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HomeMy WebLinkAboutNCC212683_Contact Update Record (Legally Resp Change)_20230323Action History (UTC-05:00) Eastern Time (US & Canada) Submit by bethany.georgoulias 3/23/2023 10:48:17 AM (Contact Changes Submitted) Certificate of NCC212683 Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters) NC Reference No. NCG01-2021-2683 Original NOI No.* 51371 Project information associated with this permit (cannot change): Permittee Listed Organizaiton cannot be changed (new COC required) City of Greensboro Project Name Contract 2020-018, Eugene & Bellemeade Streetscape Improvements Address N. Eugene Street and Bellemeade Street, Greensboro, NC County Guilford Latitude 36.0756 Longitude-79.7939 Date COC Issued* 05/10/2021 Prior Rescission Date This field will populate only if COC has already been rescinded.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? Q No (.) Yes Billing Email John.Fersner@greensboro-nc.gov NEW Billing Email jason.geary@greensboro-nc.gov Billing Telephone No. 336-373-2302 NEW Billing (336) 373-2302 Telephone No. (Optional) Legally Responsible Individual Contact Information REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES! Legally Responsible John Fersner Individual (Previous) First Name (New)* Jason Last Name (New)* Geary NEW Legally Reflects any revisions above Responsible Jason Geary Individual* Permittee Email John.Fersner@greensboro-nc.gov (Previous) NEW Permittee jason.geary@greensboro-nc.gov Email* Permittee Telephone 336-373-2302 No. (Previous) NEW Permittee (336) 373-2302 Telephone No.* Permittee Mailing Post Office Box 3136, 0, Greensboro, NC Address (Previous) 27401 NEW Permittee Street Address Mailing Address* Post Office Box 3136 Address Line 2 City Greensboro Postal / Zip Code 27402-3136 State / Province / Region NC Country USA Permittee Street 300 West Washington Street, 0, Greensboro, Address (Previous) NC 27401 NEW Permittee Street Street Address Address* 300 West Washington Street Address Line 2 City State / Province / Region Greensboro NC Postal / Zip Code Country 27401 USA Change Requested Jason Geary via Modification request submitted 3/22/2023. by: * Include any additional correspondence records in the Repository COC folder. Additional Information for this update to contact information: Addional Explanation (Optional) Date * 03/23/2023