HomeMy WebLinkAbout241389 01/22/15 CITY OF CARMEL, INDIANA VENDOR: 362876
ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $"""3,438.55'
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 241389
CHICAGO IL 60693 CHECK DATE: 01/22/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000475627 3,438.55 GENERAL INSURANCE
TRAVELERS PAGE 1
3036P64A-810 5216X7087 12/31/2014 000475627 01/15/2015 3,438.55
CURRENT
CLAIM#: E2J7314 DATE OF LOSS: 10/22/2014
DESCRIPTION: IV WAS I THE MIDDLE OF AN I/S ATTEMPTING TO MAKE A
LEFT TURN WHEN A OV
CLAIMANT: CATHERINE J STRAWMYER
LOSS 2,602.28
CLAIM TOTAL 2,602.28
CLAIM#: E2UO788 DATE OF LOSS: 11/21/2014
DESCRIPTION: BAUT C- B E HEALTHCARE SOULTIONS INC- IV STRUCK A
VEHICLE FROM BEHIND,
CLAIMANT: /BE HEALTHCARE SOLUTIONS
LOSS 836.27
CLAIM TOTAL 836.27
CURRENT CHARGES $3,438.55
ACCOUNT SUMMARY
CURRENT CHARGES 3,438.55 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 3,438.55
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 3,438.55
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
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TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00699 39258
CITY OF CARMEL,CARMEL CLAY
ONE CIVIC SQUARE
CARMEL IN 46032
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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))
12/31/14 000475627 $3,438.55
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF $
13607 Collections Center Drive
Chicage, IL 60693
$3,438.55
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Prior- Ye(1,' I hereby certify that the attached invoice(s), or
1205 I 000475627 43-475.00 $3,438.55
bill(s) is (are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Tuesday, January 20, 2015
Z2�
Director, Administr tion
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund