HomeMy WebLinkAboutInv# 398452 - AFLAC - 07/01/2025 (2)Account Name:
Address:
Date Prepared:6/14/2025
Billing Frequency:MONTHLY
Invoice Copy
6/24/2025
CITY OF DANIA
Attn Linda Gonzalez-Ext 3608
100 W Dania Beach Blvd
DANIA,FL 33004-3643
Invoice Number:398452
Account Number:FW W 12
Premium Due Date:7/1/2025
Amount Billed:$2,213.32
Amount Remitting:$2,213.32
Billing Period:June
Number of Deductions:2
Deduction Frequency:24
Billing Mode:MONTHLY
If paying by paper check,please reconcile online and send your check with the printed payment coupon to the address listed above.
Aflac
PO Box 673025,Dallas TX 75267-3025
Aflac.com
COPY -Original Invoice
Page 1 of 2
The premium amount billed for some policies may not reflect the number of deductions indicated above if the
policies were issued during the billing period. If paying by paper check,please reconcile online and send
your check with the printed payment coupon to the address listed above.
Policy Policy
Type CT Dept.Employee/
Member #Name RM Premium
Due
Employee
Sub-Total
Adjusted
Premium
Adjusted
Sub-Total CR
P1C894S1 CANCER I BACAROSSI,BIANCAMARIA $60.94 $60.94 $60.94 $60.94
P0R3Y2D7 HOSP I 0000001641 CROSS,JERRYLYN $57.60 $57.60 $57.60 $57.60
P0R265B6 ACC F 0000001806 DAMIS,W INDY $59.02 $59.02 $59.02 $59.02
P0L9D6C2 ACC S 0000001878 DEMASSIS,TAMARA C $35.76 $35.76
P0L9D6C4 HOSP S 0000001878 DEMASSIS,TAMARA C $77.62 $113.38 $77.62 $113.38
P0B8K354 ACC S 0000001670 GARDNER,KALA $35.76 $35.76
P0B8K362 HOSP S 0000001670 GARDNER,KALA $37.58 $73.34 $37.58 $73.34
P0G5T8F3 ACC F 0000001239 GREENE,DARREN $46.68 $46.68 $46.68 $46.68
P0Z7R9L8 CANCER F HUCK,MICHAEL $108.84 $108.84 $108.84 $108.84
B3058189 ACC F 0000001700 HUCK,MICHAEL $46.68 $46.68 $46.68 $46.68
P0L9D6C1 ACC S 0000001820 ICENHOUR,RACHEL N $35.76 $35.76 $35.76 $35.76
P0B8K0J8 CANCER F 0000001314 JAMES,TAMMIE D $54.00 $54.00
P0B8K0K5 HOSP F 0000001314 JAMES,TAMMIE D $71.64 $71.64
P0G5T8E4 ACC F 0000001314 JAMES,TAMMIE D $46.68 $172.32 $46.68 $172.32
P1C698B8 HOSP I 0000001890 JOLLY,CORY $68.52 $68.52
P1C698B9 ACC I 0000001890 JOLLY,CORY $24.32 $92.84 $24.32 $92.84
P0B8K0A6 ACC F 0000000947 MCHELLON,DONIAL $46.68 $46.68
P0B8K0D2 CANCER F 0000000947 MCHELLON,DONIAL $45.50 $92.18 $45.50 $92.18
P0J8H1S3 ACC F 0000001797 PECORARO,SHERRY A $46.68 $46.68
P0L9D6C3 CANCER I 0000001797 PECORARO,SHERRY A $62.54 $109.22 $62.54 $109.22
P0B8K0A7 CANCER F 0000001750 PEREZ,FRANK $45.50 $45.50 $45.50 $45.50
P0G5T8F1 ACC P REYES,EDDIE $38.22 $38.22
P0Y443K1 HOSP P REYES,EDDIE $133.52 $171.74 $133.52 $171.74
P0X152H4 ACC I RODRIGUEZ,HAROLD $24.32 $24.32
-continued on next page -
** Highlighted lines indicate that the premium amount being remitted was adjusted and/or a Change Request was submitted for the employee.
LEGEND
COVERAGE TYPE (CT)
I = Individual
F = Family
S = Single-Parent Family
P = Primary-Spouse
REMARKS (RM)
CV = Pending Conversion
PA = Policy is Paid Ahead
PC = Policy is Pending Conversion
and is Paid Ahead
CHANGE REQUEST (CR)
A=Add person to policy H = Name Change O = Other
C=Cancel Coverage I = Delete person from policy R = Retired
D=Deceased L = Non-Family Medical Leave T = No longer employed here
E=Unknown Insured-Remove M= Missed Deduction W= Transfer to another account
F=Family Medical Leave Y = Military Leave
Aflac
PO Box 673025, Dallas TX 75267-3025
1-800-99-AFLAC (1-800-992-3522)
Aflac.com
If paying by paper check, please reconcile online and send your check with the printed payment coupon to the address listed above.
Page 2 of 2
COPY - Original Invoice
The premium amount billed for some policies may not reflect the number of deductions indicated above if the
policies were issued during the billing period. If paying by paper check, please reconcile online and send
your check with the printed payment coupon to the address listed above.
Policy Policy
Type CT Dept.
Employee/
Member #
Name RM Premium
Due
Employee
Sub-Total
Adjusted
Premium
Adjusted
Sub-Total CR
P0X152H5 HOSP I RODRIGUEZ, HAROLD $75.66 $99.98 $75.66 $99.98
P1B269A5 ACC I RODRIGUEZ, MICHAEL $24.32 $24.32
P1B26945 CANCER I RODRIGUEZ, MICHAEL $60.94 $85.26 $60.94 $85.26
P0T3Y4C9 HOSP I 0000001680 RODRIGUEZ, MICHAEL $47.32 $47.32 $47.32 $47.32
P0B8K352 ACC F 0000001682 RODRIGUEZ, RICHARD $59.02 $59.02
P0B8K358 CANCER F 0000001682 RODRIGUEZ, RICHARD $48.80 $107.82 $48.80 $107.82
P1C410P5 ACC I SMITH, ROY $24.32 $24.32 $24.32 $24.32
P0V621L3 HOSP I 0000001343 STEVENS, TANIA A $64.48 $64.48
P0V621U1 ACC I 0000001343 STEVENS, TANIA A $24.32 $88.80 $24.32 $88.80
P0B8K0A4 ACC F 0000000946 THOMAS, AHMAD $46.68 $46.68
P0B8K099 HOSP F 0000000946 THOMAS, AHMAD $63.18 $109.86 $63.18 $109.86
P0H8A2F9 STD I WAREN, CASSANDRA $76.06 $76.06 $76.06 $76.06
P0J8H1T1 ACC S 0000001173 WEST, COKENYA $35.76 $35.76 $35.76 $35.76
P0V621L4 ACC I 0000001828 WESTBERRY, ANSON J $24.32 $24.32 $24.32 $24.32
P0B8K355 ACC F 0000001403 WHITE, DEON $46.68 $46.68 $46.68 $46.68
P0Y4A937 ACC P WILLIAMS, DARIUS $38.22 $38.22
P0Y4A938 HOSP F WILLIAMS, DARIUS $120.52 $158.74 $120.52 $158.74
P0B8K0A3 ACC I 0000001671 ZAPATA, MARLON $22.36 $22.36 $22.36 $22.36
Total Amount Billed:
$2,213.32 Amt Due $2,213.32
6/27/25