241772 02/03/15 Cqq
4 '• CITY OF CARMEL, INDIANA VENDOR: 366179
® it ONE CIVIC SQUARE LIBERTY MUTUAL INSURANCE CO CHECK AMOUNT: $*******100.00*
aQ; CARMEL, INDIANA 46032 25761 NETWORK PLACE CHECK NUMBER: 241772
9M��ioN�o� CHICAGO IL 60673-1257 CHECK DATE: 02/03/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
802 4340000 601004590 100.00 LEGAL FEES
Copy of Original Invoice
Liberty Mutual.
a
' SURETY
Someday is Today,LLC
7116E71STST
INDIANAPOLIS,IN 46256-4997
Liberty Mutual Surety Bond Invoice
Statement Date: 12/4/2014
Knott, Bruce A
2 Civic Square Premium: $100.00
Carmel, IN 46032
Amount Due: $100.00
Bond Number: 601004590 Payment Due Date: 1/18/2015
Make checks payable to:Liberty Mutual
Your Liberty Mutual Surety Bond Activity Summary
Effective Date: 03/01/2015
Bond Description: Renewal-New Bond Official
Pension Board Secretary Fire Department
Obligee: City of Carmel Fire Department Headquarters
Issuing Company: Ohio Casualty Insurance Company
Billing is automatic until the bond is cancelled. If your bond is no longer needed or required,please notify your agent for
cancellation.Thank you!
For billing questions or to pay by credit card,please call the Liberty Mutual Surety Billing Center at 1-800-773-3312
PLEASE DO NOT SEND ANY CORRESPONDENCE WITH YOUR PAYMENT;
1 ry THIS MAY DELAY THE PROCESSING OF YOUR PAYMENT.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Liberty Mutual Insurance Company 1
IN SUM OF$
r
25761 Network Place
Chicago, IL 60673
$100.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
601004590 moo $100.00 1 hereby certify that the attached invoice(s), or
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 .i
FEB Z 2015
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
t
;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))
601004590 Pension Secretary Bond $100.00
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