HomeMy WebLinkAbout232927 05/21/14 `% o4A�f. CITY OF CARMEL, INDIANA VENDOR: 362876
ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $*****4,643.64*
9 ��; CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 232927
M,•__.�. CHICAGO IL 60693 CHECK DATE: 05/21/14
ETON
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000461334 3,453.69 GENERAL INSURANCE
1205 4347500 000461335 1,189.95 GENERAL INSURANCE
TRAVELERS, PAGE 1
14N99887-ZPP 521GX7087 04/30/2014 000461335 05/15/2014 1, 189.95
ll CURRENT
CLAIM#: EVB6603 DATE OF LOSS: 11/08/2012
DESCRIPTION: C -PARK,GREG EEOC COMPLAINT OF DISCRIMINATION BASED ON
RETALIATION FOR
CLAIMANT: GREG PARK
EXPENSE 854.00
CLAIM TOTAL 854.00
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 335.95
CLAIM TOTAL 335.95
CURRENT CHARGES (
89.95
i�'-1
ACCOUNT.-SUMMARY
CURRENT CHARGES 1, 189.95 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 1,189.95
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 1, 189.95
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
MAY 19 2014
Clerk Treasurer
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00757 39205
CITY OF CARMEL, CARMEL CLAY PARKS BUIL
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS PAGE 1
. 303GP64A-810 5216X7087 04/30/2014 000461334 05/15/2014 3,453.69
f�4cz-- CURRENT
CLAIM#: CER0860 DATE OF LOSS: 05/05/2013
DESCRIPTION: IV IN A PARKING SPOT, PULLED OUT SPACE AND HIT OV
DRIVING THROUGH PARK
CLAIMANT: LARRY J GREEN
LOSS 2,525.46
CLAIM TOTAL 2,525.46
CLAIM#: EOA3889 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 294.04
a CLAIM TOTAL 294.04
CLAIM#: EOS0661 DATE OF LOSS: 03/31/2014
DESCRIPTION: BAUTC - HEFLIN,BONNIE IV WAS AT STOP AND STARTED
BACKING UP HIS POLIC
CLAIMANT: BONNIE I HEFLIN
LOSS 634.19
CLAIM TOTAL 634.19
CURRENT CHARGES =$3,453-r.9
ACCOUNT SUMMARY
CURRENT CHARGES 3,453.69 INSURED NAME: CITY OF CARMEL,CARMEL CLAY
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 3,453.69
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 3,453.69
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOU POLICY OR ,,,,.,,WWC,,. �
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-HELPDES @TRAvs-mhr Md To
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-850-277-6812 ANrONIO CONTRERAS
MAY 19 2014
Clerk Treasurer
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00758 39204
CITY OF CARMEL,CARMEL CLAY
ONE CIVIC SQUARE
CARMEL IN ' 46032
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF$
13607 Collections Center Drive
Chicage, IL 60693
$4,643.64
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 000461335 43-475.00 $1,189.95 I hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1205 000461334 43-475.00 $3,453.69
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, May 19, 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.
I
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
04/30/14 000461335 $1,189.95
04/30/14 000461334 $3,453.69
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