NCC242435_FRO Submitted_20240826

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM p.PE,rr
SEDIMENTATION POLLUTION CONTROL ACT 47.--1e73 •
WATER RESOURCES - t�
105-B Upchurch Street O
Town of Apex, North Carolina 27502 �
ATM .
Contact: James Misciagno
Phone: [phone] E-Mail: [e-mail]
No person may initiate any land-disturbing activity on twenty(20)thousand square feet or more before this form has been
completed and filed with the Town of Apex Water Resources Department.
PART A
Name of Project:Veridea- East Village Phases 1A, 1 B, 2B, 2C
Location of Land-Disturbing Activity:Southwest corner of US HWY 1 &NC-55,Apex, NC
Approximate Date Land-Disturbing Activity will Commence:August 2024
Acreage of Land to be Disturbed:77-acres
Latitude: 35.699 Longitude: -78.839
Land Owner(s)of Record (use blank page to list additional owners):
Name: RXR Len Apex Owner LLC Name:GREENWAY WASTE SOLUTIONS OF APEX LLC
Current Mailing Address: Current Mailing Address
625 RXR Plaza 19109 W CATAWHA AVE STE 110
City,State,Zip: Uniondale, NY 11556 City,State,Zip CORNELIUS NC 28031-5613
PART B
Person or firm financially responsible(developer)for this land disturbing activity. Financial responsibility includes, but
may not be limited to: payment of civil fines and criminal penalties and any other costs associated with bringing the
project into compliance with the Town of Apex Soil Erosion and Sedimentation Control Ordinance.
Name of Person or Firm: RXR Len Apex Owner LLC (Attention: General Counsel)
Telephone: [phone] E-mail: [e-mail]
Current Mailing Address: Street Address(if different from mailing address)
625 RXR Plaza
City,State,Zip: Uniondale, NY 11556 City,State,Zip
Revised 9/19/2019 Page 1

Land Owner(s)of Record(use blank page to list additional owners):
Name: EMC CORPORATION Name:WILDBIRD LLC
Current Mailing Address: Current Mailing Address
171 SOUTH ST 3024 BUCKINGHAM WAY
City,State,Zip:HOPKINTON MA 01748-2208 City,State,Zip APEX NC 27502-8909

If the financially responsible party is not a resident of Wake County,complete the following for an appointed agent, in
Wake County,to receive any notice, process, pleading in any action or legal proceeding arising from a violation of the
Town of Apex Soil Erosion and Sedimentation Control Ordinance. By signing below,it is agreed that any notice,process,
or pleading against the person or firm who is financially responsible for this land-disturbing activity may be served on
the undersigned and shall be of the same force and effect as if served on the financially responsible person or firm. The
intent of this provision is to establish the presumption that the constructive notice from the Town of Apex will be
addressed through the undersigned agent.
RXR Len Apex Owner LLC
Name:
Telephone: [phone]
Current Mailing Address: ctreptAddress(if different from mailing address)
625 RXR Plaza 209 NORTH SALEM STREET SUITE 310
'dale. NY 11556 APEX, NC 27502
City,S City,State,Zip
r�� Todd Rechler
Signature: rid Authorized Person
If the financially responsible party is a partnership or other person engaging in business under an assumed name,complete
Page 4 of this form, or attach a copy of the Certificate of Assumed Name or Partnership as recorded in the Register of
Deeds. If the financially responsible party is a corporation, complete the information on Page 5 of this form and submit a
current copy of the Annual Report as filed with the Secretary of State.
The information contained in this form is true and correct to the best of my knowledge and belief and was provided by
me while under oath. (This form must be signed by the financially responsible person if an individual or by an officer,
director, partner, or registered agent with authority to execute instruments for a corporation or partnership if it is the
financially responsible party). I agree to provide corrected information should there be any change in the information
provided herein.
Name: Todd Rechler Date: -7 /1% 0.09.
Title or Author' - o ed Person
Signature: , ' f�/�'!
t'. i Ah A-c-1 A41 a Notary Public of the County of Af2L� �/0 w. , State
A/1w c _�( J Todd Rechler
of N�'Tiereby certify that Authorized Person personally appeared before me this
day and under oath acknowledged that the above form was executed by him/her. Witness my hand and seal this
rf `�L
JOHN P.FLANAGAN
�. NOTARY PUBLIC,STATIC NEW YORK
5 tAG ,7Registration No. 02FL6399279
Notary My Commission Expirrsualified in Queens County
Commission Expires October 15, 2027
Financial responsibility encompasses personal liability by the person signing this disclosure form, if a partner in a
partnership or if an officer or director of a corporation which is either:(a)dissolved lawfully under North Carolina statutes:
(b) suspended from transacting business in North Carolina by the North Carolina Secretary of State; (c) insolvent; (d) in
bankruptcy; (e) undercapitalized to the extent it is unable to comply with the Soil Erosion and Sedimentation Control
Ordinance; or(f) a "shell" corporation.
Revised 9/19/2019 Page 2

PART C
Contractors and/or subcontractors(person(s)or firm(s)engaging in the land-disturbing activity):
Name Person or Firm: Name of Person or Firm:
Samet Corporation
Telephone: Telephone: [phone]
Email: Email: [e-mail]
Current Mailing Address: rlrrPnt Mailing Address
�5430 Wade Park Blvd, Suite 110
City,State,Zip: City,State,Zip Raleigh, NC 27607
The information contained in this form is true and correct to the best of my knowledge and belief was provided by me
while under oath. (This form must be signed by the person or firm engaging in the land-disturbing activity of an
individual or by an officer, director, general partner, attorney-in-fact, or other person with authority to execute
instruments for the entity engaging in the land-disturbing activity if not an individual. I agree to provide corrected
information should there be any change in the information provided herein. II
Name: Todd Rechier Date: 1 I 'g 1 aC' 4
Title or Auth im - zed Person
Signature:
I, John P n ah vo+1 a Notary Public of the County of AM ,State of No#b-
Todd Rechler
NZ1.6 101Z.4 Authorized Person
C. olinia hereby certify that personally appeared before me this
day and under oath acknowledged that the above form was executed by him/her. Witness my hand and seal this
V41%— day of ii 1.1
�''�� ✓� SEAL
/6—15 ao �
Not0 v My Commission Expires
JOHN P FLANAGAN
NOTARY PUBLIC,STATE OF NEW YORK
Registration No.02FL6399279
Qualified in Queens County
Commission Expires October 15, 2027
Revised 9/19/2019 Page 3

CERTIFICATE OF ASSUMED NAME OR PARTNERSHIP
(SEDIMENTATION POLLUTION CONTROL ACT)
The undersigned,proposing to engage in business in Wake County, North Carolina,under an assumed name or partnership
name, do hereby certify that:
T e name under which the business is to be conducted is (insert assumed or partnership name):
RXR Len Apex Owner LLC
The names and residences and mailing addresses of all the owners of the business are (Insert name and address of
each owner):
RXR NC Development Partners LP -Address: 625 Plaza, Uniondale NY 11556
IN WITNESS WHEREOF,this! certificate�is�sii�gned by each of the owners of said business,this 1 0 day of
0! ` L/-
Owner's from above Sign below:
RXr. /VC 6 QJeio peen{-PAreAratJ7$I_P
By; g S r
y , t a pne rt-i- g-P uC
PI
i —
Todd Reohlal'
State of North Carolina Authorized Plif6iM
County of Wake
i, -02 h n I- P114n 6-y-n a Notary Public, do hereby certify that on this I Vac.-- day of
Todd Rechler
'011 , 9\C314 , personally appeared before me Authorized Person
who are all signers of the foregoing instrument,and each acknowledges the due execution thereof. IN WITNESS rr�
WHEREOF, I h ereunt set rdy and and official seal this I V� U )iy , ao o``T day of
\' Ili .-_-_1_,c,„ ...„23 UAL
Nota My Commissi,n Expires JOHN P. FLANAGAN
NOTARY PUBLIC,STATE OF NEW YORK
Registration No. 02FL6399279
Qualified in Queens County
Commission Expires October 15, 2027
Revised 9/19/2019 Rage 1

Name of Corporation:
Name of registered agent,street address, mailing address of registered office in Wake County:
Name:
Street Address:
City, State,Zip:
Current Mailing Address:
City, State,Zip:
Enter first, middle,and last name of principal officers. Enter title and street address of principal officers.
Name and Title: Name and Title:
Street Address: Street Address:
City, State,Zip: City, State,Zip:
Name and Title: Name and Title:
Street Address: Street Address:
City, State, Zip: City, State,Zip:
Enter first, middle,and last name of directors. Enter title and street address of directors. Attach pages as necessary.
Name and Title: Name and Title:
Street Address: Street Address:
City, State, Zip: City, State, Zip:
Name and Title: Name and Title:
Street Address: Street Address:
City, State,Zip: City, State, Zip:
Revised 9/19/2019 Page 5