NCC205305_Contact Update Record (Legally Resp Change)_20230316

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by bethany.georgoulias 3/16/2023 1:44:40 PM (Contact Changes Submitted)

Certificate of
NCC205305
Coverage (COC) No.*
Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No.
NCG01-2020-5305
Original NOI No.*
36479
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
City of Greensboro
Project Name NCC-GUILF-2021-Contract 2018-051A, Davie Street Streetscape Improvements
Address 200 N. to 339 S. Davie Street, Greensboro, NC
County Guilford
Latitude 36.0718
Longitude-79.7891
Date COC Issued * 12/02/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.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
n Yes
Billing Email
NEW Billing Email [e-mail]
Billing Telephone No.
NEW Billing (Optional)
Telephone No.
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible John Fersner
Individual (Previous)
First Name (New)* Jason
Last Name (New)* Geary

NEW Legally Reflects any revisions above
Responsible Jason Geary
Individual*
Permittee Email
[e-mail]
(Previous)
NEW Permittee
[e-mail]
Email*
Permittee Telephone
[phone]
No. (Previous)
NEW Permittee
[phone]
Telephone No.*
Permittee Mailing Post Office Box 3136, 0, Greensboro, NC
Address (Previous) 27401
NEW Permittee Street Address
Mailing Address* Post Office Box 3136
Address Line 2
City
Greensboro
Postal / Zip Code
27402-3136
State / Province / Region
NC
Country
USA
Permittee Street 300 West Washington Street, 0, Greensboro,
Address (Previous) NC 27401
NEW Permittee Street Street Address
Address* 300 West Washington Street
Address Line 2
City
State / Province / Region
Greensboro
NC
Postal / Zip Code
Country
27401
USA
Change Requested Jason Geary (City Engineer) via Modification request submitted 3/13/2023.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 03/16/2023