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Home My WebLink About230277 03/25/14 (9- CITY OF CARMEL, INDIANA VENDOR: 362876 ONE CIVIC SQUARE TRAVELERS CHECKAMOUNT: S"""'5,938.82'CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 230277 CHICAGO IL 60693 CHECK DATE: 03/25/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 457641 134.10 GENERAL INSURANCE 1125 4358400 457642 289.12 REFUNDS AWARDS & INDE 1205 4347500 457642 5,515.60 GENERAL INSURANCE Alk TRAVELERS J PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. 1 3036P64A-810 5216X7087 02/28/2014 000457642 03/15/2014 15,406.82 �7 S�v&Q- 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 8 7.80> �7 1 )�c��$ CLAIM TOTAL 857.80 CLAIM#: EZK6237 DATE OF LOSS: 12/16/2013 DESCRIPTION: IV SLID ON SLUSHY ROAD INTO THE REAR OF OV. CLAIMANT: STANLEY E CHEN 4 LOSS JI'A2�' CLAIM TOTAL 289.12 CLAIM#: EOA2771 DATE OF LOSS: 01/06/2014 DESCRIPTION: BAUT C - MC CARTY, IAN TORT NOTICE ALLEGING DMG TO VEH FROM A SNOW PLO CLAIMANT: IAN MCCARTY L055 1 344 C' } CLAIM TOTAL 1,344.37 CLAIM#: EOA3282 DATE OF LOSS: 02/05/2014 DESCRIPTION: BAUT C- BRENIA,LESLIE IV WAS STOPPED AND PUT VEHICLE IN REVERSE AND HI CLAIMANT: STEVEN BRENIA LOSS06.71 CLAIM TOTAL 706. AGW TRAVELERS J PAGE 2 DEDUCTIBLE / SELF- INSURED INVOICE i 303GP64A-810 521GX7087 02/28/2014 000457642 03/15/2014 15,406.82 C� CURRENT CLAIM#: EOA3869 DATE OF LOSS: 02/11/2014 DESCRIPTION: IV WB AND WAS UNABLE TO STOP DUE TO THE AMOUNT OF SNOW AND SIZE OF HIS CLAIMANT: HIRA MAJID LOSS 2,606.72 CLAIM TOTAL 2 CURRENT CHARGES $5,804.72 ACCOUNT SUMMARY CURRENT CHARGES 5,804.72 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PAST DUE CHARGES 9,602. 10 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 15,406.82 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 15 406.82 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 )70- , F;ub mi tted T® MAR 2 4 2014 Clerk Treasurer AWSk TRAVELERS J PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. MUM[ 1111,111111 14N99887-ZPP 5216X7087 02/28/2014 000457641 03/15/2014 2,036.90 >11L� CURRENT 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 134. 10 CLAIM TOTAL 134. 10 CURRENT CHARGES $134. 10 ACCOUNT SUMMARY CURRENT CHARGES 134. 10 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 1 ,902.80 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 2.036.90 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 2,036.90 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 Submitted To MAR 2 4 2014 Clea Treasurer TRAVELERS NON-FUNDED DEPARTMENT ONE TOWER SQUARE -9CR HARTFORD, CT 06183 00763 39196 CITY OF CARMEL, CARMEL CLAY PARKS BUIL ONE CIVIC SQUARE CARMEL IN 46032 m 0 r v 0 0 0 N O Q O VOUCHER NO. WARRANT NO. ALLOWED 20 Travelers IN SUM OF $ 13607 Collections.Center Drive Chicage, IL 60693 s $5,649.70 ON ACCOUNT OF APPROPRIATION FOR Administration Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1205 1 hereby certify that the attached invoice(s), or 000457642 43-475.00 $2,606.72 bill(s) is (are)true and correct and that the 1205 000457642 43-475.00 $706.71 materials or services itemized thereon for 1205 000457642 43-475.00 $1,344.37 which charge is made were ordered and 1205 000457642 43-475.00 $857.80 received except 1205 000457641 43-475.00 $134.10 Monday, March 24, 2014 Director, Administrate n Title Costdistributionledger classification if claim paid motor vehicle highway fund 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)) 02/28/14 000457642 Street $2,606.72 02/28/14 000457642 Street $706.71 02/28/14 000457642 Street $1,344.37 02/28/14 000457642 Street $857.80 02/28/14 000457641 Police $134.10 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 5-11-10-1.6 120 Clerk-Treasurer Albk A R 1� ELS J PAGE 1 DEDUCTIBLE / SELF-INSURED INVOICE 303GPG4A-810 521GX7087 02/28/2014 000457642 03/15/2014 15,406.82 MAIL PAYMENT TO: PAYER: c��q.7�� TRAVELERS CITY OF CARMEL,CARMEL CLAY 13607 COLLECTIONS CENTER DRIVE ONE CIVIC SQUARE CHICAGO, IL 60693 CARMEL IN 46032 MAR 33 2014 BY: RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE WRITE THE POLICY & ACCOUNT NUMBER ON YOUR CHECK. TRAVEL RS J PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. 1 3036P64A-810 521GX7087 02/28/2014 000457642 03/15/2014 15,406.82 CURRENT 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 ` ~857.80 j CLAIM TOTAL857.80 CLAIM#: EZK6237 DATE OF LOSS: 12/16/2013 DESCRIPTION: IV SLID ON SLUSHY ROAD INTO THE REAR OF OV. CLAIMANT: STANLEY E CHEN LOSS CLAIM TOTAL 289. 12 C� CLAIM#: EOA2771 DATE OF LOSS: 01/05/2014 DESCRIPTION: BAUT C - MC CARTY, IAN TORT NOTICE ALLEGING DMG TO VEH FROM A SNOW PLO CLAIMANT: IAN MCCARTY 1 LOSS 1 344 3 �ry sr CLAIM TOTAL 1,344.37 CLAIM#: EOA3262 DATE OF LOSS: 02/05/2014 DESCRIPTION: BAUT C- BRENIA.LESLIE IV WAS STOPPED AND PUT VEHICLE IN REVERSE AND HI CLAIMANT: STEVEN BRENIA -- LOSS X706_71 CLAIM TOTAL 706.71 1�neLlyc-in cC, Cl c� Gi p y� 12Gx K I'V a"u -fPkW-k1cf— l vl c�ev�f 11125-1-01- +358400 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 2/28/14 457642 Insurance claim on park Maintenance incident $ 289.12 Total $ 289.12 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 5-11-10-1.6 20_ Clerk-Treasurer Voucher No. Warrant No. 362876 Travelers j Allowed 20 13607 Collections Center Drive Chicago, IL 60693 In Sum of$ $ 289.12 I ON ACCOUNT OF APPROPRIATION FOR 101 -General Fund PO#or INVOICE NO. CCT#/TITL :AMOUNT Board Members Dept# ( 1125 457642 4358400 $ 289.12 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-Mar 2014 W7 Signature $ 289.12 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund