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Home My WebLink AboutInv# 2022-00000850 - AFLAC - 10/20/2022 (2)Aflac Attn: Remittance Processing Services 1932 Wynnton Road,Columbus,GA 31999-0797Aflac.com Account Name: Address: Date Prepared:10/15/2022 Billing Frequency:MONTHLY Invoice Copy 10/20/2022 CITYOF DANIA Attn Linda Gonzalez-Ext 3608 100 W DaniaBeach Blvd DANIA,FL 33004-3643 Invoice Number:304724 Account Number:FWW12 Premium Due Date:11/1/2022 Amount Billed:$3,391.14 Amount Remitting:$3,352.92 Billing Period:October Numberof Deductions:2 Deduction Frequency:24 Billing Mode:MONTHLY COPY -Submitted Invoice.Contains reconciliation/changes made by account. Page 1 of 3 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. Policy Policy Type CT Dept.Employee/ Member #Name RM Premium Due Employee Sub-Total Adjusted Premium Adjusted Sub-Total CR P0S6J773 ACC F BORGOS,LUIS $58.12 $58.12 P0S6J784 STD I BORGOS,LUIS $50.70 $108.82 $50.70 $108.82 B2865120 HOSP I 0000000549 BROWN,LOUIS $27.44 $27.44 B2865121 SPEVNT I 0000000549 BROWN,LOUIS $31.86 $31.86 P0B8K0A2 ACC I 0000000549 BROWN,LOUIS $22.36 $22.36 P0B8K0D1 CANCER I 0000000549 BROWN,LOUIS $26.90 $108.56 $26.90 $108.56 B2974702 ACC I 0000001819 CIGUENE,MAUDELINE $22.36 $22.36 P0J8H1S7 HOSP I 0000001819 CIGUENE,MAUDELINE $57.60 $79.96 $57.60 $79.96 P0R3Y2D7 HOSP I 0000001641 CROSS,JERRYLYN $57.60 $57.60 $57.60 $57.60 P0R265B6 ACC F 0000001806 DAMIS,WINDY $59.02 $59.02 $59.02 $59.02 P0V6J5F0 CANCER F DIPAOLO,FRANK $91.36 $91.36 $91.36 $91.36 P0B898A4 STD I DIPAOLO,FRANK L $61.50 $61.50 P0B898A5 HOSP F DIPAOLO,FRANK L $85.94 $147.44 $85.94 $147.44 P0L9D6C2 ACC S 0000001878 DRUMMOND,TAMARA C $35.76 $35.76 P0L9D6C4 HOSP S 0000001878 DRUMMOND,TAMARA C $77.62 $113.38 $77.62 $113.38 P0R265B5 ACC I 0000001813 GAINES,TANEISHA $24.32 $24.32 P0R3Y2D4 CANCER I 0000001813 GAINES,TANEISHA $62.54 $86.86 $62.54 $86.86 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 P0V621U3 ACC S 0000001885 JAMES,TAMARAE $43.16 $43.16 $43.16 $43.16 P0B8K0J8 CANCER F 0000001314 JAMES,TAMMIED $54.00 $54.00 -continued on next page - Worldwide Headquarters •Columbus,Georgia 31999 1.800.99.AFLAC (1.800.992.3522) aflac.com LEGEND COVERAGETYPE (CT) I =Individual F =Family S =Single-Parent Family P =Primary-Spouse REMARKS (RM) CV =PendingConversion PA =Policyis Paid Ahead PC =Policyis Pending Conversion and is Paid Ahead CHANGE REQUEST (CR) A=Addperson to policy H =Name Change O =Other C=Cancel Coverage I =Deleteperson 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 =MilitaryLeave Page 2 of 3 COPY -SubmittedInvoice. Contains reconciliation/changes made by account. 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. Policy Policy Type CT Dept.Employee/ Member #Name RM Premium Due Employee Sub-Total Adjusted Premium Adjusted Sub-Total CR P0B8K0K5 HOSP F 0000001314 JAMES,TAMMIED $71.64 $71.64 P0G5T8E4 ACC F 0000001314 JAMES,TAMMIED $46.68 $172.32 $46.68 $172.32 P0B8K0A6 ACC F 0000000947 MCHELLON,DONIAL $46.68 $46.68 P0B8K0D2 CANCER F 0000000947 MCHELLON,DONIAL $45.50 $92.18 $45.50 $92.18 P0Z1Y186 HOSP P MILES,FELICIA $114.28 $114.28 $114.28 $114.28 P0Z7R9L9 ACC P OSTROFSKY,WARREN $38.22 $38.22 $0.00 R P0J8H1S3 ACC F 0000001797 PECORARO,SHERRYA $46.68 $46.68 P0L9D6C3 CANCER I 0000001797 PECORARO,SHERRYA $62.54 $109.22 $62.54 $109.22 P0B8K0A7 CANCER F 0000001750 PEREZ,FRANK $45.50 $45.50 $45.50 $45.50 P0B8K0A8 CANCER I 0000001453 PERRY,LEONARD $26.90 $26.90 P0B8K088 ACC I 0000001453 PERRY,LEONARD $22.36 $22.36 P0B8K094 HOSP I 0000001453 PERRY,LEONARD $44.08 $93.34 $44.08 $93.34 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 P0X152H5 HOSP I RODRIGUEZ,HAROLD $75.66 $99.98 $75.66 $99.98 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 P0G5T8E8 ACC I 0000001168 SALGADO,JOSE $22.36 $22.36 $22.36 $22.36 P0B8K0J0 ACC P 0000001321 SAUNDERS,JANICE $33.28 $33.28 P0B8K0K3 HOSP P 0000001321 SAUNDERS,JANICE $84.38 $117.66 $84.38 $117.66 P0V621U2 ACC I 0000001879 SHELEY,CHERIE A $24.32 $24.32 $24.32 $24.32 P0V621L3 HOSP I 0000001343 STEVENS,TANIAA $64.48 $64.48 P0V621U1 ACC I 0000001343 STEVENS,TANIAA $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 P0J8H1S6 ACC I 0000001676 VASTA,MICHAEL $22.36 $22.36 $22.36 $22.36 P0H8A2F9 STD I WAREN,CASSANDRA $76.06 $76.06 $76.06 $76.06 P0B8K359 CANCER F 0000001753 WEEKES,KATHLEEN $48.80 $48.80 P0J8H1S9 HOSP P 0000001753 WEEKES,KATHLEEN $96.46 $96.46 P0J8H1T0 SPEVNT I 0000001753 WEEKES,KATHLEEN $53.30 $198.56 $53.30 $198.56 -continued on next page - Worldwide Headquarters •Columbus,Georgia 31999 1.800.99.AFLAC (1.800.992.3522) aflac.com LEGEND COVERAGETYPE (CT) I =Individual F =Family S =Single-Parent Family P =Primary-Spouse REMARKS (RM) CV =PendingConversion PA =Policyis Paid Ahead PC =Policyis Pending Conversion and is Paid Ahead CHANGE REQUEST (CR) A=Addperson to policy H =Name Change O =Other C=Cancel Coverage I =Deleteperson 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 =MilitaryLeave Page 3 of 3 COPY -SubmittedInvoice. Contains reconciliation/changes made by account. 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. Policy Policy Type CT Dept.Employee/ Member #Name RM Premium Due Employee Sub-Total Adjusted Premium Adjusted Sub-Total CR 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 P0R265B4 ACC P 0000001790 WHITE,GEORGE $38.22 $38.22 P0R265B7 CANCER P 0000001790 WHITE,GEORGE $111.94 $150.16 $111.94 $150.16 P0Y4A937 ACC P WILLIAMS,DARIUS $38.22 $38.22 P0Y4A938 HOSP P WILLIAMS,DARIUS $114.28 $152.50 $114.28 $152.50 P0B8K0A3 ACC I 0000001671 ZAPATA,MARLON $22.36 $22.36 $22.36 $22.36 Total Amount Billed:$3,391.14 AmtDue $3,352.92