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313917 7/18/2017
CITY OF CARMEL, INDIANA VENDOR: 370269 CHECK AMOUNT: S"*'"***224.45' ONE CIVIC SQUARE ZIRMED =Q CARMEL, INDIANA 46032 1311 SOLUTIONS CENTER CHECK NUMBER: 313917 CHICAGO IL 60677-1311 CHECK DATE: 07/18/17 �*irox cam. DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT SUBSCRIPTIONS DESCRIPTION 1120 4355200 594335 224.45 n N $ « 0 m� Q I � � O 2 / ? Cl) 2 \ 0 % M \ _ 0 / k q E £ k < z E k 0 . / -1 q @ o \ k m n O \ 3 k / K £ -0 & m � � � � 3 / / CD CL -4 k 3 8 © T). 2 0 / 492 . § ) / | C J _ / i a & � / z f ( ¥ k r- 0 E » ƒJ Q m CD e a o 0 ) k ¥ R -E ; 2 �i 3 2 «, [ w ( (Da m . CD. ƒ % 3 § & � aE ; ; ± @ -4 o f R 0 CD } « k E w 2 - / ; �$ wCL $ £ ± § � | # 7 K I § # q § C# ( 7ƒ ° \ m \ crCD § \ k > \ {¥ ) nk $ C0 g § 0 7 \C \ ) ƒ k ° 0) K ' L ■ m f z n ii CD m \ 3 ) i0 =ri § k U } cr 0 D \ a 0 0� / q > 66 i § \ o CD / 0 E \ \ r O Q k z m § R C \ ., / \ D 0 w 2 . 2 p \ § . / E / _0 _ � R ] § # 6z m \ § » _ > f CDCL _) 9 0 . _ _ & � m INVOICE n t 17 voice# 594335 ZI R NE� Account# 125191 8/12/2 For overnight or Due Date 8/12/2017 www.LIRM$D.coM correspondence ONLY: Customer PO# Invoice questions?Please call(877)494-7633 ZirMed, Inc. option 4 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 125191 Zirmed 594335 7/13/2017', 8/12/2017 Monthly Professional Claims Management Fee 1 99.00 99.00 Paper Professional Claims Filed Previous Month 1 0.45 0.45 Monthly Eligibility System Access Fee 1 100.00 100.00 Monthly Remittance Advice Access Fee 1 25.00 25.00 Invoice Total $224.45 , 10 224.45 0.00 0.00 0.00 0.00 $224.45 Would you like your invoice via email? Please email billinginquiry@zirmed.com