243067 03/11/15 (9,
CITY OF CARMEL, INDIANA VENDOR: 362876
ONE CIVIC SQUARE TRAVELERS CHECKAMOUNT: $*****5,504.18*
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 243067
CHICAGO IL 60693 CHECK DATE: 03/11/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000478934 901.40 GENERAL INSURANCE
1205 4347500 000478935 2,119.50 GENERAL INSURANCE
1205 4347500 000478936 2,483.28 GENERAL INSURANCE
TRAVELERS PAGE 1
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE,
3036PG4A-810 5216X7087 02/27/2015 000478936 03/15/2015 2,483.28
CURRENT
CLAIM#: CER1798 DATE OF LOSS: 01/31/2015
DESCRIPTION: (GAO, CEN) IV PULLED OUT OF A PARKING LOT ONTO
SHELBORNE RD IN FRONT 0
CLAIMANT: CEN GAO
LOSS 2,483.28
CLAIM TOTAL 2,483.28
CURRENT CHARGES $2,483.28
ACCOUNT SUMMARY
CURRENT CHARGES 2,483.28 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 2,483.28
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 2,483.28
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
T
MAR 0,9`2015
clerk ,r reasurer
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER .SQUARE -9CR
HARTFORD, CT 06183
00677 39292
CITY OF CARMEL,CARMEL CLAY
ONE CIVIC SQUARE
CARMEL IN 46032
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..-_---- ...-------------------------- ........ .......... -.:..._.---- .- ......--..- ____....--. .._..-... ......--.. _._ ._. --------- --._.......------------------------------------ -----_.......- -.-- _..
TRAVELERS PAGE 1
: III k m ki 1i I m I
14N99887-ZPP 521GX7087 02/27/2015 000478935 03/15/2015 2, 119.50
CURRENT
CLAIM#: EXK1029 DATE OF LOSS: 12/02/2012
DESCRIPTION: PLAINITIFF ALLEGES UNLAWFUL DETENTION DUE TO POLICE
RESPONDING TO THE
CLAIMANT: JAMES .BECKETT
EXPENSE 367.20
CLAIM TOTAL 367.20
CLAIMN: 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 765.00
CLAIM TOTAL 765.00
CLAIM#: EYQ5411 DATE OF LOSS: 07/25/201.2
DESCRIPTION: -PROF C - CIMT WAS ARRETED BY-THE MARION COUNTY DRUG
TASK FORCE AND CHA
CLAIMANT: JONAH LONG
EXPENSE 91 .80
CLAIM TOTAL 91.80
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 895.50
Submitted CLAIM TOTAL 895.50
o CURRENT CHARGES $2,119.50
MAR 0,9 2015
CCler �ressurer
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00675 39295
CITY OF CARMEL, CARMEL CLAY PARKS BUIL
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS JW PAGE 2
DEDUCTIBLE / SELF-INSURED INVOICE
14N99887-ZPP 5216X7087 02/27/2015 000478935 03/15/2015 2, 119.50
ACCOUNT SUMMARY
CURRENT CHARGES 2, 119.50 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 2,119.50
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 2, 119.50
- CONTACT YOUR-AGENT-:-LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE.
- FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-HELPDESK@TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-860-277-6812 ANTONIO CONTRERAS
TRAVELERS
NON-FUNDED -DEPARTMENT'
ONE TOWER SQUARE -9CR
HARTFORD, CT o6183
00675 39294
- --C-ITY- OF CARMEL, CARMEL CLAY- PARKS BUIL.
ONE CIVIC SQUARE
CARMEL IN 46032
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF$
13607 Collections Center Drive
Chicage, IL 60693
$4,602.78
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
1 hereby certify that the attached invoice(s), or
1205 000478936 43-475.00 $2,483.28
bill(s) is (are)true and correct and that the
1205 000478935 43-475.00 $2,119.50
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, March 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.
I
Payee
I
i
Purchase Order No.
i
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
02/27/15 000478936 $2,483.28
02/27/15 000478935 $2,119.50
I
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
Adw
TRAVELERS J PAGE 1
14TG2033-ZLP 5216X7087 02/27/2015 000478934 03/15/2015 901 .40
CURRENT
CLAIM#: EYQ7995 DATE OF LOSS: 10/11/2013
DESCRIPTION: PLAINTIFF ALLEGES FALSE ARREST.
CLAIMANT: CARL COOPER
EXPENSE 657.90
CLAIM TOTAL 657.90
CLAIM#: EON3470 DATE OF LOSS: 05/28/2014
DESCRIPTION: EPL CLAIM: OFFICER CLAIMS SEXUAL HARASSMENT AND
HOSTILE WORK ENVIRONME
CLAIMANT: CRYSTAL HUGHES
EXPENSE 107. 10
CLAIM TOTAL 107.10
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 136.40
CLAIM TOTAL 136.40
CURRENT CHARGES $901.40
ACCOUNT SUMMARY
CURRENT CHARGES 901 .40 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 901.40
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 901 .40
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-HELPDESK@TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-860-277-6812 ANTONIO CONTRERAS
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00676 39293
CITY OF CARMEL
ONE CIVIC SQUARE
CARMEL IN 46032
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF$
13607 Collections Center Drive
Chicage, IL 60693
$901.40
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 I 000478934 I 43-475.00 I $901.40 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
Monday, March 09, 2015
Director, Administrati n
Title
1
Cost distribution.ledger classification if . j
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))
02/27/15 000478934 $901.40
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