NCC190599_Contact Update Record (Legally Resp Change)_20230217

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by bethany.georgoulias 2/17/2023 4:01:06 PM (Contact Changes Submitted)

Certificate of NCC190599
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2019-0599
Original NOI No.* 12116
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Conrad Farm LLC
Project Name Conrad Farm -Phase 2
Address Yadkinville Road, Lewisville, NC
County Forsyth
Latitude 36.1320
Longitude-80.4230
Date COC Issued * 06/13/2019
Prior Rescission Date This field will populate only if COC has already been rescinded.
Which Contacts Have Billing Only
Changed?* Legally Responsible Individual Only
Site Contact Only
• BOTH Legally Responsible Individual and Site Contact
Has Billing Contact Choose'Yes'to revise Billing Contact details.
Changed? U No
Yes
Billing Email
NEW Billing Email [e-mail]
Billing Telephone No.
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Christopher Lyons
Individual (Previous)
First Name (New)* Christopher
Last Name (New)* Dunbar

NEW Legally Reflects any revisions above
Responsible Christopher Dunbar
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 3608 West Friendly Avenue, Suite 202,
Address (Previous) Greensboro, NC 27410-4833
NEW Permittee Street Address
Mailing Address* 5826 Samet Drive
Address Line 2
Suite 105
City
State / Province / Region
High Point
NC
Postal / Zip Code
Country
27265
us
Permittee Street 3608 West Friendly Avenue, Suite 202,
Address (Previous) Greensboro, NC 27410-4833
NEW Permittee Street Street Address
Address* 5826 Samet Drive
Address Line 2
Suite 105
City
State / Province / Region
High Point
NC
Postal / Zip Code
Country
27265
us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Kye Bunker
(Previous)
Site Contact Title Development Manager
(Previous)
Organization Conrad Farm LLC
(Previous)
First Name (New)* Christopher
Last Name (New)* Dunbar

NEW Site Contact*
Reflects any revisions above
Christopher Dunbar
NEW Site Contact
President and COO
Title
NEW Organization
Conrad Farm LLC
This field is not required on the NOI form and may not pre -populate.
Site Contact Email
[e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 3364863653
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 3608 West Friendly Avenue, Suite 202,
Address (Previous) Greensboro, NC 27410-4833
NEW Site Contact Street Address
Mailing Address* 5826 Samet Drive
Address Line 2
Suite 105
City
State / Province / Region
High Point
NC
Postal / Zip Code
Country
27265
us
Change Requested Christopher Dunbar via Modification request submitted 2/9/2023. Automated reply in
by: * earlier communication indicated Kye Bunker is no longer an employee with Leoterra,
and so site contact info was updated as well.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 02/17/2023

Georgoulias, Bethany
From: Kye Bunker <[e-mail]>
Sent: Friday, February 17, 2023 11:46 AM
To: Georgoulias, Bethany
Subject: [External] Automatic reply: Construction SW Modification Request - Question about
Organization
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Kye Bunker is no longer an employee with Leoterra. If you need immediate assistance then please contact Dana
Sandknop by email at [e-mail].
Leoterra Development