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HomeMy WebLinkAbout307461 01/20/17 ,yw�My J t� CITY OF CARMEL, INDIANA VENDOR: 370269 R Y g ONE CIVIC SQUARE ZIRMED CHECK AMOUNT: $ .... R f 226.70 s ,�; CARMEL, INDIANA 46032 13 1 1 SOLUTIONS CENTER CHECK NUMBER: 307461 97.�. CHICAGO IL 60677-1311 CHECK DATE: 01/20/17 ��ON DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4355200 524185 226.70 SUBSCRIPTIONS n n N < < I _ m / § \ 2 \/ cn f / 7 n D R O *-kE 0 C \ m , O 0 2 c q k k E k \ 0 m 0U)2 0 m q � n § ° ■ k ) \ z 7 ] D % , a ■ @ T q w / G \ / CD _ / > � CL ° w z 3 ■ A 2 2 0> 0 (D / O | § / / m CD ) � t J i g LT 2 e \ $ m k { E E Z gM. 7 J 0 m ƒ $ ] / \ \ O E \ { ƒ f ( C_ 2 § CCD k -E m m _ E - � § $ \ § \ % 2 0 0 CML g � f - M k \ i ƒ 5 { / , ; J 0 E CL C 3 c 7 , - , y %« al \ qC= - \ (A > _ k$ \ § % \ or E 2$ i > \ ) \ # § k q C ƒ 64 0 0 a� SOD m ƒ \ k C o J ° � _ Z 0> f § k %k § k } | 0 � 5 0 > \( o i � D �/ } v E � � / CD 2 0 k n / / j E \ \ r- O £ # U) CD z E ] % C 00)" ( § $ / / CL / 2 5t (D M \ U G m f \ ] § ƒ « 7 a \ \ § \ q % \ ( 2 � § 0 � k INVOICE Date 12/12/2016 Invoice# 524185 Account# 125191 Www ZiwmL t�uM For overnight or Due Date 1/11/2017 correspondence ONLY: Customer PO# Invoice questions?Please call(877)494-7633 option 4 ZifMed, Inc. Attn: Accounting Dept Email:billinginquiry@zirmed.com 888 W.Market St., Ste 400 Louisville, KY 40202 Amount Paid Customer Support or Sales:(877)494-7633 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 Code InvoiceDate Due Date 125191 Zirmed 524185 12/12/2016 1/11/20171 Description City Price Total Monthly Professional Claims Management Fee 1 99.00 99.00 Paper Professional Claims Filed Previous Month 6 0.45 2.70 Monthly Eligibility System Access Fee 1 100.00 100.00 Monthly Remittance Advice Access Fee 1 25.00 25.00 Invoice Total $226.70 Current 1-30 Days 31-60 Days 61-90 Days Over 90 Days Account Balance 226.70 0.00 0.00 0.00 0.00 $226.70 Would you like your invoice via email? Please email billinginquiry@zirmed.com