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Home My WebLink About20212814.tiffWELD COUNTY WARRANTS AS OF: OCTOBER 4, 2021 This is to certify that all accounting and budgeting procedures have been completed on the above listed claims as shown on the attached ten (10) Check and Electronic Transmittal Registers, numbering nineteen (19) pages, and dated September 30, 2021, and October 1, 2021; and that payments should be to the respective vendors listed in the amount set opposite their names, with the total amount of $1,468,954.89. Dated this 4th day of October, 2021. Weld County Financiacer SUBSCRIBED AND SWORN TO before me this 4th day of October, 2021. t otary Public v My Commission Expires: O'/OS /20.2.3 MARIAN N HIGGINS NOTARY PUBLIC STATE OF COLORADO NOTARY ID 20194029616 MY COMMISSION EXPIRES AUGUST 5, 2023 We, the Board of County Commissioners of Weld County, Colorado, hereby approve the claims as set forth above and warrants in payment thereof are hereby ordered drawn upon the Weld County Treasurer, totaling $1,468,954.89. Dated this 4th day of October, 2021. ATTEST: dithis) .ac�so•� Weld County Clerk to the Board Deputy Clerk to the Board APPROVED AS County Attorney BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Steve Moreno air Date of signature: t0 I OM ( I Lori aine 2021-2814 Check Register Date : 09/30/2021 CheckStatus CheckDate CheckNumber Weld County Human Services *Check run processed 9/30/2021 by mhiggins Payee Amount Human Services 093021HS1 Normal 9/30/2021 5028683 MARIA A. YODICE $4,000.00 Check Register Summary Transaction Total: 1 Amount Total: $4,000.00 2021.2_814 1 \ 1 Check Register Date : 10/04/2021 CheckDate CheckNumber Department Name Weld County Flexible Benefits *Check run processed 10/4/2021 by crempel Payee Amount Flexible Benefits 100421FDV 10/4/2021 8092472 Jacy Dickens PW Maintenance Support $344.00 Check Register Summary Transaction Total: 1 Amount Total: $344.00 1 \ 1 Check Register Weld County Date: 10/04/2021 Human Services *Check run processed 10/4/2021 by crempel CheckStatus CheckDate CheckNumber Payee Amount Human Services 100421HS Normal 10/4/2021 5028684 365 REAL PROPERTY MANAGEMENT LLC $3,569.10 Normal 10/4/2021 5028685 AAPEX LEGAL SERVICES, LLC $75.50 Normal 10/4/2021 5028686 ARROW REALTY & MANAGEMENT $2,550.00 Normal 10/4/2021 5028687 ATMOS ENERGY $191.84 Normal 10/4/2021 5028688 BLASTERPROPS LLC $6,750.00 Normal 10/4/2021 5028689 BOULDER COUNTY $17.20 Normal 10/4/2021 5028690 CLEAR CREEK COUNTY $15.00 Normal 10/4/2021 5028691 COUNTRYSIDE OF GREELEY LLC $1,960.21 Normal 10/4/2021 5028692 DENVER SHERIFF DEPARTMENT $48.20 Normal 10/4/2021 5028693 FRANKLIN FLATS $4,008.61 Normal 10/4/2021 5028694 GATE WAY PLACE LTD $4,316.00 Normal 10/4/2021 5028695 BEATRIZ N. GUIJOSA $63.18 Normal 10/4/2021 5028696 INTERMOUNTAIN DATA CORP $1,594.00 Normal 10/4/2021 5028697 KPJ FIRST SERVICES, LLC $426.25 Normal 10/4/2021 5028698 LIFE STORIES CHILD & FAMILY ADVOCACY $992.75 Normal 10/4/2021 5028699 DOUGLAS A. MEASNER $3,500.00 Normal 10/4/2021 5028700 MIMG, XIV ASSOCIATES, LLC $4,944.00 Normal 10/4/2021 5028701 MONTANA VITAL STATISTICS $27.00 Normal 10/4/2021 5028702 MOUNTAIN STATES DRIVER'S EDUCATION INC $1,425.00 Normal 10/4/2021 5028703 MOUNTAIN VIEW ACRES REAL ESTATE LLC $3,500.00 Normal 10/4/2021 5028704 NOLAN LAND LLLP $2,850.00 1 \ 2 CheckStatus CheckDate CheckNumber Payee Amount XX VO 10 $0.00 N-,rnerl` -S11-28 xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx _ VO1.O Nrxl 10/4/2021 V-01O $O -O9 Normal 10/4/2021 5028708 PAPER CHASE $3,276.10 Normal 10/4/2021 5028709 PRAIRIE MOUNTAIN MEDIA $146.68 Normal 10/4/2021 5028710 SANDSTONE VISTAS APARTMENTS PHASE 1/SANDSTONE VIST $3,465.32 Normal 10/4/2021 5028711 KERMIT SHEETS $2,799.00 Normal 10/4/2021 5028712 ST JOSEPH PROPERTIES LLC $3,800.00 Normal 10/4/2021 5028713 TIMM CRESCENT COVE ONE, LLC $4,030.59 Normal 10/4/2021 5028714 UNITED POWER, INC $521.85 Normal 10/4/2021 5028715 LEVI C. VANCE $7,052.21 Normal 10/4/2021 5028716 YONG WANG $4,200.00 Normal 10/4/2021 5028717 XCEL ENERGY $684.80 Normal 10/4/2021 5028718 XCEL ENERGY $203.60 Normal 10/4/2021 5028719 XCEL ENERGY $109.50 Normal 10/4/2021 5028720 XCEL ENERGY $3,311.04 Normal 10/4/2021 5028721 XCEL ENERGY $673.29 Normal 1O/4/2021 5028722 XCEL ENERGY $365.31 Normal 10/4/2021 5028723 XCEL ENERGY $303.37 Check Register Summary Transaction Total: 40 Amount Total: $77,766.50 2 \ 2 Check Register Date : 10/04/2021 CheckDate CheckNumber Weld County Weld County *Check run processed 10/4/2021 by crempel Payee Amount Weld County, Colorado 100421 WELD 10/4/2021 3368200 ABSOLUTE STANDARDS $375.00 10/4/2021 3368201 ACHZIGER VISION $500.00 10/4/2021 3368202 AETNA BEHAVIORAL HEALTH LLC $2,350.50 10/4/2021 3368203 ALTITUDE COMMUNITY LAW $15.00 10/4/2021 3368204 AMERICAN PROFICIENCY INSTITUTE $936.12 10/4/2021 3368205 ARAMARK CORPORATION $44,999.03 10/4/2021 3368206 ARTHUR J GALLAGHER RISK MANAGEMENT SERVICES, INC $20,644.00 10/4/2021 3368207 AULT, TOWN OF $5,000.00 10/4/2021 3368208 BC SERVICES INC $771.16 10/4/2021 3368209 BRATTONS OFFICE EQUIPMENT INC $199.43 10/4/2021 3368210 KYRA CASTEEL $15.00 10/4/2021 3368211 CENTRAL SQUARE TECHNOLOGIES LLC $2,132.66 10/4/2021 3368212 CENTURY LINK $1,557.90 10/4/2021 3368213 DR DAVID CHRISTIANSEN $1,700.00 10/4/2021 3368214 COLLEGE OF AMERICAN PATHOLOGISTS $1,458.44 10/4/2021 3368215 COLORADO DEPT OF PUBLIC HEALTH/ENVIRONMENT $7,638.00 10/4/2021 3368216 COMFORCARE S WELD & BOULDER COUNTIES $192.00 10/4/2021 3368217 COMFORT DENTAL WINDSOR $560.42 10/4/2021 3368218 CONNECT HEARING INC $5,999.92 10/4/2021 3368219 COOKS CORRECTIONAL $2,209.19 10/4/2021 3368220 CORE BUSINESS TECHNOLOGIES $10,470.96 1 \ 5 CheckDate CheckNumber Payee Amount 10/4/2021 3368221 CORPORATE TRANSLATION SERVICES, INC $417.94 10/4/2021 3368222 DUANE E. DURAN $2,546.00 10/4/2021 3368223 EC AMERICA INC $581.91 10/4/2021 3368224 ENSIGHT SKILLS CENTER INC $995.00 10/4/2021 3368225 EVIDENT INC $462.06 10/4/2021 3368226 EYE CENTER OF NORTHERN COLORADO, PC $492.16 10/4/2021 3368227 FEDEX KINKO'S $408.96 10/4/2021 3368228 AGNES FERRIS $60.00 10/4/2021 3368229 STEPHANIE M. FERRIS $300.00 10/4/2021 3368230 FFF ENTERPRISES $216.35 10/4/2021 3368231 FLAGSTAR BANK $1,550.17 10/4/2021 3368232 FOSTER VALUATION COMPANY $5,500.00 10/4/2021 3368233 FRANCY LAW FIRM $15.00 10/4/2021 3368234 ANN GEBAUER $46.00 10/4/2021 3368235 GIBSON COMPUTER ASSOCIATES $700.00 10/4/2021 3368236 GMCO CORPORATION $9,000.68 10/4/2021 3368237 GREELEY COMPLETE DENTISTRY $1,000.00 10/4/2021 3368238 GREELEY EYE DOCTORS $100.00 10/4/2021 3368239 GSG ARCHITECTURE INC $450.75 10/4/2021 3368240 PHYLLIS E. HANSBERRY $79.00 10/4/2021 3368241 HOLST BOETTCHER & TEHRANI LLP $15.00 10/4/2021 3368242 HUMANE SOCIETY OF WELD COUNTY $9,782.85 10/4/2021 3368243 INORGANIC VENTURES $409.59 2 \ 5 CheckDate CheckNumber Payee Amount 10/4/2021 3368244 INTERMOUNTAIN DATA CORP $540.00 10/4/2021 3368245 IOME LLC $9,000.00 10/4/2021 3368246 J -U -B ENGINEERS $5,811.53 10/4/2021 3368247 SHELLIE JACCBUCCI $40.00 10/4/2021 3368248 JAMES G ANDERSON PC $15.00 10/4/2021 3368249 CAROL KEEFER $602.50 10/4/2021 3368250 ERIC LARSON $15.00 10/4/2021 3368251 LEXISNEXIS RISK DATA MANAGMENT INC $317.89 10/4/2021 3368252 LIGHTLE ENTERPRISES OF OHIO LLC $800.00 10/4/2021 3368253 LWRC INTERNATIONAL LLC $275.00 10/4/2021 3368254 MAHONEY ENVIRONMENTAL CONSULTING, INC $3,520.00 10/4/2021 3368255 RUHI N. MALL $80.00 10/4/2021 3368256 MARTIN MARIETTA MATERIALS INC $168,902.42 10/4/2021 3368257 METRO COLLECTION SERVICE $15.00 10/4/2021 3368258 METROHM USA INC $5,417.00 10/4/2021 3368259 MARIA MIJARES $110.00 10/4/2021 3368260 MOFFAT GLASS $3,621.00 10/4/2021 3368261 MOTOROLA SOLUTIONS INC $2,661.05 10/4/2021 3368262 MOTOROLA SOLUTIONS INC $57,728.86 10/4/2021 3368263 NMS LABS $8,384.00 10/4/2021 3368264 NORTH COLORADO HEALTH ALLIANCE $16,876.39 10/4/2021 3368265 NORTH COLORADO MEDICAL CENTER (NCMC) $621.00 10/4/2021 3368266 NORTH RANGE BEHAVIORAL HEALTH 3 \ 5 $14,969.62 CheckDate CheckNumber Payee Amount 10/4/2021 3368267 NORTHWEST PARKWAY $11.55 10/4/2021 3368268 VANESSA OFIDE $15.00 10/4/2021 3368269 ORACLE AMERICA INC $1,784.26 10/4/2021 3368270 PEAR LLC $6,535.66 10/4/2021 3368271 PRAIRIE MOUNTAIN MEDIA $1,000.00 10/4/2021 3368272 PRECISION DATA PRODUCTS INC $339.00 10/4/2021 3368273 PRODOCUMENT SOLUTIONS INC $69,091.73 10/4/2021 3368274 PROVEST LLC $15.00 10/4/2021 3368275 PUMPKIN PICKIN PARADISE $489.79 10/4/2021 3368276 QUILL CORPORATION $44.58 10/4/2021 3368277 ROBERT SHREVE ARCHITECTS & PLANNERS INC $20,989.00 10/4/2021 3368278 SAFEWAY $37.86 10/4/2021 3368279 HARRY L. SIMON $15.00 10/4/2021 3368280 CHRISTINE SNODGRASS $80.00 10/4/2021 3368281 SOUTHLAND MEDICAL LLC $676.89 10/4/2021 3368282 STATE OF COLORADO $1,790.64 10/4/2021 3368283 STATE OF COLORADO $2,271.56 10/4/2021 3368284 SUMABLES $272.47 10/4/2021 3368285 SUNRISE COMMUNITY HEALTH CENTER $373.36 10/4/2021 3368286 TAG PROCESS SERVICE INC $15.00 10/4/2021 3368287 TIME $624.00 10/4/2021 3368288 TOMOI FARMS LLC $19,400.00 10/4/2021 3368289 TOWN OF NEW RAYMER $300.00 4 \ 5 CheckDate CheckNumber Payee Amount 10/4/2021 3368290 TRI-TECH FORENSICS $83.75 10/4/2021 3368291 TYLER TECHNOLOGIES, INC/EAGLE DIVISION $145,745.61 10/4/2021 3368292 ULINE SHIPPING SUPPLY SPECIALISTS $1,317.05 10/4/2021 3368293 UNITED TOWER SERVICE LLC $600.00 10/4/2021 3368294 VANCE BROTHERS INC $315,073.70 10/4/2021 3368295 DONACIANO VEGA ARREOLA $39.00 10/4/2021 3368296 VWR INTERNATIONAL $126.09 10/4/2021 3368297 XEROX CORPORATION $174.26 Check Register Summary Transaction Total: 98 Amount Total: $1,034,509.22 PeopleSoft Report ID: WDV003 DENTAL/VISION CHECK REGISTER Benefit Year 2021 From Date: 10/04/2021 Thru Date: 10/04/2021 Check No. Check Date Check Amount 8092460 10/04/2021 $66.00 8092461 10/04/2021 $537.15 8092462 10/04/2021 $180.99 8092463 10/04/2021 $106.50 8092464 10/04/2021 $300.00 8092465 10/04/2021 $175.57 8092466 10/04/2021 $244.44 8092467 10/04/2021 $104.98 8092468 10/04/2021 $711.94 8092469 10/04/2021 $173.90 8092470 10/04/2021 $62.50 8092471 10/04/2021 $25.00 8092473 10/04/2021 $138.00 Payment Type Total $2,826.97 Employee Name Jessie L Koons Jessie L Koons Elise Johann Murphy Logan F Wilson Colleen Dawn McIntosh Staci Lynn Devore Staci Lynn Devore Karina L. Amaya Debra J Steinbar Evan Pinkham Nicholas Kenneth Ayers Allison Theunissen Jerry Marvin Roybal Employee ID 10165 10165 11231 1193 11997 4690 4690 5938 7537 7637 9183 9379 9797 Svc Type Direct D Dental D Dental ✓ Vision ✓ Vision D Dental D Dental D Dental ✓ Vision D Dental D Dental D Dental ✓ Vision D Dental Deposit Y Y Y Y Y Y Y Y Y Y Y Y Y Page No. 1 Run Date 10/01/2021 Run Time 12:23:33 REPORT FABCHKR Weld County BNPD Data RUN DATE: 10/01/2021 FISCAL YEAR 2021 Batch Disbursement Register TIME: 02:48 PM BANK: 02 TREASURER -SOCIAL SERVICES Direct Deposit Run: 10/04/2021 PAGE: 1 < DIRECT DEPOSIT REGISTER > CHECK/ < APPROVED AMOUNTS > CHK ADVICE DISCOUNT/ WITHHOLDING/ TYP NUMBER PAYEE/VENDOR NAME A/P DOC# VENDOR INV# GROSS PREV PAID ADDL CHG/TAX NET IND !0037447 CROSLEY, MONITA I2114556 MI092221 58.97 0.00 0.00 58.97 D !0037448 DEVORE, STACI I2114558 MI092321 125.28 0.00 0.00 125.28 D !0037449 FIGUEROA, MARIEFRI I2114635 MI083121 67.07 0.00 0.00 67.07 D !0037450 FLACHS, AMY I2114559 MI091721 88.02 0.00 0.00 88.02 D !0037451 FLORES, GIOVANNI I2114567 MI092121 77.76 0.00 0.00 77.76 D !0037452 FOGG, JENNIFER I2114637 MI092721 212.76 0.00 0.00 212.76 D !0037453 GILLIAM, MELISSA I2114718 MI092921 314.28 0.00 0.00 314.28 D !0037454 GRAHAM, MEGAN I2114562 MI092421 88.67 0.00 0.00 88.67 D !0037455 HESS, KIRA I2114715 MI090321 26.84 0.00 0.00 26.84 D !0037456 JAEB, ANASTASIA I2114642 MI091521 79.92 0.00 0.00 79.92 D 10037457 NACY, CHRISTIE 118.80 0.00 10037458 NIEDFELDT, JOHN 270.65 0.00 0.00 0.00 !0037459 ORTIZ, TAMMIE JO 112.70 0.00 0.00 10037460 PEAKES, ANITA 453.06 0.00 !0037461 TRAYLOR, RYAN 68.04 0.00 !0037462 WEISSHAAR, LORI 607.76 0.00 10037463 WOOD, BARBARA 18.63 0.00 10037464 WURTZ, KATE 37.80 0.00 BANK TOTAL T REPORT FABCHKR FISCAL YEAR 2021 10/04/2021 0.00 0.00 0.00 0.00 0.00 I2114560 MI091221 118.80 D I2114736 MI092321 270.65 D I2114564 MI092421 112.70 D I2114713 MI093021 453.06 D I2114640 MI092721 68.04 D I2114643 MULTIPLE 607.76 D I2114636 MI082621 18.63 D I2114565 MI092721 37.80 D 2,827.01 RUN DATE: 10/01/2021 TIME: 02:48 PM PAGE: RPTNAME: FABCHKR PARAMETER SEQUENCE NUMBER: 337891 NUMBER OF PRINTED LINES PER PAGE: 52 Weld County BNPD Data Batch Disbursement Register Check Run: 2 * * * REPORT CONTROL INFORMATION * * REPORT FABCHKR Weld County BNPD Data RUN DATE: 10/01/2021 FISCAL YEAR 2021 Batch Disbursement Register TIME: 02:46 PM BANK: 01 TREASURER -ACCOUNTS PAYABLE Direct Deposit Run: 10/04/2021 PAGE: 1 < DIRECT DEPOSIT REGISTER > CHECK/ < APPROVED AMOUNTS > CHK ADVICE DISCOUNT/ WITHHOLDING/ TYP NUMBER PAYEE/VENDOR NAME A/P DOC# VENDOR INV# GROSS PREV PAID ADDL CHG/TAX NET IND !0037438 BUSTOS, CORDERO I2114598 BUSTOS092121 30.83 0.00 0.00 30.83 D 10037439 CRANDALL, KARIN I2114712 MI091021 192.24 0.00 0.00 192.24 D 10037440 DUCHAINE, AMBER I2114719 MI092421 142.83 0.00 0.00 142.83 D !0037441 FENNER, ROCHELLE 21.60 0.00 0.00 I2114730 21.60 D !0037442 PANAS, JOHN I2114449 PANAS092821 29.34 0.00 0.00 29.34 D 10037443 RAEBURN, CHELSEA I2114519 NOVA 2021 45.09 0.00 0.00 45.09 D !0037444 ROSE, RYAN I2114501 BUDGET21 267.48 0.00 0.00 267.48 D 10037445 WRIGHT, CINDE I2114454 PE LIC RENEWAL 68.00 0.00 0.00 68.00 D !0037446 WELD COUNTY REVOLVING FUND I2114206 NOVA 2021 325.00 0.00 0.00 325.00 D BANK TOTAL 1,122.41 T REPORT FABCHKR FISCAL YEAR 2021 10/04/2021 RUN DATE: 10/01/2021 TIME: 02:46 PM PAGE: RPTNAME: FABCHKR PARAMETER SEQUENCE NUMBER: 337885 NUMBER OF PRINTED LINES PER PAGE: 52 Weld County BNPD Data Batch Disbursement Register Check Run: 2 * * * REPORT CONTROL INFORMATION * * REPORT FABCHKR Weld County BNPD Data RUN DATE: 10/01/2021 FISCAL YEAR 2021 Batch Disbursement Register TIME: 02:42 PM BANK: E2 TREASURER -SS ELECTRONIC PAYMENTS Check Run: 10/04/2021 PAGE: 1 < CHECK REGISTER > CHECK/ < APPROVED AMOUNTS > CHK ADVICE DISCOUNT/ WITHHOLDING/ TYP NUMBER PAYEE/VENDOR NAME A/P DOC# VENDOR INV# GROSS PREV PAID ADDL CHG/TAX NET IND E0002447 LABORATORY CORPORATION OF AMER I2114620 MULTIPLE 190.00 0.00 0.00 190.00 B T REPORT FABCHKR Weld County BNPD Data RUN DATE: 10/01/2021 TIME: 02:42 PM 10/04/2021 PAGE: FISCAL YEAR 2021 * RPTNAME: FABCHKR PARAMETER SEQUENCE NUMBER: 337877 NUMBER OF PRINTED LINES PER PAGE: 52 Batch Disbursement Register Check Run: 2 * * * REPORT CONTROL INFORMATION * REPORT FABCHKR Weld County BNPD Data RUN DATE: 10/01/2021 FISCAL YEAR 2021 Batch Disbursement Register TIME: 02:40 PM BANK: El TREASURER -AP ELECTRONIC PAYMENTS Check Run: 10/04/2021 PAGE: 1 < CHECK REGISTER > CHECK/ APPROVED AMOUNTS > CHK ADVICE DISCOUNT/ WITHHOLDING/ TYP NUMBER PAYEE/VENDOR NAME A/P DOC# VENDOR INV# GROSS PREV PAID ADDL CHG/TAX NET IND E0002445 GALLS INC I2114592 MULTIPLE 15,388.00 0.00 0.00 15,388.00 B E0002446 LABORATORY CORPORATION OF AMER I2114648 70379515 403.79 0.00 0.00 403.79 B BANK TOTAL 15,791.79 T REPORT FABCHKR Weld County BNPD Data RUN DATE: 10/01/2021 TIME: 02:40 PM 10/04/2021 PAGE: FISCAL YEAR 2021 * RPTNAME: FABCHKR PARAMETER SEQUENCE NUMBER: 337873 NUMBER OF PRINTED LINES PER PAGE: 52 Batch Disbursement Register Check Run: 2 * * * REPORT CONTROL INFORMATION * * vaetna Re: Funds Transfer Confirmation Prepared Date: Contractholder Name: Attention: Reference#: Activity of: Debit/Pull Amount: Account Name: Credit Bank: Bank Address: Account Number: ACH ABA Number: Monday, September 27, 2021 WELD COUNTY GOV S FREY/R FIELDER RE:MEDICAL CLAIMS 54-21267-0462 Friday, September 24, 2021 $109,965.77 SFGP/ASC Contractholders Account Bank Of America Connecticut 2601 West Broad Street Richmond VA 23220 Please make available for debit the requested funds immediately to avoid late funding interest charges, suspension of services, or termination for nonpayment pursuant to the terms of your contract. ver.3.0.7.0 For any questions, please send emails to Banking-SAMP@aetna.com or call a contact listed below. Kimberly Settle Banking Consultant Phone 330-659-8333 J2101288 09/27/2021 Daphne Fentress Banking Consultant Phone 904-351-5504 Proprietary vaetna Re: Funds Transfer Confirmation Prepared Date: Thursday, September 30, 2021 Contractholder Name: Attention: WELD COUNTY GOV S FREY/R FIELDER RE:MEDICAL CLAIMS Reference#: 54-21272-0809 Activity of: Wednesday, September 29, 2021 Debit/Pull Amount: $215,126.47 Account Name: Credit Bank: Bank Address: SFGP/ASC Contractholders Account Bank Of America Connecticut 2601 West Broad Street Richmond VA 23220 Account Number: Please make available for debit the requested funds immediately to avoid late funding interest charges, suspension of services, or termination for nonpayment pursuant to the terms of your contract. ver.3.0.7.0 For any questions, please send emails to Banking-SAMP@aetna.com or call a contact listed below. Ti,Lilt�Ir Kimberly Settle Daphne Fentress Banking Consultant Phone 330-659-8333 Banking Consultant Phone 904-351-5504 J2101300 09/30/2021 Proprietary r . • tna Re: Funds Transfer Confirmation Prepared Date: Contractholder Name: Attention: Reference#: Activity of: Friday, October 1, 2021 WELD COUNTY GOV S FREY/R FIELDER RE:MEDICAL CLAIMS 54-21273-1634 Thursday, September 30, 2021 Debit/Pull Amount: $4,484.75 Account Name: Credit Bank: Bank Address: SFGP/ASC Contractholders Account Bank Of America Connecticut 2601 West Broad Street Richmond VA 23220 Account Number: Please make available for debit the requested funds immediately to avoid late funding interest charges, suspension of services, or termination for nonpayment pursuant to the terms of your contract. ver.3.0.7.0 For any questions, please send emails to Banking-SAMP@aetna.com or call a contact listed below. (ler1t Kimberly Settle Banking Consultant Phone 330-659-8333 Daphne Fentress Banking Consultant Phone 904-351-5504 J2101313 10/01/2021 Proprietary 4, .:_• 0 T :,7;_6.50 1,C3(1,509.2 ,825.97 + ,c7.01 ,1.2.41 , 15,7"1.79 10:.,055.77 25,12S.47 - 4, ,x,76.50 1,,34,509.22 7,825.97 ?,27.01 ,1 x.41 19;".00 15,791.79 10;1955.-7 215,12+.47 /84.75 Hello