HomeMy WebLinkAbout238293 10/21/14 f..
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( F� CITY OF CARMEL, INDIANA VENDOR: 362876
® ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $****1 1,721.64*
�'� CARMEL;:INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 238293
s9y;��TON�; CHICAGO IL 60693 CHECK DATE: 10/21/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 470269 3,293.94 GENERAL INSURANCE
1205 4347500 470270 3,217.00 GENERAL INSURANCE
1205 4347500 470271 5,210.70 GENERAL INSURANCE
TRAVELERS JW PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
14N99887-ZPP 5216X7087 09/30/2014 000470271 10/15/2014 6,992.50
CURRENT
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 238.40
CLAIM TOTAL 238.40
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 1,927.30
CLAIM TOTAL 1,927.30
CLAIM#: EIE6133 DATE OF LOSS: 07/01/2012
DESCRIPTION: ALLEGATION THAT A CITY OF CARMEL POLICE OFFICER RAN
THE CLMT'S PERSONA
CLAIMANT: NICOLE RYERSON
EXPENSE 3,045.00
CLAIM TOTAL 3,045.00
1
CURRENT CHARGES $5,210.70
Submitted To
OCT 2 0 2014
Clerk �reasa�rar
TRAVELERS
NON-FUNDED-DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00811 39143
CITY OF CARMEL, CARMEL CLAY PARKS BUIL
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS JW PAGE 2
DEDUCTIBLE / SELF-INSURED INVOICE
• 1 :
14N99887-ZPP 5216X7087 09/30/2014 000470271 10/15/2014 6,992.50
ACCOUNT SUMMARY
CURRENT CHARGES 5,210.70 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 1,781 .80 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 6,992.50
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 6,992.50
-CONTACT-YOUR--AGENT LISTED-ABOVE- IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR-COVERAGE-.-
FOR
R-COVERAGEFOR 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
00811 39142
CITY OF CARMEL, CARMEL CLAY PARKS BUIL
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.
14TG2033-ZLP 5216X7087 09/30/2014 000470269 10/15/2014 9,837.62
CURRENT
CLAIM#: EYB5514 DATE OF LOSS: 07/15/2014
DESCRIPTION: GLIA C - BOLAND, ISLAM: TORT NOTICE ALLEGING PROPERTY
DAMGE FROM A POT
CLAIMANT: ISLAM BOLAD
LOSS 651 .44
��( '- i,- CLAIM TOTAL 651.44
CLAIM#: EON3470 DATE OF LOSS: 05/28/2014
DESCRIPTION: EPL CLAIM: OFFICER CLAIMS SEXUAL HARASSMENT AND
HOSTILE WORK ENVIRONME
CLAIMANT: CRYSTAL HUGHES
EXPENSE 2,642.50
CLAIM TOTAL 2,642.50
CURRENT CHARGES $3,293.94
ACCOUNT SUMMARY
CURRENT CHARGES 3,293.94 INSURED NAME: CITY 0"F CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 6,543.68 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 9,837.62
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 9,837.62
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 - - -6812 ANTONIO CONTRERAS
S Submitted To
OCT 202014
a
Clerk Treasurer
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00812 39141
CITY OF CARMEL, CARMEL CLAY PARKS BUILD
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS J� PAGE 1
3036P64A-810 5216X7087 09/30/2014 000470270 10/15/2014 3,217.00
CURRENT
CLAIM#{: ElES116 DATE OF LOSS: 08/21/2014
DESCRIPTION: BAUT C-LNGER, VADIM IV MADE A RIGHT HAND TURN AND THE
BACK OF HIS TRUC
CLAIMANT: VADIM INGER
LOSS 2,532.04
CLAIM TOTAL 2,532.04
CLAIM##: E2J2202 DATE OF LOSS: 09/04/2014
DESCRIPTION: ACTON, WILLIAM IV WAS TRYING TO PARK AND STRUCK A
PARKED UNOCCUPIED VE
CLAIMANT: WILLIAM ACTON
LOSS 684.96
CLAIM TOTAL 684.96
CURRENT CHARGES $3,217.00
ACCOUNT SUMMARY
CURRENT CHARGES 3,217.00 INSURED NAME: CITY OF CARMEL,CARMEL CLAY
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 3.217.00
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 3,217.00
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-HELPDESK@TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-860-277-6812 ANTONIO CONTRERAS
Submitted To
OCT 2 0 2014
Clerk Treasurer
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9-CR
HARTFORD, CT 06183
00813 39140
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CITY OF CARMEL,CARMEL CLAY
ONE CIVIC SQUARE
CARMEL IN 46032
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1
VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF$
13607 Collections Center Drive
Chicage, IL 60693
$11,721.64
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICENO. ACCT#/TITLE AMOUNT Board Members
1205 000470271 43-475.00• $5,210.70 I hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1205 000470269 43-475.00 $3,293.94
materials or services itemized thereon for
1205 I 000470270 I 43-475.00 I $3,217.00 which charge is made were ordered and
received except
Monday, October 20, 2014
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
i
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))
09/30/14 000470271 $5,210.70
09/30/14 000470269 $3,293.94
09/30/14 I 000470270 I I $3,217.00
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