HomeMy WebLinkAbout245305 05/13/15 CITY OF CARMEL, INDIANA VENDOR: 362876
® 31 ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $****10,952.99*
r % CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 245305
CHICAGO IL 60693 CHECK DATE: 05/13/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000482264 5,182.69 GENERAL INSURANCE
1205 4347500 000482265 3,451.70 GENERAL INSURANCE
1205 4347500 000482266 2,318.60 GENERAL INSURANCE
TRAVELERS Jam. PAGE 1
14N99887-ZPP 5`21GX7087 04/30/2015 000482266 05/15/2015 2,318.60
CURRENT
CLAIM#: EVB6603 DATE OF LOSS: 11/08/2012
DESCRIPTION: COMPLAINT OF DISCRIMINATION BASED ON RETALIATION FOR
FAILURE TO PROVID
CLAIMANT: GREG PARK
EXPENSE 232.50
CLAIM TOTAL 232.50
CLAIM#: EXK1029 DATE OF LOSS: 12/02/2012
DESCRIPTION: PLAINITIFF ALLEGES UNLAWFUL DETENTION DUE TO POLICE
RESPONDING TO THE
CLAIMANT: JAMES BECKETT
� EXPENSE 626.00
CLAIM TOTAL 626.00
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 619.50
CD �ullC� CLAIM TOTAL 619.50
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
n EXPENSE 30.60
CLAIM TOTAL 30.60
CLAIM#: E1E6133 111 DATE OF LOSS: 07/01/2012
DESCRIPTION: ALLEGATION THAT A CITY OF CARMEL POLICE OFFICER RAN
THE CLMT'S PERSONA
CLAIMANT: NICOLE RYERSON Submitted To EXPENSE 810.00
CLAIM TOTAL 810.00
MAY 1 1 2015 CURRENT CHARGES $2,318.60
Clerk Treasurer
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00655 39279
CITY OF CARMEL, CARMEL CLAY PARKS BUIL
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS PAGE 2
DEDUCTIBLE / SELF-INSURED INVOICE
1211 411 1 I 1 1
14N99887-ZPP 5216X7087 04/30/2015 000482266 05/15/2015 2,318.60
ACCOUNT SUMMARY
CURRENT CHARGES 2,318.60 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: (800) 678-0361
TOTAL DUE 2,318.80
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 2,318.60
CONTACT-YOUR--AGENT -LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE.-
FOR
OVERAGE.FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-HELPDESK@TRAVELERS.COM OR
-CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-880-277-8812 ANTONIO CONTRERAS
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00655 39278
CITY OF CARMEL, CARMEL CLAY PARKS BUIL -
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS PAGE 1
: illin
303GP64A-810 5216X7087 04/30/2015 000482264 05/15/2015 5, 182.69
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 539.37
Com, S CLAIM TOTAL 539.37
CLAIM#: EOS2642 DATE OF LOSS: 04/17/2014
DESCRIPTION: BAUT C - PEACOCK, ROBERT; IV IN A STREET SWEEPER
STOPPED AT A ROUNDABO
CLAIMANT: PAMELA J PEACOCK
LOSS 3,265.49
CLAIM TOTAL 3,265.49
CLAIM#: E3P4252 DATE OF LOSS: 03/08/2015
DESCRIPTION: IV WAS ATTEMPTING TO TURN AROUND BY BACKING UP WHEN HE
STRUCK A LIGHT
CLAIMANT: /VILLAGE GREEN HOA
LOSS 1,055.00
CLAIM TOTAL 1,055.00
CLAIM#: E3P5542 DATE OF LOSS: 03/16/2015
DESCRIPTION: BAUT C-SMITH AMANDA IV WAS STOPPED ON OFF RAMP AND
THOUGHT V2 HAD STAR
CLAIMANT: AMANDA SMITH
LOSS 322.83
CLAIM TOTAL 322.83
CURRENT CHARGES $5,182.69
Submitted T.
MAY 1 1 2015
Clerk `treasurer
i
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00657 39276
CITY OF CARMEL,CARMEL CLAY
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS, PAGE 2
DEDUCTIBLE / SELF-INSURED INVOICE
POLICY iTOTAL
303GP64A-810 521GX7087 04/30/2015 000482264 05/15/2015 5, 182.69
ACCOUNT SUMMARY
CURRENT CHARGES 5, 182.69 INSURED NAME: CITY OF CARMEL,CARMEL CLAY
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (800) 678-0361
TOTAL DUE 5.182.69
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 5, 182.69
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 1-860-277-5812 ANTONIO CONTRERAS
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00657 39275
CITY OF CARMEL,CARMEL CLAY ---
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS PAGE 1
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14T62033-ZLP 521GX7087 04/30/2015 000482265 05/15/2015 3,451.70
CURRENT
CLAIM#: EYQ7995 DATE OF LOSS: 10/11/2013
DESCRIPTION: PLAINTIFF ALLEGES FALSE ARREST.
CLAIMANT: CARL COOPER
EXPENSE 119.80
CLAIM TOTAL 119.80
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 45.90
C�1 )'o1lCQ _ CLAIM TOTAL 45.90
CLAIM#: E2U8101 DATE OF LOSS: 07/25/2014
DESCRIPTION: PROF C-LEY, LARRY J. MD TORT NOTICE ALLEGING CLAIMANT
WAS FALSELY AND
CLAIMANT: LARRY LEY
EXPENSE 3,286.00
CLAIM TOTAL 3,286.00
CURRENT CHARGES $3,451.70
ACCOUNT SUMMARY
CURRENT CHARGES 3,451.70 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (800) 678-0361
TOTAL DUE 3.451.70
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 3,451.70
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL EDUCTIBLE-HELPDESK@ OM OR'
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-86072a. T3NT®ONTR AS
MAY 112 015
Clerk Treasurer
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00656 39277
CITY OF CARMEL
ONE CIVIC SQUARE
CARMEL IN 46032
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF$
13607 Collections Center Drive
Chicage, IL 60693
$10,952.99
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 000482265 43-475.00 $3,451.70
1 hereby certify that the attached invoice(s), or
�
bill(s) is (are)true and correct and that the
1205 000482264 43-475.00 $5,182.69
materials or services itemized thereon for �
1205 I 000482266 I 43-475.00 I $2,318.60 which charge is made were ordered and
received except
Monday, May 11, 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))
04/30/15 000482265 $3,451.70
04/30/15 000482264 $5,182.69
04/30/15 I 000482266 I I $2,318.60
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