244356 4 /15/2015 '��E CITY OF CARMEL, INDIANA VENDOR: 362876
ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $****14,1 19.94*
s. =Q CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 244356
91'��TON G�` CHICAGO IL 60693 CHECK DATE: 04/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 480592 4,543.90 GENERAL INSURANCE
1205 4347500 480593 5,000.00 GENERAL INSURANCE
1205 4347500 480594 1,764.27 GENERAL INSURANCE
1205 4347500 480595 2,811.77 GENERAL INSURANCE
TRAVELERS J� PAGE 1
DEDUCTIBLE / SELF-INSURED INVOICE
• 1 i : :
GPO9315757 5216X7087 03/31/2015 000480593 04/15/2015 5,000.00
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL, CARMEL CLAY PARKS BUILD
13607 COLLECTIONS CENTER DRIVE ONE CIVIC SQUARE
CHICAGO, IL 60693 CARMEL IN 46032
RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS.
PLEASE WRITE THE POLICY & ACCOUNT NUMBER ON YOUR CHECK.
TRAVELERSJ� PAGE 1
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE
GPO9315757 521GX7087 03/31/2015 000480593 04/15/2015 5,000.00
CURRENT
CLAIM#: ESM9011 DATE OF LOSS: 11/08/2011
DESCRIPTION: C - MCNELIS, JOHN & SILVIA TORT NOTICE ALLEGING
NEGLIGENCE TO THE CITY
CLAIMANT: JOHN P MCNELIS
LOSS 5,000.00
CLAIM TOTAL 5,000.00
CURRENT CHARGES $5,000.00
ACCOUNT SUMMARY -
CURRENT CHARGES 5,000.00 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: (419) 724-1981
TOTAL DUE 5,000.00
DISPUTED ITEMS 0.00.
ACCOUNT BALANCE 5,000.00
,: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
Sllbmitted T o
A P R 13 2015
Clerk `treasurer
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00670 39285
CITY OF CARMEL, CARMEL CLAY PARKS BUILD
ONE CIVIC SQUARE
CARME L- - I N-_- 46032_
N
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TRAVELERS J� PAGE 1
DEDUCTIBLE / SELF-INSURED INVOICE
POLICY : TOTAL
14T62033-ZLP 5216X7087 03/31/2015 000480594 04/15/2015 1,764.27
MAIL PAYMENT TO: PAYER: Submitted To
TRAVELERS CITY OF CARMEL
13607 COLLECTIONS CENTER DRIVE ONE CIVIC
SQ
CHICCAGO, IL60693CARMELIN4GO32 APR 13 2015
RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TLEE-
-------------------------
qrk Treasurer
PLEASE WRITE THE POLICY & ACCOUNT NUMBER ON YOUR
-- - ........ .
TRAVELERS, PAGE 1
IPOLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE
14TG2033-ZLP 521GX7087 03/31/2015 000480594 04/15/2015 1,764.27
CURRENT
CLAIM#: EYQ7995 DATE OF LOSS: 10/11/2013
DESCRIPTION: PLAINTIFF ALLEGES FALSE ARREST.
CLAIMANT: CARL COOPER
EXPENSE 1,300.70
J CLAIM TOTAL 1,300.70
CLAIM#: EON3470 DATE OF LOSS: 05/28/2014
DESCRIPTION: EPL CLAIM: OFFICER CLAIMS SEXUAL HARASSMENT AND
HOSTILE WORK ENVIRONME
CLAIMANT: CRYSTAL HUGHES
EXPENSE 76.50
CLAIM TOTAL 76.50
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 387.07
CLAIM TOTAL 387.07
CURRENT CHARGES $1,764.27
.ACCOUNT SUMMARY
CURRENT CHARGES 1,764.27 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: (419) 724-1981
TOTAL DUE 1,764.27
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 1,764.27•
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
00672 39282
CITY OF CARMEL
ONE CIVIC SQUARE
CARMEL - IN 46032
N
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TRAVELERS PAGE 1
DEDUCTIBLE / SELF-INSURED INVOICE
14N99887-ZPP 521GX7087 03/31/2015 000480592 04/15/2015 4,543.90 .
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL,
13607 COLLECTIONS CENTER DRIVE ONE CIVIC SQUARE
CHICAGO, IL 60693 CARMEL IN 460 2 Submitted T
RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE O TRAVELARA 13 2015
PLEASE WRITE THE POLICY & ACCOUNT NUMBER ON Y UR CHECK.
Clerk Treasurer
TRAVELERS PAGE 1
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE
14N99887-ZPP 5216X7087 03/31/2015 000480592 04/15/2015 4,543.90
CURRENT
CLAIM#: EVB6603 DATE OF LOSS: 11/08/2012
DESCRIPTION: COMPLAINT OF DISCRIMINATION BASED ON RETALIATION FOR
FAILURE TO PROVID
CLAIMANT: GREG PARK
EXPENSE 1,844.50
CLAIM TOTAL 1,844.50
CLAIM#: EXK1029 DATE OF LOSS: 12/02/2012
DESCRIPTION: PLAINITIFF ALLEGES UNLAWFUL DETENTION DUE TO POLICE
RESPONDING TO THE
CLAIMANT: JAMES BECKETT
EXPENSE 1,923:60
CLAIM TOTAL 1,923.60
CLAIM#: EXK2736 ) 1 DATE OF LOSS: 07/01/2012
DESCRIPTION: ALLEGATION THAT A CITY OF CARMEL POLICE OFFICER RAN
THE CLMT'S PERSONA
CLAIMANT: NICOLE. RYERSON
EXPENSE 229.50
CLAIM TOTAL 229.50
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
CLAIM XTOTAL 15.30
c � l
CLAIM#: ElES133 DATE OF LOSS: 07/01/2012
DESCRIPTION: ALLEGATION THAT A CITY OF CARMEL POLICE OFFICER RAN
THE CLMT'S PERSONA
CLAIMANT: NICOLE RYERSON
EXPENSE 531 .00
CLAIM TOTAL 531.00
CURRENT CHARGES $4,543.90
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00671 39284
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 521GX7087 03/31/2015 000480592 04/15/2015 4,543.90
ACCOUNT SUMMARY
CURRENT CHARGES 4,543.90 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: (419) 724-1981
TOTAL DUE 4.543.90
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 4.543.90
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 061.83
00671 39283
CITY OF CARMEL, CARMEL CLAY PARKS BUIL
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS J PAGE '
DEDUCTIBLE / SELF-INSURED INVOICE
'POLICYi
303GP64A-810 521GX7087 03/31/2015 000480595 04/15/2015 2,811 .77
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL,CARMEL CLAY
13607 COLLECTIONS CENTER DRIVE ONE CIVIC SQUARE
CHICAGO, IL 60693 CARMEL IN 46032
RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS.
PLEASE WRITE THE POLICY & ACCOUNT NUMBER ON YOUR CHECK.
TRAVELERS PAGE 1
POLICY NUMBER -ACCOUNT NUMBER BILL DATEBILLNUMBER PAYMENT DUE TOTAL DUE
3036P64A-810 521GX7087 03/31/2015 000480595 04/15/2015 2,811 .77
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 2,811 .77
CLAIM TOTAL 2,811.77
CURRENT CHARGES $2,811.77
ACCOUNT SUMMARY
CURRENT CHARGES 2,811 .77 INSURED NAME: CITY OF CARMEL,CARMEL CLAY
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (419) 724-1981
TOTAL DUE 2,811.77
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 2,811 .77
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-HELPDESK@TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-860-277-6812 ANTONIO CONTRERAS
Submitted To
APR 13 2015
Clerk Treasurer
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
F
P )•s',3i�
00673 39281
CITY OF CARMEL,CARMEL CLAY
ONE CIVIC SQUARE
CARMEL IN 46032
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF$
13607 Collections Center Drive
Chicage, IL 60693
$14,119.94
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#lrITLE AMOUNT Board Members
1205 000480595 43-475.00 $2,811.77 I hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1205 000480592 43-475.00 $4,543.90
materials or services itemized thereon for
1205 000480594 43-475.00 $1,764.27 which charge is made were ordered and
1205 000480593 43-475.00 $5,000.00 received except
Monday, April 13, 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))
04/15/15 000480595 $2,811.77
04/15/15 000480592 $4,543.90
04/15/15 000480594 $1,764.27
04/15/15 000480593 $5,000.00
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