HomeMy WebLinkAbout301200 07/25/16 �(�C9q''f� CITY OF CARMEL, INDIANA VENDOR: 370269
ONE CIVIC SQUARE ZIRMED CHECK AMOUNT: $*******343.75*
j=a; CARMEL, INDIANA 46032 1311 SOLUTIONS CENTER CHECK NUMBER: 301200
M��9oN ca, CHICAGO IL 60677-1311 CHECK DATE: 07/25/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4355200 24792 475832 343.75 SOFTWARE FEES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
ZIRMED ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
888 W MEET 13« ShcanS IN SUM OF$ CITY OF CARMEL
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An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
6 n �� ��n � , �KY-�AaO� '�:a L rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
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$343.75 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
475832 43-552.00 $343.75 1 hereby certify that the attached invoice(s),or 7/18/16 475832 $343.75
1120 101 1120 101
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday,July 18,2016
David Haboush
Fire Chief
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
r INVOICE Date 7/13/2016
,,y Invoice# 475832
Account# 125191
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For overnight or Due Date 8/12/2016
wv�v""'z"�r"'``.�e(M 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 475832 7/13/2016 8/12/2016
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Monthly Professional Claims Management Fee 1 99.00 99.00
Pro-rated Professional Claims Management Fee previous month (30/30 Days) 1 99.00 99.00
Monthly Eligibility System Access Fee 1 100.00 100.00
Monthly Remittance Advice Access Fee 1 25.00 25.00
Pro-rated Remittance Advice Management Fee previous month (25/30 Days) 0.83 25.00 20.75
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ZirMed, Inc.Accounting Department phone number: (877) 370-0050 Invoice Total $343.75
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343.75 1,220.00 0.00 i 0.00 0.00 $1,563.75
Would you like your invoice via email? Please email billinginquiry@zirmed.com