NCC193032_Contact Update Record (LEG RESP CHANGE)_20211208

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 12/8/2021 3:19:06 PM (Contact Changes Submitted)

Certificate of NCC193032
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2019-3032
Original NOI No.* 19067
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
KSL Sedgefield Pilot, LLC
Project Name The Pilot at Sedgefield - Water and Sewer Improvements
Address 5300 High Point Road, Greensboro, NC
County Guilford
Latitude 36.0197
Longitude-79.8842
Date COC Issued * 12/10/2019
Prior Rescission Date This field will populate only if COC has already been rescinded.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 Craig Taylor
Individual (Previous)
First Name (New)* Mitch
Last Name (New) * Ritschel

NEW Legally Reflects any revisions above
Responsible Mitch Ritschel
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 235 North Edgeworth Street, 0, Greensboro,
Address (Previous) NC 27401-2217
NEW Permittee Street Address
Mailing Address* 5790 Fleet St
Address Line 2
Suite 300
City
Carlsbad
Postal / Zip Code
92008
State / Province / Region
CA
Country
us
Permittee Street 235 North Edgeworth Street, 0, Greensboro,
Address (Previous) NC 27401-2217
NEW Permittee Street Street Address
Address* 5790 Fleet St
Address Line 2
Suite 300
City
Carlsbad
Postal / Zip Code
92008
State / Province / Region
CA
Country
us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Mitch Ritschel
(Previous)
Site Contact Title General Counsel
(Previous)
Organization KSL Sedgefield Pilot, LLC
(Previous)
First Name (New)* Mitch
Last Name (New) * Ritschel

NEW Site Contact* Reflects any revisions above
Mitch Ritschel
NEW Site Contact General Counsel
Title
NEW Organization KSL Sedgefield Pilot, 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 760 804-7066
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 5790 Fleet St, Suite 300, Carlsbad, CA 92008
Address (Previous)
NEW Site Contact Street Address
Mailing Address* 5790 Fleet St
Address Line 2
Suite 300
City
Carlsbad
Postal / Zip Code
92008
State / Province / Region
CA
Country
us
Change Requested Shanel Goodwin via Modification Request submitted 12/3/2021.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation Site contact was already updated; this will update the legally responsible individual.
(Optional)
Date * 12/08/2021