HomeMy WebLinkAbout233883 06/18/14 CITY OF CARMEL, INDIANA VENDOR: 362876
ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $"""`8,143.20"
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 233883
CHICAGO IL 60693 CHECK DATE: 06/18/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000463146 1,778.00 GENERAL INSURANCE
1205 4347500 000463147 5,000.00 GENERAL INSURANCE
1205 4347500 000463148 1,365.20 GENERAL INSURANCE
TRAVELERS` PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
FrIBUIRM
14N99887-ZPP 521GX7087 05/30/2014 000463146 06/15/2014 2,967.95
v=;>,�oILC� - CURRENT -
CLAIM#: EVB6603 DATE OF LOSS: 11/08/2012
DESCRIPTION: C -PARK,GREG EEOC COMPLAINT OF DISCRIMINATION BASED ON
RETALIATION FOR
CLAIMANT: GREG PARK
EXPENSE 1,778.00
CLAIM TOTAL 1,778.00
CURRENT CHARGES ,778.00
ACCOUNT SUMMARY
CURRENT CHARGES 1,778.00 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 1, 189.95 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT-PHONE: (317) 817-5000
TOTAL DUE 2.967.95
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 2,967.95
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-HELPDESK@TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-860-277-6812 ANTONIO CONTRERAS
Submitted To
JUN 16.2 014
Clerk Treasurer
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00754 39191
CITY OF CARMEL, CARMEL CLAY PARKS BUIL
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS PAGE 1
�POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL OUE
14TG2033-ZLP 521GX7087 05/30/2014 000463147 06/15/2014 5,000.00
CURRENT
CLAIM#: EYB1713 DATE OF LOSS: 04/03/2014
DESCRIPTION: GLIA C-SIMINSKI, DEBBIE; TORT NOTICE ALLEGING DAMAGE
TO HOME FROM SEWA
CLAIMANT: DEBBIE SIMINSKI
LOSS 5,000.00
CLAIM TOTAL 5,000.00
CURRENT CHARGES ($=r.1000-0,0-)
ACCOUNT SUMMARY
CURRENT CHARGES 5,000.00 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 5,000.00
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 51000.00
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
JUN 162014
Clerk Treasurer
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00755 39190
CITY OF CARMEL, CARMEL CLAY PARKS BUILD
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.
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE
303GP64A-810 521GX7087 05/30/2014 000463148 06/15/2014 4,818.89
-5w-A- CURRENT
CLAIM#: EOS2642 DATE OF LOSS: 04/17/2014
DESCRIPTION: BAUT C - PEACOCK, ROBERT; IV IN A STREET SWEEPER
STOPPED AT A ROUNDABO
CLAIMANT: ROBERT J PEACOCK
LOSS 1 ,365.20
CLAIM TOTAL .20
CURRENT CHARGES $1,365.20
ACCOUNT SUMMARY
CURRENT CHARGES 1,365.20 INSURED NAME: CITY OF CARMEL,CARMEL CLAY
PAST DUE CHARGES 3,453.69 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 4,818.89
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 4,818.89
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-HELPDESK@TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-860-277-6812 ANTONIO CONTRERAS
Submitted To
JUN 16 2014
Clerk Treasurer
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00756 39189
CITY OF CARMEL,CARMEL CLAY
ONE CIVIC SQUARE
CARMEL IN 46032
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF$
13607 Collections Center Drive
Chicage, IL 60693
$8,143.20
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 000463146 43-475.00 $1,778.00 I hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1205 000463147 43-475.00 $5,000.00
materials or services itemized thereon for
1205 000463148 43-475.00 $1,365.20
which charge is made were ordered and
received except
Monday, June 16, 2014
Director, Administration j
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))
05/30/14 000463146 $1,778.00
05/30/14 000463147 $5,000.00
05/30/14 I 000463148 I I $1,365.20
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