NCC203999_NOI 31213 Payment Verification_20200918

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/10/2020 7:44:01 AM (NCG01 NOI Submission)
Approve by Clark, Paul 9/11/2020 3:20:03 PM (Review- Construction NOI 31213)
• The task was assigned to Clark, Paul by round robin distribution 9/10/2020 7:44 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 14, 2020 5:00
PM 9/10/2020 7:44 AM
Submit by Selkane, Aziza 9/18/2020 2:59:44 PM (Payment Verification for NCC203999)
* Cox -Edwards Company
• Selkane, Aziza assigned the task to Selkane, Aziza 9/18/2020 2:59 PM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 23, 2020 5:00 PM
9/11/2020 3:20 PM

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•
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• yrnent Verification
NORTH CAROLINA
Envlro me tufQuuftty
Project Name
Atlantic Casualty Insurance Co./Auto-Owners Life Insurance Co. - Phase 1
NC Reference No.*
NCG01-2020-3999
Certificate of
NCC203999
Coverage (COC)
No. *
Invoice Date
9/11/2020
Initial Invoice No.
NCC203999-2020
Initial Fee
$ 100.00
Invoice Due Date
10/11/2020
Important: If you change
the choice below to Payment NOT RECEIVED, the application will be rejected, and a COC will
not be issued. This is the ONLY way to reject an eNOI at this step.
Payment Received* r Payment Received.
r Payment NOT RECEIVED.
Payment Status
PAID
Date Payment
9/18/2020
Received *
(Or, if not received, date rejected for no payrrent)
Method of Payment*
r electronic
r check
r^ NO PAYMENT RECEIVED
r Other
Check Number*
4477
NOI Tracking No.
31213
TracWng ID referenced upon subrrittal
This is an Express
r No
Review Project
r Yes
Project Tracking ID
NCC-WAYNE-2020-Atlantic Casualty Insurance Co./Auto-Owners Life Insurance
Co. - Phase 1