HomeMy WebLinkAbout333640 12/14/18 CITY OF CARMEL, INDIANA VENDOR: 370269
• ONE CIVIC SQUARE ZIRMED CHECK AMOUNT: $*******339.75*
CARMEL, INDIANA 46032 1311 CHICAGO ISL IONS CENTER CHECK NUMBER: 333640
Aros�° CHECK DATE: 12/14/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4355200 767332 339.75 SUBSCRIPTIONS
VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995)
Vendor# 370269 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
ZIRMED IN SUM OF$ 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
$339.75
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
767332 43-552.00 $339.75 1 hereby certify that the attached invoice(s),or 12/13/18 767332 Billing $339.75
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
Thursday, December 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
120
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
INVOICE Date 12/12/2018
,4'4-"W
� W AY.S T A R Invoice# 767332
Y Y Account# 125191
aEVEuus CYGLf TECHHoL4rx For overnight or Due Date 1/11/2019
correspondence ONLY: Customer PO#
Invoice questions?Please call Waystar Shipping Code(2)
1-844-4WAYSTAR(492-9782) (Option 3) Attn: Accounting Dept
Email:billinginquiry@waystar.com 888 W.Market St., Ste 400 -�-��
Louisville, KY 40202 Amount Paid
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 767332 12/12/2018 1/11/2019
s- i . No
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 57 0.50 28.50
ACH Verification Fee 53 0.25 13.25
Invoice Total $339.75
o °a 5.
339.75 0.00 0.00 0.00 0.00 $339.75
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