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317712 10/19/17
CITY OF CARMEL, INDIANA VENDOR: 370269 ONE CIVIC SQUARE ZIRMED CHECK AMOUNT: S**.....224.00* q CARMEL, INDIANA 46032 1311 SOLUTIONS CENTER CHECK NUMBER: 317712 CHICAGO IL 60677-1311 CHECK DATE: 10/19/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4355200 624930 224.00 SUBSCRIPTIONS o q � ? k_ \ : O 2 / $ fCL 0 0 q R m 0 a O \ _ R CL® _ < 2< z E k 0 $ - o a q $ o (005 CD q # z / )/ / - k = w 13 m / G § \ / CD q 3 § 7 & ® / FD > 0 < _ j O |\ 2 m 7 0 ¥ Sr. 4 6 2 9 f § z % 0 # 2 ƒ E o . % . A g ƒ F J J k / m , ,? ;Q 2 - § 7 o � k ar kC \ § CL o . a / / / % \ QCD K 2 m 0 k k ° \ 7 k \ E OL fu@ 5 < \ C w E ƒ I y 7 § / � @ § c a t E G G 0 § E / § CL$ j --I ) \ O k § k k D \ -® 0 \ § k = -n < @2 ca ƒCD \m ƒ \ G /} CD f / - ( 0 2a G k » 0� e° © D }n ( \ ( §o ) � a 7 D « ƒ 3 $ /. CL q 0 { n ? / j E \ \ r- 0 E ¥ & ) ƒ E CD §E% m } CD n CD E 2 / (D M $ W Q CD i \ } CD \ a ° \ \ \ / D o < CD \ / k INVOICE Date 10/11/2017 I ZORIVECY Invoice# 624930 Account# 125191 www.ZIRMEo.corw For overnight or Due Date 11/10/2017 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 624930 10/11/2017' 11/10/2017 JIMNOM Monthly Professional Claims Management Fee = 1 99.00 , 99.00 Monthly Eligibility System Access Fee 1 100.00 100.00 I Monthly Remittance Advice Access Fee 1 25.00 25.00 i r i � i Invoice Total $224.001 224.00 0.00 0.00 0.00 0.001 $224.00 Would you like your invoice via email? Please email billinginquiry@zirmed.com