HomeMy WebLinkAbout260364 06/28/16 ti� CITY OF CARMEL, INDIANA VENDOR: 370269
j_ ® '� ONE CIVIC SQUARE ZIRMED CHECK AMOUNT: $R*MMM 1,220.00"
_,: CARMEL, INDIANA 46032 888 W MARKET STREET CHECK NUMBER: 260364
M,�T�N..�o�' LOUISVILLE KY 40202 CHECK DATE: 06/28/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4463202 24792 458453 1,097.00 SOFTWARE FEES
1120 4355200 24792 464444 123.00 SOFTWARE/FEES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ALLOWED 20
ZIRMED ACCOUNTS PAYABLE VOUCHER
888 W MARKET STREET IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
LOUISVILLE, KY 40202 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$1,220.00 Payee
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
24792 458453 44-632.02 $1,097.00 1 hereby certify that the attached invoice(s),or 6/20/16 458453 $1,097.00
1120 102 1120 102
24792 464444 43-552.00 $123.00 bill(s)is(are)true and correct and that the 6/20/16 464444 $123.00
1120 101 1 materials or services itemized thereon for 1120 1 101
which charge is made were ordered and
as received except
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�y
Monday,June 20,2016
' David Haboush
T4 Pi"
Fire Chief
Sk.
I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have
audited same in accordance with IC 5-11-10-1.6
20
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
INVOICE Date 6/10/2016
Invoice# 464444
z R rVE Account# 125191
www.Zir4MeD.r;om For overnight or Due Date 7/10/2016
correspondence ONLY: Customer PO#
Invoice questions?Please call(877)370-0050 ZirMed, Inc.
Email:billinginquiry@zirmed.com Attn: Accounting Dept
888 W.Market St., Ste 400
Customer Support or Sales:(877)494-7633 Louisville, KY 40202 Amount Paid
Bill To PLEASE REMIT ONLY PAYMENTS
City of Carmel Fire Department TO THE FOLLOWING:
2 Civic Square ZirMed Inc.
Carmel IN 46032 1311 Solutions Center
Chicago, IL 60677-1311
125191 Zirmed 464444 6/10/2016 7/10/2016
Description • Total
Monthly Eligibility System Access Fee 1 100.00 100.00
Pro-rated Eligibility System Management Fee previous month (7/31 Days) 0.23 100.00 23.00
ZirMed, Inc.Accounting Department phone number: (877) 370-0050 Invoice Total $123.00
1,220.00 0.00 0.00 0.00 0.00 $1,220.00
Would you like your invoice via email? Please email billinginquiry@zirmed.com
INVOICE Date 6/10/2016
Invoice# 458453
Account# 125191
tiv ••�. 2112 `� _�M - For overnight or Due Date 7/10/2016
correspondence ONLY: Customer PO#
Invoice questions?Please call(877)370-0050
ZirMed, Inc.
Email:billinginquiry@zirmed.com Attn: Accounting Dept
888 W.Market St., Ste 400
Customer Support or Sales:(877)494-7633 Louisville, KY 40202 Amount Paid�'��� �-
Bill To PLEASE REMIT ONLY PAYMENTS
City of Carmel Fire Department TO THE FOLLOWING:
2 Civic Square ZirMed Inc.
Carmel IN 46032 1311 Solutions Center
Chicago, IL 60677-1311
125191 Zirmed 458453 6/10/2016 7/10/2016
_ Nd
b • a R
Professional Claims Implementation Fee 1 499.00 499.00
Eligibility Verification Implementation Fee 1 399.00 399.00
Remittance Advice Implementation Fee 1 199.00 199.00
i
ZirMed, Inc.Accounting Department phone number: (877) 370-0050 Invoice Total $1,097.00
1,220.00 0.00 0.00 0.00 70.00 $1,220.00
Would you like your invoice via email? Please email billinginquiry@zirmed.com