Loading...
HomeMy WebLinkAbout328812 08/14/18 i or-C�q� v`/ CITY OF CARMEL, INDIANA VENDOR: 370269 ., CHECK AMOUNT: $*******351.75* ONE CIVIC SQUARE ZIRMED i�\ ,;�a'. CARMEL, INDIANA 46032 1311 SOLUTIONS CENTER CHECK NUMBER: 328812 9q'?ieei��. CHICAGO IL 60677-1311 CHECK DATE: 08/14/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4355200 726905 351.75 SUBSCRIPTIONS VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) ALLOWED 20 ACCOUNTS PAYABLE VOUCHER Vendor# 370269 ZIRMED IN SUM OF$ 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 $351.75 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 726905 43-552.00 $351.75 1 hereby certify that the attached invoice(s),or 8/13/18 726905 $351.75 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,August 13,2018 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 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer INVOICE Date 8/10/2018 ZIAF R NE Invoice# 126905 UAccount# 125191 .2iRt�ds©.��M For overnight or Due Date 9/9/2018 www 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 a o o e. `'sh€r2 125191 Zirmed 726905 8/10/2018 9/9/2018 Monthly Professional Claims Management Fee 1 h 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 61 0.50 30.50 ACH Verification Fee 53 0.25 13.25 ACH Return Fee 2 5.00 10.00 Invoice Total $351.7 am, ° 351.75 0.00 0.00 O.OD 000 $ ia.7 Would you like your invoice via email? Please email billinginquiry@zirmed.com