NCC210035_NOI 40364 Payment Verification_20210106

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/4/2021 3:28:08 PM (NCG01 NOI Submission)
Approve by Clark, Paul 1/5/2021 12:14:37 PM (Review- Construction NOI 40364)
• The task was assigned to Clark, Paul by round robin distribution 1/4/2021 3:29 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 6, 2021 5:00
PM 1/4/2021 3:29 PM
Submit by Selkane, Aziza 1/6/2021 9:44:11 AM (Payment Verification for NCC210035)
* Matt D Jones
• Selkane, Aziza assigned the task to Selkane, Aziza 1/6/2021 9:43 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: February 16, 2021 5:00
PM 1/5/2021 12:15 PM

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•
V.
• yrnent Verification
NORTH CAROLINA
Envlro me tufQuuftty
Project Name
Cape Fear Valley Health System Academic Center
NC Reference No.*
NCG01-2021-0035
Certificate of
NCC210035
Coverage (COC)
No. *
Invoice Date
1/5/2021
Initial Invoice No.
NCC210035-2021
Initial Fee
$ 100.00
Invoice Due Date
2/4/2021
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 eNO1 at this step.
Payment Received* r Payment Received.
r Payment NOT RECEIVED.
Payment Status
PAID
Date Payment
1/6/2021
Received *
(Or, if not received, date rejected for no payrrent)
Method of Payment*
r electronic
r check
r NO PAYMENT RECEIVED
r Other
ePayment
552226938
Transaction
Number*
NOI Tracking No.
40364
Tracking ID referenced upon subrrittal
This is an Express
r No
Review Project
r Yes
Project Tracking ID
NCC-CUMBE-2021-Cape Fear Valley Health System Academic Center