HomeMy WebLinkAbout231904 04/23/14 �r Cqq .
'" CITY OF CARMEL, INDIANA VENDOR: 362876
-i. CHECK AMOUNT: $*****4,280.86*
.�; ® :, ONE CIVIC SQUARE TRAVELERS
s ,ice CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 231904
+.y_oN`o, CHICAGO IL 60693 CHECK DATE: 04/23/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000459568 283.10 GENERAL INSURANCE
1205 4347500 000459569 3,997.76 GENERAL INSURANCE
AW
TRAVELERS J PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
14N99887-ZPP 521GX7087 03/31/2014 000459568 04/15/2014 283. 10
,:7, (T.')-1 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 283. 10
CLAIM TOTAL 283. 10
CURRENT CHARGES $283. 10
ACCOUNT SUMMARY
CURRENT CHARGES 283. 10 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 134. 10 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 134. 10- AGENT PHONE: (317) 817-5000
TOTAL DUE 283. 10
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 283. 10
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
APR 2 12014
Clerk Treasurer
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TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00755 39203
CITY OF CARMEL, CARMEL CLAY PARKS BUIL
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
303GP64A-810 521GX7087 03/31/2014 000459569 04/15/2014 3,997.76
CURRENT
CLAIM#: EOA1087 DATE OF LOSS: 01/18/2014
DESCRIPTION: BAUT C - DILLON, AMMIE - IV N/B ON BROOKSHIRE PKWY,
PLOWING, AND PULLE
CLAIMANT: MATTHEW DILLON
LOSS 2,723.97
CLAIM TOTAL 2,723.97
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
LOSS 130.37
CLAIM TOTAL 130.37
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 188.39
CLAIM TOTAL 188.39
CLAIM#: EOA6119 / 1 DATE OF LOSS: 02/21/2014
DESCRIPTION: BAUT C- NAPIER, FRED IV WAS BACKING AND STRUCK A
PARKED UNOCCUPIED VEH
CLAIMANT: FRED NAPIER-JR
LOSS 955.03
r� CLAIM TOTAL 955.03
o CURRENT CHARGES $3,997.76
Submitted
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APR 2 12014
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Clerk Treasurer i
Aaw
TRAVELERS J PAGE 2
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DEDUCTIBLE / SELF- INSURED INVOICE
303GP64A-810 521GX7087 03/31/2014 000459569 04/15/2014 3,997.76
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ACCOUNT SUMMARY
CURRENT CHARGES 3,997.76 INSURED NAME: CITY OF CARMEL,CARMEL CLAY
PAST DUE CHARGES 5,804.72 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 5,804.72- AGENT PHONE: (317) 817-5000
TOTAL DUE 3,997.76
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 3,997.76
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
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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))
03/31/14 000459568 $283.10
03/31/14 000459569 $3,997.76
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.
ALLOWED 20
Travelers
IN SUM OF $
13607 Collections Center Drive
Chicage, IL 60693
$4,280.86
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
1205 000459568 43-475.00 $283.10 1 hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1205 000459569 43-475.00 $3,997.76
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, April 21, 2014
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund