HomeMy WebLinkAbout330363 09/21/18 %���p'' CITY OF CARMEL, INDIANA VENDOR: 370269
4 ONE CIVIC SQUARE ZIRMED CHECK AMOUNT: $*******355.25*
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CARMEL, INDIANA 46032 1311 SOLUTIONS CENTER CHECK NUMBER: 330363
9'�'?fSn':c� CHICAGO IL 60677-1311 CHECK DATE: 09/21/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4355200 737045 355.25 SUBSCRIPTIONS
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER .
Vendor# 370269
ZIRMED IN SUM OF$ 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
$355.25
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
737045 43-552.00 $355.25 1 hereby certify that the attached invoice(s),or 9/17/18 737045 Ambulance Billing $355.25
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, September 17,2018
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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
i F
INVOICE Date 9/13/2018
Invoice# 737045
ZR- N E Em"J" Account# 125191
'NWW.Z1RF F-0.'UC1M For overnight or Due Date 10/13/2018
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
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737045 9/13/2018 10/13/2018
.aMERM
thly Professional Claims Management Fee 1 99.00 99.00
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 77 0.50 38.50
ACH Verification Fee 75 0.25- 18.75
Invoice Total $355.25
355.25 0.00 0.00 0.00 0.00 $355.25
Would you like your invoice via email? Please email billinginquiry@zirmed.com