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MAul ENDORSEMENT No, 7
PRIX N&Lnbmry 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 10/28/85 12:01 AM 10/16/85
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
NAME OF EMPLOYEE EMPLOYEE WHERE EMPLOYED I F POSITION AMOUNT OF
I AMOUNT OF COY. COVERAGE
I
DEDUCTIONS FROM SCHEDULE: EACH POSITION
David Goldberg Deputy District/Greeley, CO
Attorney
5,000.00
David J. Plasters Deputy District/Greeley, CO
Attorney
5,000,00
ADDITIONS TO SCHEDULE:
Patricia J. Rosales— Deputy District/Greeley,C0
Kroll Attorney 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( INE INSURANCE COMPANY
By K[.(t�� � 4 241
Kathy Lee/, 'fttorn y-'n Fact
22240 Ed. 7-73 Printed in U.S.A. IJ
INSURED C . hjper /3/i
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