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DECLARATIONS HU[INI l_UFY <br /> ��DocuSign Envelope ID:621DEAB3-6156-4AE9-B6CB-627B92CC15E2 <br /> ►Ti Erie ERIE INSURANCE EXCHANGE <br /> % Insurance * * GENERAL LIABILITY POLICY <br /> AMENDED DECLARATIONS EFFECTIVE 09/17/14 <br /> 100 Erie Insurance Place Erie,PA 16530 <br /> ATTACH THIS TO YOUR POLICY. <br /> REASON FOR AMENDMENT - ADDED ADDITIONAL INSURED <br /> Agent ITEM 2. Policy Period Policy Number <br /> 771010 THE BALLARD AGY INC 09/17/14 TO 09/17/15 Q33 1700764 NC <br /> ITEM 1. Named Insured and Address ITEM 3. Other Interest <br /> HISTORIC HILLSBOROUGH <br /> COMMISSION <br /> PO BOX 922 <br /> HILLSBOROUGH NC 27278-0922 <br /> SCHEDULE OF FORMS <br /> FORM NUMBER EDITION DATE DESCRIPTION <br /> CGL 03/01 COMMERCIAL GENERAL LIABILITY POLICY <br /> UFB748 08/14 IMPORTANT NOTICE - COMMERCIAL GENERAL LIABILITY <br /> FORM <br /> UFB785 09/14 IMPORTANT NOTICE TO POLICYHOLDERS - COMMERCIAL <br /> GENERAL LIABILITY PROGRAM <br /> CG0001 04/13 COMMERCIAL GENERAL LIABILITY COVERAGE FORM <br /> CG2147 12/07 EMPLOYMENT-RELATED PRACTICES EXCLUSION <br /> GU32 03/01 EXCLUSION - LEAD LIABILITY <br /> IL0021 09/08 NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT <br /> ULQN 06/14 EXCLUSION - PROFESSIONAL LIABILITY <br /> ULQJ 08/14 EXTRA LIABILITY COVERAGES <br /> CG0099 11/85 CHANGES IN GENERAL LIABILITY FORMS FOR COMMERCIAL <br /> PACKAGE POLICIES <br /> ULOW 06/14 COVERAGE FOR PUNITIVE DAMAGES (MD,NC,TN,VA,WI,WV) <br /> IL0269 09/08 NORTH CAROLINA CHANGES - CANCELLATION <br /> AND NONRENEWAL <br /> ULED 09/05 EXCLUSION - ASBESTOS <br /> GU30 03/01 AMENDMENT OF POLICY - TWO OR MORE COVERAGE PARTS <br /> CG2167 12/04 FUNGI OR BACTERIA EXCLUSION <br /> CG2170 01/08 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM <br /> IL985E* 01/14 DISCLOSURE PURSUANT TO TERRORISM <br /> RISK INSURANCE ACT <br /> UF4111 01/10 IMPORTANT NOTICE TO POLICYHOLDERS - TERRORISM <br /> COVERAGE - LIABILITY <br /> UF4812* 03/08 IMPORTANT NOTICE - POLICY SERVICE FEES <br /> UFS385 03/95 IMPORTANT NOTICE <br /> UF6330* 08/09 IMPORTANT NOTICE : DO YOU USE SUBCONTRACTORS? <br /> CG2196 03/05 SILICA OR SILICA-RELATED DUST EXCLUSION <br /> GU136 03/09 AMENDMENT OF MOBILE EQUIPMENT DEFINITION <br /> IL0017 11/98 COMMON POLICY CONDITIONS <br /> FORM SA 11/12 SUBSCRIBERS AGREEMENT <br /> CG2106 05/14 EXCLUSION-ACCESS OR DISCLOSURE OF CONFIDENTIAL OR <br /> PERSONAL INFORMATION AND DATA-RELATED LIABILITY- <br /> WITH LIMITED BODILY INJURY EXCEPTION <br /> CG2026 04/13 * ADDITIONAL INSURED - DESIGNATED <br /> PERSON OR ORGANIZATION <br /> See Reverse Side LAC 10/17/14 <br />