NCC193100_Payment Verification_20191210

Action History (UTC-05:00)Eastern Time(US&Canada)
Subrrit by Anonymous User 12/4/2019 1:43:23 PM(NCG01 NOI Submission)
Approve by Morman,Alaina 12/6/2019 2:11:19 PM(Review-Construction NOI 19121)
• The task was assigned to Morman,Alaina by round robin distribution 12/4/2019 1:43 PM
• The task was assigned to DEMLR NCG01 NOI Review Team.The due date is: December 6,2019 5:00
PM.The priority is: High 12/4/2019 1:43 PM
Submit by McCoy, Suzanne 12/10/2019 7:41:51 AM(Payment Verification for NCC193100)
* Quanisia Broadie
• McCoy,Suzanne assigned the task to McCoy, Suzanne 12/10/2019 7:41 AM
• The task was assigned to DEMLR NCG01 Payment Team.The due date is:January 17, 2020 5:00 PM.
The priority is: High 12/6/2019 2:11 PM

Payrmnt Verification
NORTH CAROLINA
Environmental Quvllly
Project Tracking ID* NCC-WAYNE-2020-Re Nu Life:Traumatic Brain Injury Services
NC Reference No.* NCG01-2019-3100
Certificate of NCC193100
Coverage (COC)
No.*
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.
Date Payment 12/10/2019
Received*
Method of Payment* r electronic
f check
r NO PAYMENT RECEIVED
f Other
ePayment 492850124
Transaction
Number*
NOI Tracking No. 19121
Tracking ID referenced upon subrrittal
This is an Express f No
Review Project r Yes