NCC230273_FRO Submitted_20230131

CITY OF MONROE STANDARD SPECIFICATIONS AND DETAIL MANUAL
Part II
Person(s) or ftrni(s) who are financially responsible for this land disturbing activity (use blank page to list
additional owners)
Name NV77Rpp, Inc. Cor orate name / location) Name Local address as follows:
Mailing U90 Plaza America Dr., Suite 500 Mailing A dap7 0 Sikes Place, Suite 300
Reston, VA 20190
Street Address
Phone NIA
Charlotte, NC 28277
Street Address
Phone [phone]
NIA Fax [phone]
A) if the Financially Responsible Party is not a resident of North Carolina, give name and address of a North
Carolina Agent
Name of Registered Agent Corporation Service Company
Mailing Address 2626 Glenwood Ave., Suite 550 Raleigh, NC 27608
Street address City State Zip
Phone NIA
Email NIA
NIA
B) if the Financially Responsible Party is a Partnership or other person engaging in business under an assumed
name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible Party is a
Corporation, give the name and street address of the Registered Agent:
Name of Registered Agent Corporation Service Company
Mailing Address 2626 Glenwood Ave., Suite 550 Raleigh, NC 27608
Street address City State Zip
Phone NIA
Email NIA Fax NIA
The above information is true and correct to the best of my knowledge and belief and was provided by me
raider oath. I agree to provide corrected information should there be any change in the information provided
herein. (This form must be signed by the financially responsible person if an individual or his attorney in fact,
or if not an individual, by an officer, director, partner, or registered agent with authority to execute instruments
for the financially responsible person)
Type or Pr t aOl�ilaK. Hess Title —Vice President
Signatuu'
Date 01 20 1 2023
I, a Notary I1 ' c he County of State of North CRroliiue,
hereby certify that appeared personally before me this day and being dily sworn acknowledged
that the above form was executed by him.
Witness my I� tdttAttnnul}yri�l seal, this � day of S
ON Mo
Gj�.`s� ,�f ; 0
(Notary)
My commission expires._�il
2�:?�d �eLIC 07-19 Permits, Checklists, and Forms
0� Leh 6, 202� ' G Division 07
---