NCC223784_FRO Submitted_20221115

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this
form and an acceptable erosion and sedimentation control plan have been completed and approved by
the Land Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the
appropriate Regional Office. (Please type or print and, if the question is not applicable or the e-mail and/
or fax information unavailable, place N/A in the blank.)
Part A. 24 Hour Storage
1. Project Name
2. Location of land -disturbing activity: CountyCabarruS City or Township City of Concord
Highway/Street 620 Webb Rd Latitude 35.378059 Longitude-80.583977
3. Approximate date land -disturbing activity will commence: April 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 6.50
6. Amount of fee enclosed: $ 700 . The application fee of $100.00 per acre
(rounded up to the next acre) is assessed without a ceiling amount (Example: 8.10 ac = $900.00).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Randall Bozard Email Address [e-mail]
Telephone [phone] Cell # 704-779-2397 Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Velocity Property Management, Inc.
Name Telephone Fax Number
1800 Camden Road, Ste 10701 704-779-2397
Current Mailing Address Current Street Address
Charlotte, NC 28203
City State Zip City State Zip
10. Deed Book No. 15546 Page No. 0229 Provide a copy of the most current deed.
Part B.
1. Company(ies) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.) if the company or firm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party.
Velocity Property Management, Inc.
Name E-mail Address
1800 Camden Road, Ste 10701
Current Mailing Address Current Street Address
Charlotte, NC 28203
City State Zip City State Zip
Telephone [phone] Fax Number.

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(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:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
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.
Randall Bozard President
Type or print name Title or Authority
Sig ature Date
------------------------------------------------------------------------------------------------......__------------------------
I, a Notary Public of the County of UuLyr V.
State of North Carolina, hereby certify that j �____ 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 D d
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NOTARY PUBLIC
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My commission expires

Jet_ BUSINESS CORPORATION ANNUAL REPORT
1/6/zozz
NAME OF BUSINESS CORPORATION: Velocity Property Management, Inc.
SECRETARY OF STATE ID NUMBER: 1270230 STATE OF FORMATION: NC
REPORT FOR THE FISCAL YEAR END: 12/31 /2021
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: Bozard. Randall
2. SIGNATURE OF THE NEW REGISTERED AGENT:
Filing Ut ice Use Unly
E - Filed Annual Report
1270230
CA202209301438
4/3/2022 05:00
❑X Changes
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
1800 Camden Rd Ste 10701 1800 Camden Rd Ste 10701
Charlotte, NC 28203 Mecklenburg County
SECTION B: PRINCIPAL OFFICE INFORMATION
Charlotte, NC 28203
1. DESCRIPTION OF NATURE OF BUSINESS: Property Management
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS 5. PRINCIPAL OFFICE MAILING ADDRESS
1800 Camden Rd. Ste 10701
Charlotte, NC 28203
1800 Camden Rd. Ste 10701
Charlotte, NC 28203
6. Select one of the following if applicable. (Optional see instructions)
❑ The company is a veteran -owned small business
❑ The company is a service -disabled veteran -owned small business
SECTION C: OFFICERS (Enter additional officers in Section E.)
NAME: Randall Bozard
TITLE: Pracirlanf
ADDRESS:
1800 Camden Rd Ste 10701
Charlotte, NC 28203-4690
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business
entit .
Randall Bozard 4/3/2022
SIGNATURE DATE
Form must be signed by an officer listed under Section C of this form.
Randall Bozard President
Print or Type Name of Officer Print or Type Title of Officer
This Annual Report has been filed electronically.
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525