HomeMy WebLinkAbout325618 05/23/18 r Coq
CITY OF CARMEL, INDIANA VENDOR: 370269
z\. CHECK AMOUNT: $*******198.00*
ONE CIVIC SQUARE 21RMED
CARMEL, INDIANA 46032 1311 SOLUTIONS CENTER CHECK NUMBER: 325618
9�'iror CHICAGO IL 60677-1311 CHECK DATE: 05/23/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4355200 101469 689422 198.00 CHECK CREDIT CARD PRO
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
Vendor# 370269 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
ZIRMED IN SUM OF$ CITY OF CARMEL
1311 SOLUTIONS CENTER An invoice or bill to be property 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
$198.00
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
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
101469 689422 43-552.00 $198.00 I hereby certify that the attached invoice(s),or 5/21/18 689422 $198.00
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
Monday, May 21, 2018
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
ZAP' INVOICE Date 5/10/2018
Invoice# 696349
RIVE En"J" Account# 125191
www.zir�rreia•�cz�s For overnight or Due Date 6/9/2018
correspondence ONLY: Customer PO#
Invoice questions?Please call(877)494-7633 ZirMed, Inc. Shipping Code(2)
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
e • •o • lye PEW= a D.
125191 Zirmed 696349 5/10/2018 6/9/2018
�' 4' N a
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
422.00 0.00 0.00 0.00 0.00 $422.00
Would you like your invoice via email? Please email billinginquiry@zirmed.com