HomeMy WebLinkAbout234766 07/15/14 CITY OF CARMEL, INDIANA VENDOR: 362876
ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $**""6,299.75•
,rte; CARMEL, INDIANA 46032 CHICAGO O ILL COLLECTIONS CENTER DRIVE CHECK NUMBER: 234766
,roN CHECK DATE: 07/15/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 464899 3,729.90 GENERAL INSURANCE
1205 4347500 464900 1,000.00 GENERAL INSURANCE
1205 4347500 464901 1,569.85 GENERAL INSURANCE
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Aim
PAGE 1
TRAVELERS )
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
14N99887-ZPP 5216X7087 06/30/2014 000464899 07/15/2014 5,507.90
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 3,549.50
CLAIM TOTAL 3,549.50
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 180.40.
CLAIM TOTAL 180.40
CURRENT CHARGES =
,72i.90
SUMMARY
CURRENT CHARGES 3,729.90 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 1,778.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 5,507.90
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 5,507.90
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
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00772 39177
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.
14TG2033-ZLP 521GX7087 06/30/2014 000404900 07/15/2014 6,000.00
CURRENT
CLAIM#: EXK5063 1 DATE OF LOSS: 06/24/2013
DESCRIPTION.: GLIA C - COLEMAN, PEGGY TORT-NOTICE ALLEGING CLAIMANT
TRIPPED ON SIDEW
CLAIMANT: PEGGY COLEMAN
LOSS 1,000.00
CLAIM TOTAL 1,000.00
CURRENT CHARGES $1,000.00
ACCOUNT SUMMARY
CURRENT CHARGES 1,000.00 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 5,000.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS`- 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 6,000.00 _
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 6,000.00
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
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TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00773 39176
CITY OF CARMEL, CARMEL CLAY PARKS BUILD
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS/ J PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
3036P64A-810 5216X7087 06/30/2014 000464901 07/15/2014 2,9961105
CURRENT
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 260.25
CLAIM TOTAL 260.25
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 117.62
CLAIM TOTAL 117.62
CLAIM#: EOS4383 DATE OF LOSS: 04/07/2014
DESCRIPTION: AMBULANCE HIT CORNER OF AWNING CAUSING DAMAGE TO ROOF.
DAMAGE ESTIMATE
CLAIMANT: /WILSON VILLAGE
LOSS 402.94
CLAIM TOTAL 402.94
CLAIM#: EOS7623 DATE OF LOSS: 05/24/2014
DESCRIPTION: BAUT C -INDY GO-IV ON AN EMERGENCY RUN & PULLED UP
ALONGSIDE A STOPPED
CLAIMANT: /INDIANAPOLIS PUBLIC TRAN
LOSS 789.04
CLAIM TOTAL 789.04
URRENT CHARGES $1,569.85
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00774 39175
CITY OF CARMEL,CARMEL CLAY
ONE CIVIC SQUARE
CARMEL IN 46032
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DEDUCTIBLE / SELF-INSURED INVOICE
POLICY NUMBER ACCOUNTDATE BILL NUMBER PAYMENT OUE TOTALDUE
3036PG4A-810 521GX7087 06/30/2014 000464901 07/15/2014 2,935.05
ACCOUNT SUMMARY
CURRENT CHARGES 1,569.85 INSURED NAME: CITY OF CARMEL,CARMEL CLAY
PAST DUE CHARGES 1,365.20 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 2,935.05
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 2,935.05
-CONTACT YOUR AGENT LISTED ABOVE IF- YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-HELPDESK@TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-860-277-6812 ANTONIO CONTRERAS
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00774 39174
CITY OF CARMEL,CARMEL CLAY
ONE CIVIC SQUARE
-CARMEL IN- 45032
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF$
13607 Collections Center Drive
Chicage, IL 60693
$6,299.75
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 000464899 43-475.00 $3,729.90 1 hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1205 000464900 43-475.00 $1,000.00
materials or services itemized thereon for
1205 I 000464901 I 43-475.00 I $1,569.85 which charge is made were ordered and
received except
Monday, July 14, 2014
Director,Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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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))
06/30/14 000464899 $3,729.90
06/30/14 000464900 $1,000.00
06/30/14 I 000464901 I I $1,569.85
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