H POSITION
DEDUCTIONS FROM SCHEDULE:
$
Carolyn Ann Olson Deputy Dist. Attorney Greeley,Co 5,000.00
ADDITIONS TO SCHEDULE:
$ $
Regina M. Walsh Deputy Dist. Attorney Greeley, Co 5,000.00
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: ST. PAUL FIRE AND MARINE INSURANCE COMPANY
By
7:-/X--r2.
f7. 2
Denora May Attorney-in-Fact ,/' 237
22240 Ed. 7-73 Printed in U.S.A.
INSURED
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