NCC201529_Contact Update Record (Leg Resp Change)_20220509

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 5/9/2022 10:57:42 AM (Contact Changes Submitted)

Certificate of NCC201529
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2020-1529
Original NOI No.* 24342
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
BP NODA, LLC
Project Name The Exchange
Address 2710 Chick Godley Road, Charlotte, NC
County Mecklenburg
Latitude 35.2479
Longitude-80.8125
Date COC Issued * 05/15/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.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 Brand Morgan
Individual (Previous)
First Name (New)* Michael
Last Name (New) * Adams

NEW Legally Reflects any revisions above
Responsible Michael Adams
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 3328 Peachtree Road Northeast, Suite 100,
Address (Previous) Atlanta, GA 30326
NEW Permittee Street Address
Mailing Address* 3328 Peachtree Road Northeast
Address Line 2
Suite 100
City
State / Province / Region
Atlanta
GA
Postal / Zip Code
Country
30326
us
Permittee Street 3328 Peachtree Road Northeast, Suite 100,
Address (Previous) Atlanta, GA 30326
NEW Permittee Street Street Address
Address* 3328 Peachtree Road Northeast
Address Line 2
Suite 100
City State / Province / Region
Atlanta GA
Postal / Zip Code Country
30326 us
Change Requested Michael Adams via Modification request submitted 5/6/2022.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 05/09/2022