NCC216408_Contact Update Record (Email Correction)_20231219

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 12/19/2023 7:30:20 AM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC216408
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2021-6408
Original NOI No.* 73129
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
BDB, LLC
Project Name BDB, LLC
Address Jameson Way, Prestige Business Park, Denver, NC, Denver, NC
County Lincoln
Latitude 35.4300
Longitude -81.0117
Date COC Issued* 11/16/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.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
Yes
Billing Email [e-mail]
Billing Telephone No. [phone]
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Jennifer Joy
(Previous)
Site Contact Title Registered Agent,Vice President
(Previous)
Organization BDB, LLC
(Previous)
First Name(New)* Jennifer

Last Name(New)* Joy
NEW Site Contact* Reflects any revisions above
Jennifer Joy
NEW Site Contact Registered Agent,Vice President
Title
NEW Organization BDB, LLC
This field is not required on the NOI form and may not pre-populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact [phone]
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 531 Brentwood Road,#248,0, Denver, NC
Address(Previous) 28037
NEW Site Contact Street Address
Mailing Address* 531 Brentwood Road,#248
Address Line 2
City State/Province/Region
Denver NC
Postal/Zip Code Country
28037 us
Change Requested Jenny Joy via e-mail on 12/18/2023(email address correction only)
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 12/19/2023