NCC192835_Contact Update Record_20210406

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany 4/6/2021 3:15:09 PM (Contact Changes Submitted)

Certificate of NCC192835
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2019-2835
Original NOI No.* 18587
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new OOC required)
City of Fayetteville - Fayetteville Regional Airport
Project Name
Fayetteville Regional Airport Terminal Improvements - Phase 2
Address
400 Airport Road, Suite 1, Fayetteville, NC
County
Cumberland
Latitude
35.0000
Longitude
-79.0000
Date COC Issued*
11/20/2019
Prior Rescission
This field will populate only if COChas already been rescinded.
Date
Which Contacts
f Billing Only
Have Changed?*
f Legally Responsible Individual Only
f Site Contact Only
r BOTH Legally Responsible Individual and Site Contact
Has Billing Contact
Choose'Yes'torevise Billing Contact details.
Changed?
r No
r Yes
Billing Email
NEW Billing Email [e-mail]
Billing Telephone
No.
NEW Billing [phone]
Telephone No. (Cptional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Bradley Whited
Individual
(Previous)

First Name (New)* Alvester Toney
Last Name (New) * Coleman
NEW Legally Reflects any revisions above
Responsible Alvester Toney Coleman
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee 910-433-1160
Telephone No.
(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 400 Airport Road, 0, Fayetteville, NC 28306-
Address (Previous) 8872
NEW Permittee
Mailing Address*
Street Address
400 Airport Road
Address Line 2
Suite 1
City
Fayetteville
Fbstal / Zip Code
28306
State / Rovince / R gion
NC
Country
us
Permittee Street 400 Airport Road, 0, Fayetteville, NC 28306-
Address (Previous) 8872
NEW Permittee Street Address
Street Address* 400 Airport Road
Address Line 2
Suite 1
aty
State / Rovince / Region
Fayetteville
NC
Fbstal / Zip Code
Country
28306
us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Bradley Whited
(Previous)
Site Contact Title Airport Director
(Previous)
Organization Fayetteville Regional Airport
(Previous)

First Name (New)*
Alvester Toney
Last Name (New) *
Coleman
NEW Site Contact*
Reflects any revisions above
Alvester Toney Coleman
NEW Site Contact
Airport Director
Title
NEW Organization Fayetteville Regional Airport
This field is not required on the N01 form and nay not pre -populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email *
Site Contact 910-433-1160
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 400 Airport Road, 0, Fayetteville, NC 28306-
Address (Previous) 8872
NEW Site Contact
Mailing Address*
Street Address
400 Airport Road
Address Line 2
Suite 1
City
Fayetteville
Postal / Zip Code
28306
State / province / Region
NC
Country
us
Change Requested Alvester Coleman on 3/26/2021 (submitted Mod request for this project as new
by: Airport Director)
Include any additional correspondence records in the Repository CDC folder.
Additional Information for this update to contact information:
Addional Legally responsible person change form provided 4/6/2021 via e-mail.
Explanation
(Optional)
Date * 04/06/2021