HomeMy WebLinkAbout327850 07/20/18 a`% ��p�;� CITY OF CARMEL, INDIANA VENDOR: 370269
' �•: CHECK AMOUNT: $*******319.50*
ONE CIVIC SQUARE 21RMED
a; �q CARMEL, INDIANA 46032 1311 SOLUTIONS CENTER CHECK NUMBER: 327850
M�Ifmi•co. CHICAGO IL 60677-1311 CHECK DATE: 07/20/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4355200 716130 319.50 SUBSCRIPTIONS
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER -
Vendor# 370269
zIRMED IN SUM OF$ 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
$319.50
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
716130 43-552.00 $319.50 1 hereby certify that the attached invoice(s),or 7/13/18 716130 $319.50
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
Tuesday,July 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
mom
125191 Zirmed 716130 7/12/2018 8/11/2018
o: e o
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
Patient Payments-Virtual Terminal Fee 1 25.00 25.00
Patient Payments Ecommerce Monthly Portal Fee 1 49.00 49.00
ACH Transaction Fee 29 0.50 14.50
ACH Verification Fee 28 0.25 7.00
Invoice Total $319.50
A ®. Ina p 11 1 1, .a e. •a ®. ® •a ®.
319.50 0.00 224.00 0.00 0.00 $543.50
Would you like your invoice via email? Please email billinginquiry@zirmed.com