NCC221300_Contact Update Record_20240410

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 4/10/2024 1:56:12 PM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC221300
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2022-1300
Original NOI No.* 85950
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Rock Creek Investments LLC
Project Name Project KB
Address 3041 Hendren Road,WHITSETT, NC
County Guilford
Latitude 36.0582
Longitude -79.6045
Date COC Issued* 04/01/2024
Prior Rescission Date This field will populate only if COC has already been rescinded.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? Q No
0 Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 336-202-8383
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Richard Beard
Individual(Previous)
First Name(New)* Brett
Last Name(New)* Schulman

NEW Legally Reflects any revisions above
Responsible Brett Schulman
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [e-mail]
Telephone No.*
Permittee Mailing 125 South Elm Street,0, Greensboro, NC
Address(Previous) 27401-2644
NEW Permittee Street Address
Mailing Address* 1515 W.Cornwallis Drive
Address Line 2
Suite 210
City State/Province/Region
Greensboro NC
Postal/Zip Code Country
27408 us
Permittee Street 125 South Elm Street,0, Greensboro, NC
Address(Previous) 27401-2644
NEW Permittee Street Street Address
Address* 1515 W.Cornwallis Drive
Address Line 2
Suite 210
City State/Province/Region
Greensboro NC
Postal/Zip Code Country
27408 us
Change Requested Brett Schulman(Member/Manager)via Modification request submitted 4/8/2024.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 04/10/2024