HomeMy WebLinkAboutInv# 2024-00000738 - Fidelity Security Life Insurance Company - 08/28/2024 (2)SUMMARY INVOICE FOR:
INVOICE NUMBER:
SUBGROUP ID:
GROUP ID:
BILLING PERIOD:August, 2024
The City of Dania Beach COBRA
5000544
1001
166380609
FULL MONTH
COVERAGE TIER COUNT RATE TOTAL
Benefit Level 1
Employee + Family 1 $12.24 $12.24
FULL MONTH TOTAL $12.24
CURRENT BILLING PERIOD TOTAL $12.24
FIDELITY SECURITY LIFE INSURANCE CO.
PO BOX 632530
CINCINNATI OH 45263-2530
Remit To:
GROUP ID:
SUBGROUP ID:
INVOICE NUMBER:
TOTAL INVOICE AMOUNT DUE:
5000544
1001
166380609
$12.24
THE CITY OF DANIA BEACH COBRA
LINDA GONZALE
100 W. DANIA BEACH BLVD.
DANIA BEACH FL 33004
PAYMENT IS DUE IN FULL UPON RECEIPT
THE INVOICE CALCULATION IS BASED ON MEMBERSHIP AS OF 07/20/24
PLEASE DETACH AND RETURN
Forwarding Service Requested
THE CITY OF DANIA BEACH COBRA
LINDA GONZALE
100 W. DANIA BEACH BLVD.
DANIA BEACH FL 33004
11,014
EyeMed
4000 LUXOTTICA PL
MASON OH 45040-8114
J5FF [11,014] 3 of 6
[DM-BS]
20240726B05J5FF3300 38195
8/27/24