240705 01/07/15 cqq .
CITY OF CARMEL, INDIANA VENDOR: 00352999
® _ ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $****98,889.00*
CARMEL, INDIANA 46032 301 PENNSYLVANIA PKWY,SUITE 201 CHECK NUMBER: 240705
9y._o�Eo:r INDIANAPOLIS IN 46280 CHECK DATE: 01/07/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
302 5023990 65911 22,975.00 OTHER EXPENSES
302 5023990 65916 48,498.00 OTHER EXPENSES
302 5023990 65917 10,000.00 OTHER EXPENSES
302 5023990 65949 17,116.00 OTHER EXPENSES
1801 4347500 67964 100.00 GENERAL INSURANCE
1801 4347500 68013 100.00 GENERAL INSURANCE
1801 4347500 68116 100.00 GENERAL INSURANCE
Please Return Top with Remittance To: 301 Pennsylvania Pkwy,Ste 201,Indianapolis,IN 462800925
mount
Workers Compensation 'Excess Policy# EWC008873 Effective: 1d/15 1dd6
Issuing Company Midwest Employers Casualty Co
414830 1/1/2015 1/1/2015 RENB EXCESS WORKERS COMP 48.498.00
Total Invoice Balance: *48.498.00
Submitted
|
JAN 0 5 2014
[Cle:rke U rer
|
'AtHYLANT mylam'Indiamapolis 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280
/
� rn Top with Remittance To: 301 Pennsylvania Pkwy,Ste 201,Indianapolis, IN 462800925
Workers'Compensation Policy# BL0465905401 Effective: 1U/15 1dM8
Issuing Company Great American E&SIns Co
415033 1/1/2015 1/1/2015 RENB VVCBUFFER LAYER 17.116.00
Total Invoice Balance: $17.116.00
E Submitted To|
To
JAN 0 5 2014
Clerk Treasurer
A-EYLANT nylan '|mdianopm|ou 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280
[
/
rn Top with Remittance To: 301 Pennsylvania Pkwy,Ste 201,Indianapolis,IN 462800925
Third Party Administnator-CommovcioPo|icy# 0385 Effective: 1M115 1/1M6
Issuing Company Midwest Employers Casualty Co
414023 1/1/2015 1/1/2015 REN8 TR4C 1 of2Semi-Annual 22.075.00
Total Invoice Balance: $22.975.00
|
FSubmitted To
JAN 0 57t2014
Clerk TrLaaSU
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AtHYLANI nvla,u'mdianapo|is ao1Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280
Please Return Top with Remittance To: 301 Pennsylvania Pkwy,Ste 201,Indianapolis,IN 462800925
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.�! '_��'==_.'�_' "�^_���--�^,^�^��=�-'—�''.���_��..'
Agency Fee'Commercial Policy# VVCRISK MANAGEMENT FEE Effective: 1/1d5 1/1/16
Issuing Company Hy1ontGroup Fees
414031 1/1/2015 1/1/2015 AFEE VVCRISK MANAGEMENT FEE 10.000.00
Total Invoice Balance: $10.000.00
|
Submitted To
JAN 0 5 2014
Clerk Treasurer
At'HYLANT Hylant-Indianapolis 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280
1 12/5/201 insured City of Carmel Loan# Invoice#65917 UBAMA1 Page 1 of 1
/ �
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Forth No.201(Rev.1995)
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
HYLANT GROUP Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12106M 4 "Rair, Policy EWC008873 $48,498.00
1
L0465905401 17,116.00
1E P ficy #0385 22,975.00
1 Risk Management Fee 10,000.00
Total $98,589'
00
1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor-
dance with IC 5-11-10-1.6.
, 20
Clerk-Treasurer
VOUCHER WARRANT NO.
ALLOWED 20
HYLANT GROUP IN SUM OF $
301 Pennsylvania Parkway, Suite 201
Indianapolis, IN 46280
$98,589.00
ON ACCOUNT OF APPROPRIATION FOR
302 WORK COMP FUND
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s),
or bill(s) is (are) true and correct and that
65916 302 $48498.00 the materials or services itemized thereon
65949 $17116.00 for which charge is made were ordered and
r,liau- 2Q2 $99 975 on received except
66 ae2 $19
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
rTrans,EffDate �:DueDate; `; ��� .a'' 7�� —�'
�Traris� Description: �:�� - °` Amount
BOND-Other(Specify) Policy# 104574067 Effective: 1/1/15 12/31/15
Issuing Company Travelers Cas &Surety of Amer
432092 1/1/2015 1/1/2015 RENB POB FOR WILLIAM R. HAMMER 100.00
Total Invoice Balance: $100.00
`*PLEASE NOTE REMITTANCE ADDRESS CHANGE"
�I
®�I HYLANT Hylant-Indianapolis 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280
12/31/20 Insured Carmel Redevelopment Comm Loan# Invoice#68013 UBAMA1 Page 1 of 1
--' —
mount
BOND 'Other(Spocify) Policy# 105580380 Effective: 12131/14 12/31/15
Issuing Company Travelers Cas &Surety ofAmer
432095 12/31/2014 12/31/2014 REN8 POB FOR DAVID C. BOWERS 100.00
Total Invoice Balance: s100.00
—PLEASE NOTE REMITTANCE ADDRESS CHANGE~^
�
|
/ |
�.
4HYLANT Hylant-Indianapolis 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280
item
.# y:Trans EffDate :Due Dat��� Trans= Description~ ° 3 :Amount
BOND-Other(Specify) Policy# 105700672 Effective: 12/31/14 12/31/15
Issuing Company Travelers Cas & Surety of Amer
430544 12/31/2014 12/31/2014 RENB POB BOND-JEFF WORRELL 100.00
Total Invoice Balance: $100.00
®oe►HYLANT Hylant-Indianapolis 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280
12/30/20 Insured Carmel Redevelopment Comm Loan# Invoice#67964 UBAMA1 Page 1 of 1
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995)
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
r
C Purchase Order No.
X41 pehr�s�llvani� Pk��l )�Ie �-�I Terms
h1l Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
mu Mo V i 4vn ua
\2-31-1 ° ower I °
Od 60qL 3zU
Total
t hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor-
dance with IC 5-11-10-1.6.
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or
DEPT.N INVOICE NO. ACCT#/TITLE AMOUNT I hereby certify that the attached invoice(s),
or bill(s) is (are) true and correct and that
5the materials or services itemized thereon
for which charge is made were ordered and
received except
1-5- 2015
U
-P ignature
r1,2 a A 2-4
- /ATTitle
Cost distribution ledger classification if
claim paid motor vehicle highway fund