HomeMy WebLinkAbout000244.tiff 4SRiuI ENDORSEMENT 12
Properly&lmdlN 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 FV 7613 11/30/83 12:01 AM 7/21/83
ISSUED TO
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
NAME OF EMPLOYEE EMPLOYEE WHERE EMPLOYED AMOUNT OF
I AMOUNT P OSI IONCO COVERAGE
I EACH POSITION
DEDUCTIONS FROM SCHEDULE:
$ S
Dean M. Dinner Deputy Dist.Attorney Greeley,Co 5,000.00
ADDITIONS TO SCHEDULE:
S S
Linda D. Lauchli Deputy Dist.Attorney Greeley,Co 5,000.00
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1
DEC 1 2983 •t
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GRF�L'=Y, GOLD.
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 Li /J.-P��IivZ / �st�r
Denora May Attorney-in-Fact
22240 Ed. 7-73 Printed in U.S.A. 244
INSURED
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