HomeMy WebLinkAboutNCG180242_Ownership Change Form_20180208IT
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Division of Energy, Mineral &Land Resources FOR AGENCY USE ONLY
Date Received
Land Quality Section/Stormwater Permitting Year Month Da
NC®ENR
National Pollutant Discharge Elimination System
U. u'a
PERMIT NAME/OWNERSHIP CHANGE FORM
I. Please enter the permit number for which the change is requested.
NPDES Permit
(or) Certificate of Coverage
N I C I S 10 11 1 8 1 0 1 0 0
N I C I G 11 1 8 10 12 14 1 2
II. Permit status prior to requested change.
a. Permit issued to (company name):
Kohler Company
b. Person legally responsible for permit:
First MI Last
r
ulyIr - C-► dock LH S
RECEIVED
Title
444 Highland Drive
FEB Q 8 2018
Permit Holder Mailing Address
Kohler 5 044
DENR-LAND QUALITY
City State Zip
ip
STORM111ATER PERMITTING
( 920) 457-4441 ( )
Phone Fa.�
c. Facility name (discharge):
Baker Furniture
d. Facility address:
1 Baker Way
Address
Connelly Springs, NC 28612
City State Zip
e. Facility contact person:
Will L. Stange ( 828 ) 397-1255
First / MI /Last Phone
III. Please provide the following for the requested change (revised permit).
- a. Request for change is a result of
® Change in ownership of the facility
® Name change of the facility or owner
If other please explain:
b. Permit issued to (company name):
Baker Interiors Furniture Company
c. Person legally responsible for permit:
Kevin E. Ward
First MI Last
COO
Title
1105 22nd Street SE
Permit Holder Mailing Address
Hickory NC 28602
City State Zip
) 624-7000 kward@Bakerinteriorsgroup.com
_(828
Phone E-mail Address
d. Facility name (discharge):
Baker Interiors Furniture Company
e. Facility address:
1 Baker Way
Address
Connelly Springs, NC 28612
City State Zip
f. Facility contact person:
Will L. Stange
First Ml Inst
wstange@Bakerinteriorsgroup.com
( 828 ) 397-1255
E-mail Address
Phone E-mail Address
IV. Permit contact information (if different from the person legally responsible for the permit)
12012
Revised Jan. 27. 2014
n
NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact: Will L. Stange
First Ml Last
Project Safety Specialist
Title
1 Baker Way
Mailing Address
Connelly Springs, NC 28612
City State Zip
wstange@Bakerinteriorsgroup.com ( 828 ) 397-1255
E -Mail Address Phone E-mail Address
V Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
......................................................................................................................
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package -will be
returned as incomplete.
Signature f Date
APPLICANT CERTIFICATION
I, � attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
( I � 131 I IV
Signature bate
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan. 27, 2014
STOCK POWER
FOR VALUE RECEIVED, the undersigned, Kohler Co. ("Seller"), hereby sells, assigns, and
transfers unto S son Investment Holding Co., Thirty -Five Thousand (35,0) shares of Common
Stock, no par alue, of KOHLER INTERIORS GROUP, LTD,, a Dela are corporation (the
"Corporation"), standing in the name of Seller on the books of the Corporation, represented by
Certificate No. 24, and herewith irrevocably constitutes and appoints
attorney to transfer such stock on the books of the Corporation with full power of substitution in the
premises.
Dated effective as of tib, as of the 1 day of , 2017.
KO7ER CO.
Name: James M. (Buddy) Robinson IV
Title: Sr. Vice President — General Counsel, Corporate
Secretary and Business Development
7� 08 2018
1 140 Pa a n
MIL -27597590-1
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OF THE STATE OF DELAWARE
ThisCclificsTha at Kohler Co, ,!l���,®�r��7�i,
Thirty -Five Thousand (36,000)
SHARES OF CAPITAL STOCK OF KOHLER INTERIORS GROUP, LTi).
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21st �i �� February �'.�. 2017
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Delaware Page
The First State
I, JERMWY W. SrwC9, SECRETARY OF STATE OF THE S OF
DELAWARE, DO HEREBY (CERTIFY THE ATTACHED IS A. TRUE AND CORRECT
COPY OF THE CERTIFICATE OF ABOND NT OF "ME1LER INTERIOR'S
GROUP, LTD.", CHANGING ITS NABM FROM "HOHLER INTERIORS GROUP,
LTD." TO "BArM INTERIORS GROUP, LTD_", FILED IN THIS OFFICE ON
THE; TWENTY—EIGHTH DAY OF FEBRUARY, : A. D. 2017, AT 12.03 O ' CLOCK
A FILED COPY OF THIS CERTIFICATE HAS BEEN FORWARDED TO THE
NEW CASTLE COUNTY RECORDER OF DEEDS.
649524 8100 \�v
SR# 20171384720
You may verify this certificate online at corp.delaware.gov/authver.shtmi
\/-nA�(�:
.Ja7rTl Yl, Bu119GR.SKMtuY of Sats
Authentication: 202113357
Date: 02-28-17
� •�. ... � n� .� .. _��- -� ...r. ,_..-.- .. ....,rn F ._..� .. _ .. _. ... r. - ..-v�♦ � +iv a.,.- sxa_ a._. ._. �� r �.x-i a .. �- � _ - i r
State of Delaware
Secretary of State
Division of Corporations
Delivered 12:03 Elf 02128/1017
MED 12:03 Elf 02/29N17 CERTIFICAf I'E of AAMNDMENT
SR 20171384720 - Re:Vomber 649524 TO THE
CERTIFICATE gfINCORPORATION
I of
KOHLER INTERIORS GROUP, ETD.
KOHLER INTERIORS GROUP, Lt, a corporation organized and existing under the
General Corporation Law of the State of Dela are does hereby certify that:
1. The name -of the corporation is KOHLER INTERIORS GROUP, LTD.
2, The Certificate of Incorporation ofthe corporation is hereby amended by deleting the
text of Article I in its entirety and replacing it with the following text:
"ARTICLE I: The name of the Corporation. is BAKER INTERIORS
GROUP, LTD."
3. The above amendment was duly adopted in accordance with the applicable provisions
of Section 242 and 228 of the General Corporation Law of the State of Delaware.
IN WITNESS WHEREOF, Kohler Interiors Group, LTD, has caused this Certificate to be
signed by James M. (Buddy) Robinson IV, its Vice President and Secretary this 28°i day of February,
2017.
J s M. {Buddy} Robinson .
Vice President and Secretary
NUL-27SO2462-1
k --
NORTH CAROLINA
e
Department of the Secretary of State
31 h
r.�
To all whom these presents shall elome, Greetings:
1, Elaine F. Marshall, Secretary of State of the State of North Carolina, do hereby certify
the following and hereto attached to be a true copy of
ARTICLES OF AMENDMENT
OF
KOHLER INTERIORS FURNITURE COMPANY
WHICH CHANGED ITS NAME TO
BAKER INTERIORS FURNITURE COMPANY
the original of which was- filed in this office on the 28th day of February, 2017.
Scan to verify online.
Documenthh 0201705900811
Verify this certificate online at hitp://www.sasne.gov/verification
IN WITNESS WHEREOF, I have hereunto set
my hand and affixed my official seat at the City
of Raleigh, this 28th day of February, 2017.
0.0
Secretary of State
SOSID: 0009377
Date Filed: 2/28/2017 2:39:00 PM
Elaine F. Marshall
North Carolina Secretary of State
C2017 059 00811
ARTICLES oJAM ENDMENT
TO THE
ARTICLES ojINCORPORATION
Of
KOHLER INTERIORS FURNITURE COMPANY
Pursuant to § 55-10-06 of the General Statutes of North Ca olina, the undersigned
corporation hereby submits the following Articles of amendment for the purpose of amending its
Articles Pf Incorporation: .
1! The name of the corporation is KOALER INTERIORS FURNITURE COMPANY.
2. The Articles of Incorporation are hereby amended by deleting the text of Item no.1 in
its entirety and by substituting therefor the following Item no. 1:
"I. The name ofthe Corporation is BAKER INTERIORS FURNITURE i
COMPANY."
3. The amendme t -does not provide for an exchange, reclassification, or cancellationof
issues shares. =--- -
4. The date of adoption of the amendment is February 28, 2017.
•5. The amendment was approved by shareholder action, and such shareholder approval
was obtained as required by Chapter 55 of the North Carolina General Statutes.
6. These articles will be effective as of February 28, 2017.
This the 28m day of February, 2017.
KOHLEA INTERIORS FURNITURE
COMPANY
Js M. (Buddy) Robinson IV
Sr ice Preside
ntyint and Secretary
NUL-27505183-1 .