NCC214093_Contact Update Record_20221215

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 12/15/2022 11:51:29 AM (Contact Changes Submitted)

Certificate of NCC214093
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2021-4093
Original NOI No.* 58852
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Wake County Board of Education
Project Name Elementary School 51 Site Construction
Address Woods Creek Road, Holly Springs, NC
County Wake
Latitude 36.0000
Longitude-79.0000
Date COC Issued * 07/22/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.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
[e-mail]
NEW Billing Email
[e-mail]
Billing Telephone No.
919-694-0232
NEW Billing
[phone]
Telephone No.
(Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible David Neter
Individual (Previous)
First Name (New)* Mark
Last Name (New)* Strickland

NEW Legally Reflects any revisions above
Responsible Mark Strickland
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 5625 Dillard Dr., Crossroad Building 1, Cary,
Address (Previous) NC 27518
NEW Permittee Street Address
Mailing Address* 100 Corning Road
Address Line 2
Suite 190
City State / Province / Region
Cary NC
Postal / Zip Code Country
27518 United States
Permittee Street 5625 Dillard Dr., Crossroad Building 1, Cary,
Address (Previous) NC 27518
NEW Permittee Street Street Address
Address* 100 Corning Road
Address Line 2
Suite 190
City State / Province / Region
Cary NC
Postal / Zip Code Country
27518 United States
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact William Hartley
(Previous)
Site Contact Title Director
(Previous)
Organization Wake County Board of Education
(Previous)
First Name (New)* Douglas
Last Name (New) * Congdon

NEW Site Contact*
Reflects any revisions above
Douglas Congdon
NEW Site Contact
Program Executive, Facilities Design and Construction
Title
NEW Organization
Wake County Public School System
This field is not required on the NOI form and may not pre -populate.
Site Contact Email
[e-mail]
(Previous)
NEW Site Contact
Email*
Site Contact
Telephone No.
(Previous)
[e-mail]
919-588-3577
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 5625 Dillard Dr., Crossroad Building 1, Cary,
Address (Previous) NC 27518
NEW Site Contact Street Address
Mailing Address* 5625 Dillard Dr.
Address Line 2
Crossroad Building 1
City State / Province / Region
Cary NC
Postal / Zip Code Country
27518 United States
Change Requested Douglas Congdon via emails on 8/18 and 12/15/2022 (provided form for Legally
by: * Responsible individual change).
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 12/15/2022