NCC242734_FRO Submitted_20240909

JCN
DURHAM
COUNTY Durham City/County (Office Use Only)
Sedimentation and Erosion Control
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
O WITH LANDOWNER CONSENT FORM
�1881/
No person may initiate any land-disturbing activity covered by the Durham City-County Unified Development Ordinance before a
Land Disturbing Permit is issued by the Sedimentation and Erosion Control Office.Issuance of a Land Disturbing Permit does not
relieve the pennittce of the obligation to obtain any other licenses, permits and approvals as may be required by Federal, State,
County or Municipal governments. This office must be notified in writing of any change to the information on this form.
PLEASE TYPE OR PRINT
1. Project name: Fidelity Campus Raleigh Green& Farm Extension: Yes or No
2. Road location of land-disturbing activity: 100 New Millenium Way Durham,NC 27709
Tax Map-Block-Parcel: DB 6809 PG 0078 PIN: 0747177358
3. Square footage of land to be disturbed or uncovered: 120,230 SI' 109,060 SF
4. List below the landowner of record. Each landowner must complete Item 8.
(If there are multiple owners,please list on a separate page):
FMR RTP LLC
Name
200 Seaport Blvd
Address
Boston MA 02210
City State Zip
Telephone Fax Email
5. List the person or entity financially responsible for this land-disturbing activity:The financially responsible party shall be
(1)the developer or other person who has or holds themselves as having financial or operational control over the land-disturbing
activity and/or(2)the land owner or person in possession or control of the land when they have directly or indirectly allowed
the land-disturbing activity or have benefited from it and(3)the named party on the Land Disturbing Permit.
Fidelity Investments
Name
100 New!11illenium Way
Street Address
Durham NC 27709
City State Zip
513-289-183(1 kevin.dau benm ire(a,f mr.com
I elephune Fax Email
49 As the Financially Responsible Party,I consent to receiving notifications regarding this project via electronic
(Initials) communication at_ kevin.daubenmire(a,fmr.com
(Email Address)
I agree to provide any updated email addresses as necessary to ensure consistent communication is maintained between myself
and Durham County Sedimentation and Erosion Control.
Electronic notifications may include Plans Review Comments,Approvals,Disapprovals,and/or enforcement actions including
Notices of Violation,Stop-Work Orders,and/or Civil Penalties.
201 E.Main St,516 Floor, Durham,N.C.27701 •[phone]•Fax[phone]
www.co.durhrm.nc.us/ceng

6. For business applicants,list below the North Carolina registered agent for the financially responsible entity:
Kevin Daubenmire
Name
100 New Millennium Way
Street Address
Durham NC 27709
City State Zip
513-289-1830 Kevin.Dau ben mi re)fm r.com
Telephone Fax Email
7. The above information is true and correct to the best of my knowledge and belief and was provided by me while under oath. I
understand that the person or entity listed on Line 5 above will be: (I)the owner of the Land Disturbing Permit when issued;
(2)responsible for ensuring compliance with the Act and Ordinance;and,(3)will be the only person or entity with standing to
appeal any action taken or decision made by the Sedimentation and Erosion Control Office.
S /22/24 Kevih Daubcv"i re-
Date Type or Print Name
S13 — - /730 reeler, projccl- D1k"r
Telephone .�� R Fax Title or Authorit
K .. Q,,,btvtr„ FM .cot, 'LI
Email Signature
Business Applicant(Provide corporate resolution on signatory authority)
1, Law-v. 1-1(4,.. ,a Notary Public of the County of gOOt
State of lk e n\Qct ,hereby certify that KW A 17c ) r\M;rc
personally came before me this day and acknowledged that he is Ou c\L(
of 1p. S,�C� �� Cram. f and acknowledged,on behalf of r•kV%
`MO\04*115 ,the due execution of the foregoing instrument.
Witness my hand and official seal,this Z/ day of MG-\ ,20 Zit
Sr Not‘
� ublic
My commission expires NC it QL \ ,20 LS
Individual Applicant1
I, Lau( rl4S ,a Notary Public of the County of Kjly ^
State of t'\UAl`/C11.`3 ,hereby certify that tk cv,+x
personally appeared before me this date and under oath acknowledged that the above form was executed by them.
Witness my hand and official seal,this ?�� day of MP`. ,20 2 Li
Not/ Public
My commission expires Iv OV4Ny 1Ls \ 20 I—s
(AURA HEDGES
Notary Public
Commonwealth of Kentucky
Commission Number KVNP79579
My Commission Expires Nov 1.2025
APNIPROPIWItrkiweramtememarKerm
Provide a Notarized Item 8 for each landowner listed in Item 4.

8. Land Owner Consent. As a landowner,I provide my consent for land-disturbing activities to occur on the property listed in
Item 2 by the person or entity listed in Item 5.
Ktvih Da,6cnrn NV--
Date Type or Print N e
513- 2P9-1 Pao Nf A. DiNvclvor, ro3ed- ;veer
Telephone Fax , itle or A�ri
N��/1
Email Signature
Business Landowner(Provide corporate resolution on signatory authority)
I, 1.-CAORi l4C.4 ,a Notary Public of the County of N t/v i r,s
State of L9 eA- )ct ,hereby certify that K(U%n NJ o D t.4 M�'�--
personally came before me this day and acknowledged that he is D,,,(1 f
of li^ A-,Sk,rko‘ Off fAA and acknowledged,on behalf of f4t.1;4
'Cu\�,t raS ,the due execution of the foregoing instrument.
Witness my hand and official seal,this 22 day of MAD ,20 2-1
Notary Public
i
My commission expires d IOVC04.1 sr ,20 is
Individual Landowner
I, ( .i`' 11.4y.t ,a Notary Public of the County of k<A}o r\
State of Kt Au . ,hereby certify that Kt.V,\ \aJ 'C4I ,rc_
personally appeared before me this date and under oath acknowledged that the above form was executed by them.
Witness my hand and official seal,this /Z day of MA ,20 2-4
Not PuW- - --- -- - - - -
LAURA HEDGES
t
My commission expires ovIm \�r 20 Zc I Notary Commonwealth Public h Kentucky
I Commission Number KYNP39579
My Commission Expires Nov 1,2025
The Sedimentation and Pollution Control Act(Act)and the Durham City-County—Unitied'Di'ToTmni'UTt3itt"aiTEe*(Ordinance)
includes,but is not limited to,the following legal obligations of the financially responsible party:
• Maintain a set of approved sedimentation and erosion control plans, if required,on site.
• Display permit on site.
• Understand and implement any required plan,including the construction sequence and details.
• Inspect,maintain and repair sedimentation and erosion control measures,especially after rainfall events.
• Provided adequate ground cover or otherwise stabilize all areas that have not been actively graded within 21 calendar days.
• Plan and conduct all land-disturbing activity so as to prevent off-site sedimentation.
SE-03 Rev.07/06