HomeMy WebLinkAboutInv# 2025-00000340 - Fidelity Security Life Insurance Company - 04/30/2025eveEyeMed 4000 LUXOTTICA PL MASON OH 45040-8114
Forwarding Service Requested
THE CITY OF DANIA BEACH COBRA LINDA GONZALE 100 W. DANIA BEACH BLVD. DANIA BEACH FL 33004
BILLING PERIOD: April, 2025
FULL MONTH
COVERAGE TIER
Benefit Level 1
Employee + Family
17,817
20250325806 JJ.45 ]30018195
1145 [17,817] 3 of6
[DM-BS]
SUMMARY INVOICE FOR: The City of Dania Beach COBRA
GROUP ID: 5000544
SUBGROUP ID: 1001
INVOICE NUMBER: 166728398
COUNT RATE TOTAL
$12.24 $12.24
FULL MONTH TOTAL $12.24
CURRENT BILLING PERIOD TOTAL $12.24
PAYMENT IS DUE IN FULL UPON RECEIPT eve THE IN VOICE CALCULATION IS BASED ON MEMBERSHIP AS OF 03/20/25 PLEASE DETACH AND RETURN
THE CITY OF DANIA BEACH COBRA LINDA GONZALE 100 W. DANIA BEACH BLVD. DANIA BEACH FL 33004
Remit To: FIDELITY SECURITY LIFE INSURANCE CO. PO BOX 632530 CINCINNATI OH 45263-2530
GROUP ID: 5000544
SUBGROUP ID: 1001
INVOICE NUMBER: 166728398
TOTAL INVOICE AMOUNT DUE: $12.24
7