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DECLARATIONS AVtNI C.UNY <br /> pr��DocuSign Envelope ID:621DEAB3-6156-4AE9-B6CB-627B92CC15E2 <br /> '�Erie ERIE INSURANCE EXCHANGE <br /> Insurance GENERAL LIABILITY POLICY <br /> AMENDED DECLARATIONS EFFECTIVE 09/17/14 <br /> 100 Erie Insurance Place ATTACH THIS TO YOUR POLICY. <br /> Erie,PA 16530 <br /> REASON FOR AMENDMENT - ADDED ADDITIONAL INSURED <br /> Agent ITEM 2. Policy Period Policy Number <br /> 731010 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 /> RECORD OF ADDITIONAL INSUREDS - DESIGNATED PERSON OR ORGANIZATION <br /> - --- - --- - - - - - - - - - -- -- -- - --- - --- -- -- - ---- - ---- - -- - - - - - -- - -- --- - - - - <br /> ORANGE COUNTY HUMAN <br /> SERVICES AGENCY <br /> PO BOX 8181 <br /> HILLSBOROUGH NC 27278-8181 <br /> See Reverse Side LAC 10/17/14 <br />