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328011 07/25/18 CITY OF CARMEL, INDIANA VENDOR: 370269 ONE CIVIC SQUARE ZIRMED CHECK AMOUNT: $*******200.00* 9 �: CARMEL, INDIANA 46032 1311 SOLUTIONS CENTER CHECK NUMBER: 328011 �'�TON�°. CHICAGO IL 60 677-1 31 1 CHECK DATE: 07/25/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4355200 696349 200.00 SUBSCRIPTIONS VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201 (Rev.1995) Vendor# 370269 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER ZIRMED IN SUM OF$ 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 $200.00 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 696349 43-552.00 $200.00 1 hereby certify that the attached invoice(s),or 7/23118 696349 Partial Payment made previously $200.00 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,July 23,2018 U,ar -zA_ 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 INVOICE Date 5/10/2018 Z1,4 R N E Invoice# 696349 Account# 125191 www.ZIRME£©.rom 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 Q 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 696349 5/10/2018 6/9/2018 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 $224.00 422.00 0.00 0.00 0.00 0.00 $422.00 Would you like your invoice via email? Please email billinginquiry@zirmed.com