HomeMy WebLinkAboutNCG060126_Name Change Form_20180307�' Division of Energy, Mineral & Land Resources FOR AGENCY USE ONLY
• Date Received
Land Quality Section/Stormwater Permitting Year Month Day
A7011
NC®�Nit �®® National Pollutant Discharge Elimination System
No- CAR- Dtvurtr+Erm OF
ENVIRONMENT-NRURAL RESOURCES PERMIT NAME/OWNERSHIP CHANGE FORM
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
a 16 10 2
II. Permit status prior to requested change. / /
a. Permit issued to (company name): S� t re%c� F1112. 10-j �0jQ 01- 'T1' dq —TPrdZ ) u i5�c
b. Person legally responsible for permit: Coil Id
First MI Last
Ge_k /tt- -
RECEIVED Tale
MAR 07 2018 Pe_rmitt Halder Mailing Address 9 Q Z
DENR-LAND QUALITY city State Zip
STORMWATER PERMITTING 0t a )gra 7 6 7 S 0 S2 g"7
P on Fax I �,,
c. Facility name (discharge): itU(�io�, I L/' s
d. Facility address: X55 (_>q <1�1 LA-)
1I Address
-THLA ed A) ( _
City State Zi �/7
e. Facility contact person: Rob cit (0 ) X d- � 7
First / MI /Last Phone
III. Please provide the following for the requested hange (revised permit).
a. Request for change is a result of: hange in ownership of the facility
VName change of the iaciiity or owner
If other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit:
First MI Last
Title
Po � 0 X em
Permit Holder Mailing Address
rml- _Reel A-) L a93I
City"-� / & �/ 7 State J Zip C L`
(Cft�3) SVJ 7 1- C1-QweoSe )tit of Lt7t^
Phon E-mail Address
d. Facility name (discharge): 5 ; � �� F,re5t", CO2—-t4-yz-
e. Facility address: 15 65 5 1A is � w--, A'1 t,0
�I Addre s
tty tate Zip t
f. Facility contact person: �t� j MEt f ,,- ms
First MI Last
C'757) & ► 3 13 3 i /` �� � �r i 5 el*
Phone
E-mail Address
IV. Permit contact information (if different from the person legally responsible for the permit)
Revised Jan 27, 2014
NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
First MI Last
Title
Pa P) ox ` /`ij
Permit contact:
T Ly e,�/Mailing Address
2 -
City StateZip
(�s�) 613 i33i r�11�m��e 5,�t;�Il
Phone E-mail Address
V Will the permitted facility continue to conduct the same industrial activities conducted prior
tot ownership or name change?
Yes
❑ No (please explain)
Require Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE COMPLETE OR MISSING: j
LT This completed application is required for both name change and/or ownership change
equests.
Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PER IT CERTIFICATION (Permit holder prior to ownership change):
I, C ��N t that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all req 'red supporting information is not included, this application package will be
returned -as incomplete.• --- --- - - ---- - _-
C9�� l
Simnature Date
APPLICANT CERTIFICATION
attes that this application for aname/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan. 27, 2014
Delaware Page 1
The First State
I, JEFFREY W. BULLOCK, SECRETARY OF STATE OF THE STATE OF
DELAWARE, DO HEREBY CERTIFY THE ATTACHED IS A TRUE AND CORRECT
COPY OF THE CERTIFICATE OF INCORPORATION OF "SMITHFIELD FRESH
MEATS CORP.", FILED IN THIS OFFICE ON THE SIXTH DAY OF
NOVEMBER, A.D. 2017, AT 2:27 O'CLOCK P.M.
AND I DO HEREBY FURTHER CERTIFY THAT THE EFFECTIVE DATE OF
THE AFORESAID CERTIFICATE OF INCORPORATION IS THE EIGHTH DAY OF
NOVEMBER, A.D. 2017 AT 12:01 O'CLOCK A.M.
A FILED COPY OF THIS CERTIFICATE HAS BEEN FORWARDED TO THE
NEW CASTLE COUNTY RECORDER OF DEEDS.
6605607 8100 ` 0IV
SR# 20176947282
You may verify this certificate online at corp.delaware.gov/authver.shtml
w ---y—
Jaffray W. Bullock. Stmtary of Slate
Authentication: 203529372
Date: 11-07-17
State- of Delamare
Secretan of State
DiTision of Corporatlons
Delkered 02:27 PM 11/0612017
FILED - 02:27 P11f 1110612017 CER'T'IFICATE OF INCORPORATION
SR 20176947281 - He Number 6605607
Ki
SMITHFIELD FRESH MEATS CORP.
ARTICLE FIRST
The name of the corporation is Smithfield Fresh Meats Corp. (the "Corporation'l.
ARTICLE SECOND
The address ofthe Corporation's Registered Office in the State ofDelaware is 1209 Orange'
Street, Corporation Trust Center, in the City of Wilmington, County of New Castle, State of
Delaware, 19801. The name of the Registered Agent at such address is The Corporation Trust
Company,
ARTICLE THIRD
The purpose of the Corporation is to engage in any lawful act or activity for which
corporations may be organized under the General Corporation Law of Delaware, but the
Corporation is not formed to engage in any act or activity requiring the consent or approval of any
state or federal official, department, board. agency or other body without such consent or approval
first being obtained.
ARTICLE FOURTH
The total number of shares of capital stock of the Corporation which the Corporation shall
have authority to issue is 1,000 shares, with no par value,
ARTICLE FIFTH
A. The business and affairs of the Corporation shall be managed by or under the
direction of a board of directors (the "Board"), except as may be otherwise provided in the
Delaware General Corporation Law or in this Certificate of Incorporation. If any such provision
is made in this Certificate of Incorporation, the powers and duties conferred or imposed upon the
Board by the Delaware General Corporation law shall be exercised or performed to such extent
and by such person or persons as shall be provided for in this Certificate of Incorporation.
B. Unless and except to the extent that the Bylaws of the Corporation shall be so
required, the election of directors of the Corporation need not be by written ballot,
ARTICLE SIXTH
The name and mailing address of the incorporator is:
Michael H. Cole
c/o Smithfield Foods, Inc.
200 Commerce Street
Smithfield, Virginia 23430
ARTICLE SEVENTH
The Board is expressly authorized to make, alter or repeal Bylaws of the Corporation but
the stockholders may make additional Bylaws and may alter or repeal any Bylaw whether adopted
by them or otherwise.
ARTICLE EIGHTH
Whenever a compromise or arrangement is proposed between the Corporation and its
creditors or any class of them and/or between the Corporation and its stockholders or any class of
them, any court of equitable jurisdiction within the State of Delaware may, on the application in a
summary way of the Corporation or of any creditor or stockholder thereof, or on the application
of any receiver or receivers appointed for the Corporation under the provisions of Section 291 of
the Delaware General Corporation Law or on the application of trustees in dissolution or of any
receiver or receivers appointed for the Corporation under the provisions of Section 279 of the
Delaware General Corporation Law order a meeting of the creditors or class of creditors, and/or
of the stockholders or class of stockholders of the Corporation, as the case may be, to be summoned
in such manner as the said court directs. If a majority in number representing three-fourths (3/4)
in value of the creditors or class of creditors, and/or of the stockholders or class of stockholders of
the Corporation, as the case may be, agree to any compromise or arrangement and to any
reorganization of the Corporation as a consequence of such compromise or arrangement, the said
compromise or arrangement and the said reorganization shall, if sanctioned by the court to which
the said application has been made, be binding on all the creditors or class of creditors, and/or on
all the of the stockholders or class of stockholders, ofthe Corporation, as the case may be, and also
on the Corporation.
ARTICLE NINTH
No director of the Corporation shall be liable to the Corporation or its stockholders for
monetary damages for breach or breaches of fiduciary duties as a director, provided that the
provisions of this article shall not eliminate or limit the liability of a director (i) for any breach of
the director's duty of loyalty to the Corporation or its stockholders, (ii) for acts or omissions not
in good faith or which involve intentional misconduct or a knowing violation of the law, (iii) under
Section 174 of the Delaware General Corporation Law, or (iv) for any transaction for which the
director derived an improper personal benefit. The Corporation shall, to the fullest extent permitted
by Section 145 of the Delaware General Corporation Law, as the same may hereafter be amended
or supplemented, indemnify any and all directors, officers, employees and agents of the
Corporation whom it shall have power to indemnify under such Section from and against any and
all expenses (including attorneys' fees), judgments, fines, amounts paid in settlement and other
liabilities in respect of all matters referred to in or covered by such Section. The indemnification
provided for herein shall not be deemed exclusive of any other rights to which those indemnified
may be entitled under any bylaw, agreement, vote of stockholders or disinterested directors, or
otherwise, and shall continue as to a person who has ceased to be a director, officer, employee or
agent and shall inure to the benefit of the heirs, executors, administrators and personal
representatives of such director, officer, employee or agent. No amendment to or repeal of this
Article NINTH shall apply to or have any effect on the liability or alleged liability of any person
for or with respect to any acts or omissions of such person occurring prior to such amendment or
repeal.
ARTICLE TENTH
This Certificate of Incorporation shall be effective as of 12:01 a.m., Eastern Time, on
November 8, 2017,
[Signature Page Follows]
IN WITNESS WHEREOF, I have signed this certificate of incorporation this 31d day of
November, 2017.
", v' `C- .^�..
Michael II. Cole
Incorporator
[Signature Page to Smithfield Fresh Meats Corp. Certificate of Incorporation]
Harris, Robert
From: Bailey, Keith
Sent: Monday, January 08, 2018 12:46 PM
To: Prentice, Charlie; Harris, Robert; Bowen, Frederick; Barnett, Joseph W.; Park, Christy; Strong,
Kerry B.; McAuley, Pam; Meyer, John
Subject: Fwd: Legal docs name change
Attachments: image001.jpg; ATT00001.htm; Smithfield Fresh Meats Corp.-DE-Incorporation.pdf;
ATT00002.htm; Certificate of Amendment (Name Change) EFFECTIVE 10-30-2017.pdf;
ATT00003.htm
Here the legal docs required for the ownership change. It is a new owner for everyone except Charlotte.
Tax ID to follow.
Keith Bailey
Smithfield Foods, Inc
757 613 1283.
Begin forwarded message:
From: "Saunders, Kelly" <ksaunders@smithfield.com>
Date: January 8, 2018 at 12:28:52 PM EST
To: 'Bailey, Keith" <kbailey@smithfield.com>
Cc: "Meyer, John" <jwmeyer@smithfield.com>
Subject: RE: Legal docs name change
Keith,
The legal documents are attached. Smithfield Fresh Meats Corp. is a new entity this was not a name
change. John Morrell & Co. changed its name to Smithfield Packaged Meats Corp.
The facilities that fall under packaged and fresh are noted below.
Smithfield Packaged Meats Corp. are:
Cumming, GA
Charlotte, NC (formerly Stefano Foods)
Wilson, NC
Kinston, NC
Smithfield Fresh Meats Corp. are:
Tar Heel, NC
Clinton, NC
Clayton, NC
Thank you,
Kelly N. Saunders
Paralegal
Form
w-9
Request for Taxpayer
Give Form to the
(Rev. December 2014)
Identification Number and Certification
requester. Do not
Department
of the Treasury
send to the IRS.
Internal Revenue Service
1 Name (as shown on your income tax return). Name is required on this line, do not leave this line blank
SMITHFIELD PACKAGED MEATS CORP.
N
2 Business nameldisregarded entity name, if different from above
m
rn
a
3 Check appropriate box for federal tax classification; check only one of the following seven boxes
4 Exemptions (codes apply only to
H
❑IndividuaVsole proprietor or
P p ❑✓ C Corporation ❑ S Corporation ❑ Partnership ❑ TrusVestate
certain entities, not individuals, see
instructions on page 3):
CL m C
o
single -member LLC
Limited liabilitycompany Enter the tax classification C=C corporation, S=S corporation, P=partnership) 0,
❑ P y ( p P)Exemption
Exempt payee code (if any) 5
`p
Note. For a single -member LLC that is disregarded, do not check LLC, check the appropriate box in the line above for
from FATCA reporting
the tax classification of the single -member owner.
code (IT any) E
t c
IL o
❑Other (see instructions) ►
(gapMs to ea•unrs ma,nroureu ansae u,c u sI
6 Address (number, street, and apt or suite no)
Requester's name and address (optional
D
'CL
200 COMMERCE STREET
co
6 City, state, and ZIP code
C0
SMITHFIELD, VA 23430
7 List account number(s) here (optional)
lkiQfn Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid social security number
backup withholding For individuals, this Is generally your social security number ( page However, for a - m -
resident alien, sole proprietor, or disregarded entity, see the Part I Instructions on page 3. For other
entitles, it Is your employer Identification number (EIN). If you do not have a number, see How to get a
TIN on page 3, or
Note. If the account is In more than one name, see the instructions for line 1 and the chart on page 4 for I Employer identification number
guidelines on whose number to enter.
Certification
Under penalties of perjury, I certify that.
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be Issued to me); and
2 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. 1 am a U.S. citizen or other U.S person (defined below); and
4. The FATCA code(s) entered on this form (if any) Indicating that I am exempt from FATCA reporting Is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all Interest and dividends on your tax return. For real estate transactions, Item 2 does not apply. For mortgage
interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and
generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the
Instructions on page 3.
Sign Signature of �� ���
Here U.S. person ► ` �t+a%cd"NL- �� W Date 10 -
General
General Instructio
Section references are to the Internal Revenue Code unless otherwise noted
Future developments Information about developments affecting Form W-9 (such
as legislation enacted after we release it) is at www.irs govlAv9
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an information
return with the IRS must obtain your correct taxpayer identification number (TIN)
which may be your social security number (SSN), Individual taxpayer identification
number ([TIN), adoption taxpayer identification number (ATIN), or employer
Identification number (EIN), to report on an Information return the amount paid to
you, or other amount reportable on an Information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099 -INT (interest earned or paid)
• Form 1099 -DIV (dividends, Including those from stocks or mutual funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)
• Form 1099-B (stock or mutual fund sales and certain other transactions by
brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage Interest), 1098-E (student loan Interest), 1098-T
(tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U S person (including a resident alien), to
provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might be subject
to backup withholding See What is backup withholding? on page 2
By signing the filled -out form, you.
1 Certify that the TIN you are giving is correct (or you are waiting for a number
to be Issued),
2 Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U S exempt payee If
applicable, you are also certifying that as a U.S person, your allocable share of
any partnership income from a U.S trade or business Is not subject to the
withholding tax on foreign partners' share of effectively connected income, and
4 Certify that FATCA code(s) entered on this form (if any) Indicating that you are
exempt from the FATCA reporting, is correct See What is FATCA reporting? on
page 2 for further information.
Cat No. 10231X Form W-9 (Rev 12-2014)
Harris, Robert
From: Bailey, Keith
Sent: Monday, January 08, 2018 12:50 PM
To: Harris, Robert; Bowen, Frederick; Prentice, Charlie; Strong, Kerry B.; McAuley, Pam; Barnett,
Joseph W.; Park, Christy; Meyer, John
Subject: Fwd: Legal docs name change
Attachments: image001.jpg; ATT00001.htm; image004.jpg; ATT00002.htm; FEIN Smithfield Fresh Meats
Corp.pdf; ATT00003.htm; W9 w 200 Commerce Str address.pdf; ATT00004.htm
See federal tax ID number below.
Keith Bailey
Smithfield Foods, Inc
757 613 1283.
Begin forwarded message:
From: "Saunders, Kelly" <ksaunders(d,)smithfield.com>
Date: January 8, 2018 at 12:41:00 PM EST
To: 'Bailey, Keith" <kbailey@smithfield.com>
Cc: "Meyer, John" <jwmeyer@smithfield.com>
Subject: RE: Legal docs name change
Smithfield Fresh Meats Corp. tax id number is 30-1010290
Smithfield Packaged Meats Corp. tax id number is 36-2332471
Kelly N. Saunders
Paralegal
3/1/2018
(757) 357-8161 tel
(757) 357-8165 fax
(804) 690-5430 mobile
ksaunders@smithfield.com
Smithfield Foods
200 Commerce Street
Smithfield, VA 23430
www.smithfieldfoods.com
From: Saunders, Kelly
Sent: Monday, January o8, 201812:29 PM
To: Bailey, Keith <kbailey@smithfield.com >
Cc: Meyer, John <jwmeyer@smithfield.com >
Subject: RE: Legal docs name change
Keith,
ATT00001 (003).htm
The legal documents are attached. Smithfield Fresh Meats Corp. is a new entity this was not a name change. John Morrell & Co. changed its name to
Smithfield Packaged Meats Corp.
The facilities that fall under packaged and fresh are noted below.
Smithfield Packaged Meats Corp. are:
Cumming, GA
Charlotte, NC (formerly Stefano Foods)
Wilson, NC
Kinston, NC
file:///C:/Users/buddyharris/AppData/Local/Microsoft/Windows/Temporary%201ntemet%20Files/Content.Outlook/7CU24XLI/ATT00001%20(003) htm
1/2
3/1/2018
Smithfield Fresh Meats Corp. are:
Tar Heel, NC
Clinton, NC
Clayton, NC
Thank you,
Kelly N. Saunders
Paralegal
ATT00001 (003).htm
file:///C•/Users/buddyharris/AppData/Local/Microsoft/Windows/Temporary%201ntemet%20Files/Content Outlook/7CUMLI/ATT00001 %20(003).htm 2/2