NCC243376_FRO Submitted_20241031

CITY OF GREENSBORO
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
GRFNS6OkO
No person may initiate any land-disturbing activity covered by the Sedimentation Pollution Control Act before this form
has been completed and filed with the Sediment and Erosion Control Section of the City of Greensboro. (Please type
or print and, if questions are not applicable, place N/A in the blank).
Part A:
1. Project Name: Greensboro Main Event
2 Location of land-disturbing activity: 603 Guilford College Road,Greensboro,NC 27409
3 Approximate date land disturbing activity will be commenced: September 24th,2024
4. Development type: Commercial ✓ Industrial Institutional MF residential_SF residential
5. Approximate acreage of land to be disturbed: 7.9
6. Has an erosion and sediment control plan been filed? Yes ✓ No
7. Landowner(s) of Record (attach pages to list additional owners):
JS7 Properties LLC,JS8 Properties LLC,NC Greenslj
Name Telephone Email
Current Mailing Address Current Physical Street Address
Greenville SC 29602
City State Zip City State Zip
8. Deed County: Guilford Book: 8561 Page; 709
9. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name: Main Event Entertainment(Angel Robinson) Telephone: [phone]
E-mail: [e-mail] Other:
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.
Main Event Entertainment,Inc.
Name Telephone Email
1221.S.Belt Line Rd,Ste.500 same
Current Mailing Address Current Physical Street Address
Coppell TX 75019
City State Zip City State Zip

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 Telephone Email
Current Mailing Address Current Physical Street Address
City State Zip City State Zip
(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:
Brian Moran
CO—P 1 t.0 CD 1,9cI E-4-e Se(V i CeS 800-345-4647 [e-mail]
Name Telephone Email
Z(o Kt vv.. Lake Ck.) S utfe, too Same. as ma.* ►he
Current Mailing Address Current Physical Street Addcss
.c4-I e t c t I'1� a1 15"
City State Zip City State Zip
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.
(WYA M C cr/A 1 S/DtAtiT
Type or print name Title or Authority itPO23
Signature Date
I, JhPRet ►"I . g , a Notary Public of the County of b0J (aS
State of J e,XLLS , hereby certify that a rk/61.A f"IC�I .cQ key
Personally accepted before me this day and under oath acknowledged that the above form was
executed by owner(s).
Witness my hand and notarial seal, this /7 day of A-pr,r I . 20 2 3
My Commission expires $ ^ 60 - vZ�{
o,7,17,1* SHERRI M. SMITH S
;, Notary Public
STATE OF TEXAS
''F oc�� ID#247383-4
Comm.Ex � v Aug.30,2024 iI
�v