323276 03/21/18 f. CITY OF CARMEL, INDIANA VENDOR: 370269• CHECK AMOUNT: $*******224.00*
ONE CIVIC SQUARE ZIRMED ;
CARMEL, INDIANA 46032 1311 SOLUTIONS CENTER CHECK NUMBER: 323276
CHICAGO IL 60677-1311 CHECK DATE: 03/21/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER: AMOUNT DESCRIPTION
1120 4355200 673940 224.00 SUBSCRIPTIONS
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 370269 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
ZIRMED IN SUM OF$ CITY OF CARMEL
1311 SOLUTIONS CENTER An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
CHICAGO, IL 60677-1311
Payee
$224.00
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
673940 43-552.00 $224.00 1 hereby certify that the attached invoice(s),or 3/17/18 673940 $224.00
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
Saturday, March 17, 2018
David Haboush
Fire Chief
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 3/12/2018
9 IL Invoice# 673940
R- Account# 125191
WWW.ZJRMF-0.00M For overnight or Due Date 4/11/2018
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 a�
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
WOM
I IMP
125191 Zirmed 673940 "3/12/20184/11/2018
Monthly Professional Claims Management Fee 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
Invoice Total $224.00
72274.00 0.00 0.00 0.00 0.00 $224.00
Would you like your invoice via email? Please email billinginquiry@zirmed.com