NCC222729_FRO Submitted_20220729

=�w WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
P:T1 SEDIMENTATION POLLUTION CONTROL ACT
`HAKENo person may initiate any land -disturbing activity on one or more acres as covered by the Wake
County Unified Development Ordinance before this form and an acceptable erosion and
COUNTY sedimentation control plan have been completed and approved by Wake County Department of
NORTH CAROLINA Environmental Services, Water Quality Division. (Please type or print and, if the question is not
applicable, place N/A in the blank.)
Part A.
0
Project Name Flexshell -Morrisville
2. Location of land -disturbing activity: Jurisdiction Morrisville
3
4
Highway/Street Southport Drive Latitude 35.835521 °
Approximate date land -disturbing activity will commence: 8/1/2022
(Wake Co. or Municipality)
Longitude-78.825077'
Type of development (residential, commercial, industrial, institutional, etc.): Industrial
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): 10.29 Acres
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Tim Wipperman E-mail Address [e-mail]
Telephone [phone]
Cell # N/A
Fax # N/A
7. Landowner(s) of Record (attach accompanied page to list additional owners):
CMP Management, LLC as Manager of 401 Southport, LLC 813-598-7344
Name(s) Telephone
400 N. Ashley Drive 400 N. Ashley Drive
Current Mailing Address Current Street Address
cbrewer(cb_cmpreit.com
Fax or E-mail address
Tampa FL 33602 Tampa FL 33602
City State Zip City State Zip
8. Deed Book No. 019091 Page No. 01190 Provide a copy of the most current deed.
Part B.
1. Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet. Include requested information):
CMP Management, LLC as Manager of 401 Southport, LLC [e-mail]
Name E-mail Address
400 N. Ashley Drive 400 N. Ashley Drive
Current Mailing Address Current Street Address
Tampa FL 33602 Tampa FL 33602
City State Zip City State Zip
Telephone [phone] Fax Number N/A

2. (a) If the Financially Responsible Party is not a resident of Wake County, identify a designated agent in
Wake County to receive any notice, process, pleading in any action or legal proceeding arising out of any
matter relating to the Wake County Erosion and Sedimentation Control Ordinance and/or Land
Disturbance Permit:
Ragsdale Liggett, PLLC, Attn: Eric R. Spence
Name
2840 Plaza Place, Suite 400
Current Mailing Address
Raleigh NC 27612
City State Zip
Telephone [phone]
[e-mail]
E-mail Address
2840 Plaza Place, Suite 400
Current Street Address
Raleigh NC 27612
City State Zip
Fax Number 919.783.8991
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible
Party is a Corporation, give name and street address of the Registered Agent:
N/A
Name of Registered Agent
N/A
Current Mailing Address
N/A N/A N/A
City State Zip
Telephone N/A
N/A
E-mail Address
N/A
Current Street Address
N/A N/A N/A
City State Zip
Fax Number N/A
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath (This form must be signed by the Financially Responsible Person if an individual
or his attorney -in -fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Person). I agree to provide
corrected information should there be any change in the information provided herein.
CHRISTOPHER W. BREWER, MANAGER OF
CMP MANAGEMENT, LLC, MANAGER OF Manager
401 SOUTHPORT, LLC
Type or print name
Signature
Title or Authority
7/26/12
Date
I, 4^64-(U T . a Notary Public of the County of Hillsborough, State of Florida
Ij
State ef hereby certify that Christopher W. Brewer, as Manager appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal, this 26 day of July
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