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DocuSign Envelope ID:C8F16CD1-FF19-486F-8DD6-57316D1FCD54 <br /> BALLARD AGENCY INC <br /> PO Box 1559 INVOICE <br /> Hillsborough, NC 27278 <br /> Phone:(919)732-2158 Date: 1/17/2017 <br /> Fax:(919)732-9636 Producer: <br /> Entered by: <br /> HILLSBOROUGH ARTS COUNCIL Customer Due Date Invoice.# <br /> PO BOX 625 <br /> HILLSBOROUGH, NC 27278 Policy Number Policy Effective Policy Expiration <br /> EPP4917790 1/16/2017 1/16/2018 <br /> -Please detach and return with remittance- <br /> Amount Remitted $ <br /> Policy:EPP4917790 <br /> Effective: 1/16/2017 to 1/16/2018 <br /> Company . tine of Business Transaction Description Premium <br /> GREAT D&O LIABILITY RENEWAL S713.00 <br /> AMERICAN <br /> INSURANCE CO. <br /> Please Pay This Amount S713.00 <br /> NOTES <br /> THANK YOU FOR YOUR BUSINESS! <br />