HomeMy WebLinkAbout237558 09/23/14r-
%'�,q,,f. CITY OF CARMEL, INDIANA VENDOR: 362876
• ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $*****8,325.48*
49 �� CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 237558
M,�TON�. CHICAGO IL 60693 CHECK DATE: 09/23/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 468445 1,781.80 GENERAL INSURANCE
1205 4347500 468447 6,543.68 GENERAL INSURANCE
DEDUCTIBLE / SELF-INSURED INVOICE
• � : :
14TG2033-ZLP 5216X7087 08/29/2014 000468447 09/15/2014 6,543.68
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL, CARMEL CLAY PARKS BUILD
1.3607 COLLECTIONS CENTER DRIVE ONE CIVIC SQUARE
CHICAGO, IL 60693 CARMEL IN 46032 Submitted To
RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO RAVELERSJEP 2j 2 2��4
PLEASE WRITE THE POLICY & ACCOUNT NUMBER ON YOU CHECK.
,W Clerk Treasurer
TRAVELERS J PAGE
14TG2033-ZLP 5216X7087 08/29/2014 000468447 09/15/2014 6,543.68
CURRENT
CLAIM#: EYB6075 DATE OF LOSS: 07/15/2014
DESCRIPTION: GLIA C - MEHTA, CHARU. TORT NOTICE ALLEGING DMG TO
CLMNTS PERSONAL VEH
CLAIMANT: CHARU MEHTA
LOSS 682.07
CLAIM TOTAL 682.07
CLAIM#: EON3470 DATE OF LOSS: 05/28/2014
)ESCRIPTION:
:LAIMANT:
EXPENSE 894.00
CLAIM TOTAL 894.00
:LAIM#: EON8188 DATE OF LOSS: 07/15/2014
)ESCRIPTION: WEST, SAMUEL. TORT ALLEGING DAMAGE TO TIRES FROM A
ROUGH AREA OF THE R
:LAIMANT: SAMUEL WEST
LOSS 1,485.00
j CLAIM TOTAL 1,485.00
:LAIM#: EON8194 DATE OF LOSS: 07/15/2014
)ESCRIPTION: ANDERSON, PETER TORT NOTICE ALLEGING DAMAGE TO 2 TIRES
ON PERSONAL VEH
;LAIMANT: PETER ANDERSON
LOSS 782.61
CLAIM TOTAL 782.61
;LAIM#: EOS2410 DATE OF LOSS: 02/20/2014
)ESCRIPTION: GLIA C - SARAVANAN, SHAKTHI TORT NOTICE ALLEGING
FACIAL INJURY DURING
:LAIMANT: SHAKTHI SARAVANAN
LOSS 2,700.00
CLAIM TOTAL 2,700.00
CURRENT CHARGES
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00800 39161
CITY OF CARMEL, CARMEL CLAY PARKS BUILD
ONE CIVIC SQUARE - - -- - - -
CARMEL IN 46032
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TRAVELERS/ J PAGE 2
DEDUCTIBLE / SELF-INSURED INVOICE
12 i i
14T62033-ZLP 5216X7087 08/29/2014 000468447 09/15/2014 6,543.68
ACCOUNT SUMMARY
CURRENT CHARGES 6,543.68 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 6,543.68
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 6,543.68
CONTACTYOUR AGENTLISTEDABOVE-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
00800 39160
CITY OF CARMEL, CARMEL CLAY PARKS BUILD
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS PAGE 1
DEDUCTIBLE / SELF- INSURED INVOICE
1
14N99887-ZPP 5216X7087 08/29/2014 000468445 09/15/2014 3,748.55
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL, CARMEL CLAY PARKS BUIL
13607 COLLECTIONS CENTER DRIVE ONE CIVIC SQUARE
CHICAGO, IL 60693 CARMEL IN 46032
RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS.
PLEASE WRITE THE POLICY & ACCOUNT NUMBER ON YOUR CHECK.
TRAVELERS PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
POLICY NUMBER ACCOUNT NUMBER BILL OATE BILL NUMBER PAYMENT DUE TOTAL OUE
14N99887-ZPP 521GX7087 08/29/2014 000468445 09/15/2014 3,748.55
T:5, CURRENT
, '� 1Cr_...
CLAIM#: EXK2736 DATE OF LOSS: 07/01/2012
DESCRIPTION: ALLEGATION THAT A CITY OF CARMEL POLICE OFFICER RAN
THE CLMT'S PERSONA
CLAIMANT: NICOLE RYERSON
EXPENSE 547.70
CLAIM TOTAL 547.70
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 595. 10
CLAIM TOTAL 595. 10
CLAIM#: ElEG133 DATE OF LOSS: 07/01/2012
DESCRIPTION: ALLEGATION THAT A CITY OF CARMEL POLICE OFFICER RAN
THE CLMT'S PERSONA
CLAIMANT: NICOLE RYERSON
_ EXPENSE 639.00
CLAIM TOTAL 639.00
Submitted To CURRENT CHARGES $1,781.80
SEP 2 2 2014
Clerk Treasurer
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00799 39163
CITY OF CARMEL, CARMEL CLAY PARKS BUIL
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS PAGE 2
DEDUCTIBLE / SELF-INSURED INVOICE
14N99887-ZPP 5216X7087 08/29/2014 000468445 09/15/2014 3,748.55
ACCOUNT SUMMARY
CURRENT CHARGES 1,781 .80 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 1,966.75 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 3,748.55
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 3,748.55
- CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL. DEDUCTIBLE-HELPDESK@TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-860-277-6812 ANTONIO CONTRERAS
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00799 39162
CITY OF CARMEL, CARMEL CLAY PARKS BUIL
ONE CIVIC SQUARE
CARMEL IN 46032 --
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.... ..... ----..-----------.-------..-------------------------.-__-...-...------------------_-__._..-.. .-......_... .. - .. -. _. ...._-._-...
VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF$
13607 Collections Center Drive
Chicage, IL 60693
$8,325.48
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
i
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 000468447 43-475.00 $6,543.68 I hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1205 000468445 43-475.00 $1,781.80
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, September 22, 2014
7 7—
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.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
08/29/14 000468447 $6,543.68
08/29/14 000468445 $1,781.80
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