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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 i 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 0 N m m m a 0 0 0 N O Q O 1 ! P r i 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 i i APR 2 12014 �I Clerk Treasurer i Aaw TRAVELERS J PAGE 2 a I DEDUCTIBLE / SELF- INSURED INVOICE 303GP64A-810 521GX7087 03/31/2014 000459569 04/15/2014 3,997.76 I i I I 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 I I i I i I� I I i I i i i I t F 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