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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 CHECK AMOUNT: $9,602.10 �.o CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE 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 AWIlk TRAVELERS J PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. 303GP64A-810 521GX7087 01/31/2014 000455727 02/15/2014 18, 128.57 C1IRRENT 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 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 C7 U '1�11 C��S CLAIM TOTAL 1, 184.41 CLAIM#: EOA1125 1 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 2,031.95 CURRENT CHARGES $9,602. 10 Submitted To FEB 2 4 2014 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 a 0 0 0 N O Q O O TRAVELERS J PAGE 2 DEDUCTIBLE / SELF- INSURED INVOICE 303GP64A-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 0 a a 0 0 Q 0 0 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 000455729 -43-475.00 $526.76 1 hereby certify that the attached invoice(s), or � bill(s) is (are)true and correct and that the 0000455728 43-475.00 $1,902.80 materials or services itemized thereon for 1205' 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 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 5-11-10-1.6 20 Clerk-Treasurer TR VELE S J PAGE 1 DEDUCTIBLE / SELF-INSURED INVOICE 3036P64A-810 521GX7087 C01/31�/2014 ';' r 000455727__7) 02/15/2014 18, 128.57 MAIL`\PAYMENT TOS Zt � PAYER: TRAiVELERS , " a -`� CITY OF CARMEL,CARMEL CLAY 13'607 CO`LL`ECTIONS lCENTER=.DRIVE ONE CIVIC SQUARE CHICAGO., °RL =60693 CARMEL IN 46032 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE WRITE THE POLICY & ACCOUNT NUMBER ON YOUR CHECK. ANSk TRAVELERSPAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. IN 3036P64A-810 5216X7087 01/31/2014 000455727 02/15/2014 18, 128.57 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 6,385.74 =7 '�•y,/ CLAIM TOTAL 6,385.74 CLAIMN: EZK6237: `,DATE OF LOSS: 12/16/2013 DESCRIPTION: IV SLI R D ON SLUSITY'ROAD INTO THE REA +OF OV. CLAIMANT: STANLEY E CHEN LOSS 1. 18,4;41' Z? -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 2,031 .95 CLAIM TOTAL 2,031.95 CURRENT CHARGES $9,602.10 4Bo8L), wort') TRAVELERS J PAGE 1 DEDUCTIBLE / SELF-INSURED INVOICE 303GP64A-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. �� ELS 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 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 6,385.74 7 ��5 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 a! 9 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 2,031 .95 CLAIM TOTAL 2,031.95 CURRENT CHARGES $9,602. 10 ,-ur^.haS9 ?JOA p wor� �Y ;,.,. . Mph 7).o.# 59 -P oreF #_ , tom- -a-ter o00 na:� r Date— Ar"proval a?eA°proval G lt3 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#or Board Members INVOICE NO. ACCT#/TITL AMOUNT Dept# 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 r Signature $ 1,184.41 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund