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Home My WebLink About242101 2 /10/2015 .y 4�gMF CITY OF CARMEL, INDIANA VENDOR: 362876 4/ f (_ '} ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $****15,1 16.81* ;, ;_� CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 242101 'M; __.--o• CHICAGO IL 60693 CHECK DATE: 02/10/15 �tON� DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 000477308 2,563.80 GENERAL INSURANCE 1205 4347500 000477309 7,350.88 GENERAL INSURANCE 1205 4347500 000477310 3,202.13 GENERAL INSURANCE 1205 4347500 000477311 2,000.00 GENERAL INSURANCE TRAVELERS J PAGE 1 14TG2033-ZLP 521GX7087 01/30/2015 000477309 02/15/2015 7,350.88 CURRENT CLAIM#: EYB9539 DATE OF LOSS: 07/15/2014 DESCRIPTION: ALLEGING DAMAGE TO TWO TIRES FROM A HOLE IN THE ROAD NEAR A WATER MAIN CLAIMANT: MARY BOUSTANI LOSS 586.08 CLAIM TOTAL 586.08 CLAIM#: EYQ1920 DATE OF LOSS: 08/20/2013 DESCRIPTION: GLIA C - DATTILO, ANGELO CLMT WAS RIDING HIS BIKE AND STRUCK A STEP TH CLAIMANT: ANGELO DATTILO LOSS 5,000.00 CLAIM TOTAL 5,000.00 CLAIM#: EYQ7995 DATE OF LOSS: 10/11/2013 DESCRIPTION: PLAINTIFF ALLEGES FALSE ARREST. CLAIMANT: CARL COOPER EXPENSE 904.90 CLAIM TOTAL 904.90 CLAIM#: E2SO202 DATE OF LOSS: 12/29/2014 DESCRIPTION: EPLI C- THOMPSON, JAMES L JR. EEOC COMPLAINT ALLEGING RETALLIATION DUE CLAIMANT: JAMES L THOMPSON EXPENSE 859.90 CLAIM TOTAL 859.90 CURRENT CHARGES $7,350.88 Submitted To FEB 0 9'Z014 Clerk Treasurer TRAVELERS NON-FUNDED DEPARTMENT ONE TOWER SQUARE -9CR HARTFORD, CT 06183 00697 39274 CITY OF CARMEL ONE CIVIC SQUARE CARMEL IN 46032 n N O m n n a 0 o 0 N O Q O N TRAVELERS PAGE 2 DEDUCTIBLE / SELF-INSURED INVOICE POLICY NUMBER ACCOUNT NUMBER BILL OATE BILL NUMBER PAYMENT DUE TOTAL 14TG2033-ZLP 5216X7087 01/30/2015 000477309 02/15/2015 7,350.88 ACCOUNT SUMMARY CURRENT CHARGES 7,350.88 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 7,350.88 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 7,350.88 ..... 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 00697 39273 CITY OF CARMEL ONE CIVIC SQUARE CARMEL IN 46032 N m m 0 m n a 0 0 o N Q O N TRAVELERS PAGE , 14N99887-ZPP 521GX7087 01/30/2015 000477308 02/15/2015 2,563.80 CURRENT CLAIM#: EXK1029 DATE OF LOSS: 12/02/2012 DESCRIPTION: PLAINITIFF ALLEGES UNLAWFUL DETENTION DUE TO POLICE RESPONDING TO THE CLAIMANT: JAMES BECKETT EXPENSE 1,698.30 CLAIM TOTAL 1,698.30 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 290.70 CLAIM TOTAL . 290.70 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 15.30 CLAIM TOTAL 15.30 CLAIM#: EIES133 DATE OF LOSS: 07/01/2012 . DESCRIPTION: ALLEGATION THAT A CITY OF CARMEL POLICE OFFICER RAN THE CLMT'S PERSONA CLAIMANT: NICOLE RYERSON EXPENSE 559.50 CLAIM TOTAL 559.50 CURRENT CHARGES $2,563.80 Submi-tted TO FEB Ott2014 Cher _TrgqaSur(qr TRAVELERS NON-FUNDED DEPARTMENT ONE TOWER SQUARE -9CR HARTFORD, CT 06183; 00696 39276 CITY OF CARMEL, CARMEL CLAY PARKS BUIL ONE CIVIC SQUARE CARMEL IN 46032 n N T m ("I n n a 0 0 0 N O Q O ' O TRAVELERS` PAGE 2 DEDUCTIBLE / SELF- INSURED INVOICE 14N99887-ZPP . 5216X7087 01/30/2015 000477308 02/15/2015 2,563.80 ACCOUNT SUMMARY CURRENT CHARGES 2,563.80 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 2,563.80 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 2,563.80 ---- --- 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 00696 39275 CITY OF CARMEL, CARMEL CLAY PARKS BUIL ONE CIVIC SQUARE CARMEL IN 46032 n N m n r a 0 0 0 N Q O O AW PAGE 1 TRAVELERS GP09313908• 521GX7087 01/30/2015 000477311 02/15/2015 2,000.00 CURRENT CLAIM#: ENZ9660 DATE OF LOSS: 09/11/2010 DESCRIPTION: CLMT FELL ON UNEVEN SIDEWALK CAUSING HER TO FALL TO THE GROUND AND INJ CLAIMANT: MARY DONICA LOSS 2,000.00 CLAIM TOTAL 2,000.00 CURRENT CHARGES $2,000.00 ACCOUNT SUMMARY CURRENT CHARGES 2,000.00 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 2,000.00_ DISPUTED ITEMS 0.00 ACCOUNT BALANCE 2,000.00 .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 FEB 01 92014 Clea �ressurer TRAVELERS NON-FUNDED DEPARTMENT ONE TOWER SQUARE -9CR HARTFORD, CT 06183 00695 39277 CITY OF CARMEL; CARMEL CLAY PARKS ATTN: JIM SPELBRING ONE CIVIC SQUARE CARMEL IN 46032 n N m m n n a 0 0 0 N O Q O N TRQVELERSAM PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. : Tvaivilvi mill] 3036PG4A-810 521GX7087 01/30/2015 000477310 02/15/2015 6,640.68 CURRENT CLAIM#: E2J2982 DATE OF LOSS: 09/22/2014 - DESCRIPTION: IV PULLED UP BEHIND OV, GOT OUT TO OFFER ASSISTANCE AND DID NOT PUT HI CLAIMANT: /PENSKE CAR RENTAL LOSS 700.43 CLAIM TOTAL 700.43 CLAIM#: E2J9713 DATE OF LOSS: 11/12/2014 DESCRIPTION: ARNOLD, SHEILA, IV WAS ADJUSTING THE REAR VIEW MIRROR AND DID NOT BNOT CLAIMANT: SHEILA A ARNOLD LOSS 1,035.30 CLAIM TOTAL 1,035.30= CLAIM#: E2U0788 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 664.86 CLAIM TOTAL 664.86 CLAIM#: E2U3777 DATE .OF LOSS: 12/13/2014 DESCRIPTION: BAUT C-REYNOLDS, WILLIAM JR. IV WAS STOPPED IN TRAFFIC STARTED TO BAC CLAIMANT: WILLIAM REYNOLDS-JR LOSS 801 .54 CLAIM TOTAL 801.54 CURRENT CHARGES $3,202.13 TRAVELERS NON-FUNDED DEPARTMENT ONE TOWER SQUARE -9CR HARTFORD, CT 06183 00698 39272 CITY OF CARMEL,CARMEL CLAY ONE CIVIC SQUARE CARMEL IN 46032 N n N OI m o m n n a 0 0 0 N O Q O O TRAVELERS Alk PAGE 2 DEDUCTIBLE / SELF-INSURED INVOICE MEN IT p 303GP64A-810 5216X7087 01/30/2015 000477310 02/15/2015 6,640.68 ACCOUNT SUMMARY CURRENT CHARGES 3,202. 13 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PAST DUE CHARGES 3,438.55 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 6,640.68 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 6,640.68 ...... ---CONTACT--YOUR- AGENT"LISTED-ABOVE IF YOU HAVE QUESTIONS RELATED TO-YOUR-POLICY--OR COVERAGE- FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-HELPDESK@TRAVELERS.COM OR CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-860-277-6812 ANTONIO CONTRERAS E T®14surer TRAVELERS NON-FUNDED DEPARTMENT ONE TOWER SQUARE -9CR HARTFORD, CT 06183 00698 39271 CITY OF CARMEL,CARMEL CLAY ONE CIVIC SQUARE CARMEL IN 46032 N m m O m n n a 0 0 0 N Q O O VOUCHER NO. WARRANT NO. Travelers ALLOWED 20 IN SUM OF$ 13607 Collections Center Drive Chicage, IL 60693 $18,555.36 ON ACCOUNT OF APPROPRIATION FOR Administration Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1205 000477309 43-475.00 $7,350.88 I hereby certify that the attached invoice(s), or bill(s) is (are)true and correct and that the 1205 000477308 43-475.00 $2,563.80 materials or services itemized thereon for 1205 000477311 43-475.00 $2,000.00 which charge is made were ordered and 1205 000477310 43-475.00 46;640`T68 received except Monday, February 09, 2015 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)) 01/30/15 000477309 $7,350.88 01/30/15 000477308 $2,563.80 01/30/15 000477311 $2,000.00 01/30/15 000477310 $6,640.68 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