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DECLARATIONS AGENT COPY <br /> rjr1."q DocuSign Envelope ID:621DEAB3-6156-4AE9-B6CB-627B92CC15E2 <br /> Erie ERIE INSURANCE EXCHANGE <br /> NInsurancE� GENERAL LIABILITY POLICY <br /> AMENDED DECLARATIONS * * EFFECTIVE 09/17/14 <br /> 100 Erie Insurance??lace <br /> Erie,PA 16530 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 OCT 2 '� 214 <br /> PO BOX 922 <br /> HILLSBOROUGH NC 27278-0922 <br /> POLICY PERIOD BEGINS AND ENDS AT 12.01 A.M. STANDARD TIME AT THE STATED <br /> ADDRESS OF THE NAMED INSURED. <br /> ----- - --- -- ----- - - -- --- --- - -- ----- - - --- -- - - - - - - -- - - - ---- - - - - - --- - - - - - - -- --- -- --- <br /> TYPE OF POLICY - OCCURRENCE BUSINESS TYPE - OTHER <br /> COUNTY - ORANGE <br /> THE ERIE ' S LIMIT OF PROTECTION FOR EACH COVERAGE IS STATED BELOW. <br /> THIS IS SUBJECT TO ALL APPLICABLE TERMS OF THE POLICY AND ATTACHED FORMS. <br /> ----- - --- -- ----- - - -- --- --- - ------- - - ----- - - - - - - -- - -- ----- -- - - --- - - - - - - -- --- -- --- <br /> LIMITS OF INSURANCE <br /> ----- - --- - - ----- - - -- - - ---- - -- - ---- - --- - -- - - - - - - -- - -- ---- - -- - - --- - - - - - - -- --- -- --- <br /> EACH OCCURRENCE LIMIT $1,000,000 <br /> DAMAGE TO PREMISES <br /> RENTED TO YOU LIMIT $1,000,000 ANY ONE PREMISES <br /> MEDICAL EXPENSE LIMIT $ 5,000 ANY ONE PERSON <br /> PERSONAL & ADVERTISING INJURY LIMIT $1,000,000 ANY ONE PERSON OR ORGANIZATION <br /> GENERAL AGGREGATE LIMIT $2,000,000 <br /> PRODUCTS/COMPLETED OPERATIONS AGGREGATE LIMIT INCL IN GENERAL AGGREGATE LIMIT <br /> ----- - --- - - ------ - -- --- ---- --- ---- - - --- -- - - - - - - -- - -- ----- ------- - - - - ---- --- - ---- <br /> COVERAGES & PREMIUMS <br /> ----- - --- -- ------- -- --- ---- --- ---- - - --- - - - - - - - - -- - -- - ---- ------- - - - - ------- - ---- <br /> PREMISES/OPERATIONS $ 205. <br /> PRODUCTS/COMPLETED OPERATIONS INCLUDED <br /> ----- - --- -- ------- -- --- - --- --- -- -- - - - -- - -- - - - -- - -- --- -- - - - ---- - -- -- - ----- - - - -- - - <br /> OPTIONAL COVERAGES - <br /> ADDITIONAL INSUREDS $ 35. <br /> TOTAL DEPOSIT PREMIUM - - - - - $ 240. <br /> ADDITIONAL CHARGE DUE TO THIS CHANGE - - - - - $ 35. <br /> APPLICABLE FORMS - SEE SCHEDULE OF FORMS <br /> ***ADDED ADD' L INSURED FOR ORANGE COUNTY HUMAN <br /> SERVICES AGENCY <br /> See Reverse Side LAC 10/17/14 <br />