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Home My WebLink About229326 2/25/2014 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1 ONE CIVIC SQUARE TRAVELERS CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $9,602.10 , oN io CHICAGO IL 60693 CHECK NUMBER: 229326 CHECK DATE: 2/25/2014 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1125 4351000 455727 1, 184 .41 AUTO REPAIR & MAINTEN 1205 4347500 455727 8, 417 . 69 GENERAL INSURANCE TRAVELERS PAGE 1 14TG2033-ZLP 521GX7087 01/31/2014 000455729 02/15/2014 4,998.00 '� T I�-- CURRENT CLAIM#: EYQ4713 DATE OF LOSS: 10/10/2013 DESCRIPTION: PROF C - WYNN, BARBARA EEOC COMPLAINT FOR WRONGFUL TERMINATION FROM CA CLAIMANT: BARBARA M WYNN EXPENSE 4,998.00 CLAIM TOTAL 4,998.00 CURRENT CHARGES $4,998.00 ACCOUNT SUMMARY CURRENT CHARGES 4,998.00 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 4,998.00 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 4,998.00 CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE. FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-HELPDESK@TRAVELERS.COM OR CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-860-277-6812 ANTONIO CONTRERAS -#4)cnz - I';. 1 SZ� `7U Submitted T® ll FEB 2 4 2014 Clerk Treasurer TRAVELERS NON-FUNDED DEPARTMENT ONE TOWER SQUARE -9CR HARTFORD, CT 06183 00763 39190 CITY OF CARMEL, CARMEL CLAY PARKS BUILD ONE CIVIC SQUARE CARMEL IN 46032 0 n v 0 I o 0 0 a 0 TRAVELERS PAGE , THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. 14N99887-ZPP 5216X7087 01/31/2014 000455728 02/15/2014 3,475.70 ,f, CURRENT CURRENT CLAIM#: EXK2736 DATE OF LOSS: 07/01/2012 DESCRIPTION: ALLEGATION THAT A CITY OF CARMEL POLICE OFFICER RAN THE CLMT'S PERSONA CLAIMANT: NICOLE RYERSON ^` EXPENSE 904.50 01 )'o\1CSL CLAIM TOTAL 904.50 CLAIM#: EYQ5411 DATE OF LOSS: 07/25/2012 DESCRIPTION: PROF C - CIMT WAS ARRETED BY THE MARION COUNTY DRUG TASK FORCE AND CHA CLAIMANT: JONAH LONG EXPENSE 998.30 CLAIM TOTAL 998.30 CURRENT CHARGES ,� $1,902 \ ACCOUNT SUMMARY CURRENT CHARGES 1,902.80 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 1 ,572.90 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 3,475.70 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 3,475.70 CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE. FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-HELPDES TRAVE�L� § M CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-860-277-6812 AN ONIO N, R . Ai d To FEB 2 4 2014 Clea: Treasurer TRAVELERS NON-FUNDED DEPARTMENT ONE TOWER SQUARE -9CR HARTFORD, CT 06183 00762 39191 CITY OF CARMEL, CARMEL CLAY PARKS BUIL ONE CIVIC SQUARE CARMEL IN 46032 N V O O O N O Q O O TRAVELERS PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. � *011101 M kill]NN 4.M:114 M 17.11 IM41 Re kill] JNA ild 3036P64A-810 521GX7087 01/31/2014 000455727 02/15/2014 18, 128.57 ", -S ,-�- CUR REP:T CLAIM#: EVA9684 DATE OF LOSS: 01/09/2014 DESCRIPTION: IV AND OV MAKING A LEFT TURN, IV STOPPED AND PUT VEHICLE IN REVERSE, I CLAIMANT: DEBORAH BENEDETTI -...` LOSS 85.74 CLAIM TOTAL6,385.74 CLAIM#: EZK6237 DATE OF LOSS: 12/16/2013 DESCRIPTION: IV SLID ON SLUSHY ROAD INTO THE REAR OF OV. CLAIMANT: STANLEY E CHEN LOSS 1, 184.41 C� 0�y)1"T-LQ5 CLAIM TOTAL 1,184.41 CLAIM#: EOA1125 DATE OF LOSS: 01/19/2014 DESCRIPTION: BAUT C - JUN, BENJAMIN - IV PLOWING SNOW & BACKED UP, STRIKING PARKED, CLAIMANT: BENJAMIN JUN LOSS C�2,031.95 CLAIM TOTAL CURRENT CHARGES $9,602.10 Submitted To FEB 2 4 2014 7s/,Z,S = 4 Fo 1`? . L`1- Clerk `treasurer TRAVELERS NON-FUNDED DEPARTMENT ONE TOWER SQUARE -9CR HARTFORD, CT 06183 00764 39189 CITY OF CARMEL,CARMEL CLAY ONE CIVIC SQUARE CARMEL IN 46032 0 N r N V O O O N O Q O O TRAVELERS PAGE 2 DEDUCTIBLE / SELF- INSURED INVOICE 'T 3036P64A-810 521GX7087 01/31/2014 000455727 02/15/2014 18, 128.57 ACCOUNT SUMMARY CURRENT CHARGES 9,602. 10 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PAST DUE CHARGES 8,526.47 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 18. 128.57 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 18, 128.57 CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE. FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-HELPDESK@TRAVELERS.COM OR CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-860-277-6812 ANTONIO CONTRERAS TRAVELERS NON-FUNDED DEPARTMENT ONE TOWER SQUARE -9CR HARTFORD, CT 06183 00764 39188 CITY OF CARMEL,CARMEL CLAY ONE CIVIC SQUARE CARMEL IN 46032 m m 0 0 0 0 Q 0 0 TW Prescribed by state Board of Accounts City Form No.201 (Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service 'rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s)or bill(s)) 01/31/14 000455729 Fire $526.76 01/31/14 0000455728 Police $1,902.80 01/31/14 000455727 Utilities $2,031.95 01/31/14 000455727 Street $6,385.74 I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance with IC 5711-10-1.6 20 Clerk-Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 Travelers IN SUM OF $ 13607 Collections Center Drive Chicage, IL 60693 $10,847.25 ON ACCOUNT OF APPROPRIATION FOR Administration Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members I hereby certify that the attached invoice(s), or 000455729 -43-475.00 $526.76 � bill(s) is (are)true and correct and that the 0000455728 43-475.00 $1,902.80 materials or services itemized thereon for '<5f 120'5 000455727 43-475.00 $2,031.95 which charge is made were ordered and 1205-' 000455727 43-475.00 $6,385.74 received except Monday, February 24, 2014 Director, Administration Title Cost distribution ledger classification if claim paid motor vehicle highway fund i I VELERS J PAGE i THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. 3036P64A-810 5216\X7087 01/31/2014 000455727 02/15/2014 18, 128.57 CURRENT CLAIM#: EVASS84 DATE OF LOSS: 01/09/2014 DESCRIPTION: IV AND OV MAKING A LEFT TURN, IV STOPPED AND PUT VEHICLE IN REVERSE, I CLAIMANT: DEBORAH BENEDETTI ) LOSS 6,385.74 V-7 •��s/" CLAIM TOTAL 6,385.74 CLAIM#: EZK6237` . ' .DATE OF LOSS: 12/16/2013 DESCRIPTION: IV SLID bN SLUSITY'ROAD INTO THE REAR OF OV. CLAIMANT: STANLEY E CHEN LOS ' 1„ 184.41' �� Z}�}��-l•2S % CCAIM •TO,TAL:--.--. ;1;.:1_'84.4 i ,� CLAIM#: EOA1125 DATE OF LOSS: 01/19/2014 DESCRIPTION: BAUT C - JUN, BENJAMIN - IV PLOWING SNOW & BACKED UP, STRIKING PARKED, CLAIMANT: BENJAMIN JUN LOSS 2,031.95 CLAIM TOTAL 2,031.95 CURRENT CHARGES $9,602.10 b08 wor yi Ljffl� -" �.31 5 POF TRAVELE S J PAGE 1 DEDUCTIBLE / SELF-INSURED INVOICE 1 i 3036P64A 810 5216X7087 r 01/31/2014 000455727• -----_.,.., ti r 02/15/2014 18, 128.57 MA 41E tTOI: TRAVELERS k't_.`' PAYER: 13'607=� OLLECTI.ON&,CENTER.DRIVE CITY OF CARMEL,CARMEL CLAY ',CHICAGO'.,' ,I"L `,,.60693, ONE CIVIC SQUARE CARMEL IN 46032 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE WRITE THE POLICY & ACCOUNT NUMBER ON YOUR CHECK. m 1�-K '�`-E- `y� �Y.sA r t � -� Y_�s�-."rf---�ay,�=''= - *_�5 �r_ -�� "� _-`t` �- "�`"�c _ "�y„5•= F: s: Y -,y4-` 'r: ..+:F�,'`+�fi`¢ --*�' - '"-'�- k's. -E �•� -�'vi.� _ ""fie" � f 'S;�"' i��.-i."'w.a'_� ..�,� f- �1` ,� -�r�'.��,� '�,sr♦ .e'�� ''c ! -•.r,�'-�g„�, ."� a �� - n `'^�+�w�r�z„n �-.^.�-'," ,fie--- dfi�Y�' -"k �r.�-�3� � -�°+�x{`k�,+. - �,� ��-�'��'9•�. .,T �Y} �+;- 5 a x�` -y"`;" -� �`+�'^--y i� -d �; -i-' sa=� ---��,• �n��9. ••� 'fi. .�_ - y,�� -_�)''tnx„� �-- +F TRAVELERS J PAGE 1 DEDUCTIBLE / SELF-INSURED INVOICE 3036P64A-810 521GX7087 01/31/2014 000455727 02/15/2014 18, 128.57 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL,CARMEL CLAY 13607 COLLECTIONS CENTER DRIVE ONE CIVIC SQUARE CHICAGO, IL 60693 CARMEL IN 46032 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE WRITE THE POLICY & ACCOUNT NUMBER ON YOUR CHECK. TRAVELERS J PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. 3036P64A-810 5216X7087 01/31/2014 000455727 02/15/2014 18, 128.57 CUR R E NT CLAIM#: EVA9684 DATE OF LOSS: 01/09/2014 DESCRIPTION: IV AND OV MAKING A LEFT TURN, IV STOPPED AND PUT VEHICLE IN REVERSE, I CLAIMANT: DEBORAH BENEDETTI LOSS 6,385.74 t 7 ' 7�:•s% CLAIM TOTAL 6,385.74 CLAIM#: EZK6237 DATE OF LOSS: 12/16/2013 DESCRIPTION: IV SLID ON SLUSHY ROAD INTO THE REAR OF OV. CLAIMANT: STANLEY E CHEN }} LOSS 1, 184.41 CLAIM TOTAL 1, 184.41 CLAIM#: E6A1125 DATE OF LOSS: 01/19/2014 DESCRIPTION: BAUT C - JUN, BENJAMIN - IV PLOWING SNOW & BACKED UP, STRIKING PARKED, CLAIMANT: BENJAMIN JUN LOSS 2,031 .95 CLAIM TOTAL 2,031.95 CURRENT CHARGES $9,602.10 Purchase dBc)V V w0r� on� � MCA um�n.1_ P.C .# �` ' 5�LPoO Purchaser Date Approval Da t3 i ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. 362876 Travelers Terms 13607 Collections Center Drive Chicago, IL 60693 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO# Amount 1/31/14 455727 Body work repair M01 36594 $ 1,184.41 Total $ 1,184.41 1 hereby certify that the attached invoice(s), or bill(s)is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 20_ Clerk-Treasurer Voucher No. Warrant No. 362876 Travelers Allowed 20 13607 Collections Center Drive Chicago, IL 60693 In Sum of$ $ 1,184.41 ON ACCOUNT OF APPROPRIATION FOR 101 -General Fund PO#orBoard Members Dept# INVOICE NO. CCT#/TITL AMOUNT 1125 455727 4351000 $ 1,184.41 1 hereby certify that the attached invoice(s), or bill(s) is(are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except 20-Feb 2014 Signature $ 1,184.41 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund