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Home My WebLink About231717 04/23/14 ��CAA . j "*. CITY OF CARMEL, INDIANA VENDOR: 00352999 j, ii ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $*****7,258.00* r. CARMEL, INDIANA 46032 301 PENNSYLVANIA PKWY,SUITE 201 CHECK NUMBER: 231717 �,;,,roN,�,? INDIANAPOLIS IN 46280 CHECK DATE: 04123114 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1180 4347500 43099 50.00 GENERAL INSURANCE 1180 4347500 43100 50.00 GENERAL INSURANCE 1205 4347500 43590 7,158.00 GENERAL INSURANCE -------------- --_.....--- Hylant-Indianapolis Invoice # 43590 ®S HYLANT 307 Pennsylvania Pkwy,Ste 201 — �Date: _ Balance:Due On i Indianapolis,IN 46280 P-(800)678-0361 j 4/8/2014 4/8/2014 hylantcom i F-(317)817-5151 -- �`zs City of Carmel 5 Account:Numbers; Am6uni9.6q CARMELO-02 $7,158.00 City of Carmel Attn: STEVE ENGELKING One Civic Square Carmel, IN 46032 Please Return Top with Remittance To: 301 Pennsylvania Pkwy,Ste 201,Indianapolis,IN 462800925 i _..: ltem#:.,:. ... :::7rans Eff Date::; Due Date:<: Trans. Description- ::: .:.,:.:.. . Amount Business Auto Policy# H8103036P64ACOF13 Effective: 111113 - 1/1/14 Issuing Company Charter Oak Fire Insurance Co 243831 1/1/2013 4/8/2014 AUDI AUTO FINAL AUDIT 1/1/13 7,158.00 PREMIUM ALLOCATION: POLICE DEPT.$4,796 ADDL PREM; FIRE DEPT.$2,362 ADDL PREM Total Invoice Balance: $7,158.00 04 HYLANT Hylant-Indianapolis 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280 + 4!8/2014 Insured City.of Carmel _ —� Loan# Invoice# 43590 UBAMA1 Page 1 of 1 Premium Audit "� PO Box 2927 ! R ELER Hartford,CT 06104-2927 THE TRAVELERS INDEMNITY COIUIF�ANY Pre:r tii`m Ad'us rri nt Notice ,rNi is tioT;d a► CITY OF CARMEL, Policy Number: H-810-3036P64A-IND-13 ONE CIVIC SQUARE Policy Period: 011011201.3 to 01/01120.14 CARMEL, IN 46032 Audit Period: 01/01/2013 to 01/01/2014 Issue Office: 24T G8433 Date of This Notice: 3/29/2014 HYLANT GROUP INC Mode of Adjustment: ANNUAL AUDIT 301 PENNSYLVAVIA PKWY STE 201 INDIANAPOLIS, IN 46280 Total Earned Premium $ 249,723.00 Audit Contact: `Premium Prior to Audit $ 242,565.00 CUSTOMER SERVICE (GL) Additional Premium Due $ 7,158.00 1-800-842-4271 Return Premium $ 0.00 "Premium Prior to Audit"includes the original policy premium and any endorsements during the policy term. This does not reflect actual payments made. THIS ADJUSTMENT STATEMENT WAS PREPARED FROM:A Report You Submitted. RAT:E.' MANUAL P•REMi: EARNED PREMIUM CLASS:: PREMIUM_:::' COMP,:OR P.D. ;: -SUBJECT.; COMP_OR. = P.D. STATE'f CLASSIFICATIONS :'.:'.... _ CODE ; .KEY BASfS:``": 'BIL LtAB. CIA8`:' TO.MOD: —' B.t.L1A6.:., LIAR COMPOSITE RATED POLICY AS ISSUED LIABILITY POWER UNITS U 408.00 486.000 197,954,00 COMPREHENSIVE OCN F 17,957,631.00 0.110 20,416.00 COLLISION OCN F 17,957,631.00 0.135 24,195.00 AUDITED RESULTS LIABILITY POWER UNITS U 13.00 486.000 6,318.00 COMPREHENSIVE OCN F 342,600.00 0.110 377.00 COLLISION OCN F 342,600.00 0.135 463.00 Print Date:4/3/2014 Page 1 of 1 Insured Copy 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)) 04/08/14 43590 Policy H8103036P64ACOF13 $7,158.00 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. Hylant Group ALLOWED 20 IN SUM OF $ 301 Pennsylvania Parkway, Suite 201 Indianapolis, IN 46280-0925 $7,158.00 ON ACCOUNT OF APPROPRIATION FOR Administration Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1205 I 43590 I 43-475.00 $7,158.00 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 M nday, April 21, 2014 Director, Administra on Title Cost distribution ledger classification if claim paid motor vehicle highway fund Please Return Top with Remittance To: 301 Pennsylvania Pkwy,Ste 201,Indianapolis,IN 462800925 „„... Item# -Trans Eff Qate Liue'Qate' ..w,,.°°-i rans <• Gescripticr,> amount Bond-Notary Policy# 325430371 Effective: 4/3/14 - 4/3/15 Issuing Company Ohio Casualty Insurance Company 241947 4/3/2014 4/3/2014 NEWB NOTARY BOND- ELIZABETH ROYSE 50.00 Total Invoice Balance: $50.00 O*Ai HYLANT Hylant-Indianapolis 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280 4/3/2014 Insured City of Carmel Loan# Invoice# 43099 UBAMA1 Page 1 of 1 Please Return Top with Remittance To: 301 Pennsylvania Pkwy,Ste 201,Indianapolis, IN 462800925 Item# i rans'Eff Date -'—.Due Date ------ o6iii Bond-Notary Policy# 325430372 Effective: 4/3114 4/3/15 Issuing Company Ohio Casualty Insurance Company 241948 4/3/2014 4/3/2014 NEWB NOTARY BOND- FELICIA MYERS 50.00 Total Invoice Balance: $50.00 04,HYLANT Hylant-Indianapolis 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280 4/3/2014 Insured City of Carmel Loan# Invoice#43100 UBAMA1 Page 1 of 1 Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995) 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 Hylant Indianapolis Purchase Order No. 301 Pennsylvania Pkwy, Ste. 201 Terms Indianapolis, IN 46280 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 4/18/14 4347500 Payment of Nota Bond insurance for Elizabeth Ro se $50.00 4/18/14 4347500 Payment of Notary Bond insurance for Felicia Myers $50.00 Per attached invoices Total I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor- dance with IC 5-11-10-1.6. , 20 Clerk-Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 Hylar+ — IN SUM OF $ 301 Pennsylvania Pkwy, Suite 201 Indianapolis, IN 46280 $ $100.00 ON ACCOUNT OF APPROPRIATION FOR Department of Law - 1180 434-7500 -General Insurance Board Members PO#or INVOICE NO. ACCT#!TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), 1180 43099 4347500 $50.00 or bill(s) is (are) true and correct and that 1180 43100 4347500 50.00 the materials or services itemized thereon for which charge is made were ordered and received except 20 gnatu V 7f7:7::� Cost distribution ledger classification if Titl claim paid motor vehicle highway fund