245511 05/20/15 0Coq -
`� ,f CITY OF CARMEL, INDIANA VENDOR: 00352999
d ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $ *4,525.00'
f' ?� CARMEL, INDIANA 46032 PO BOX 638720 CHECK NUMBER: 245511
+. or'�O CINCINNATI OH 46263-8720 CHECK DATE: 05/20/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 79755 4,525.00 GENERAL INSURANCE
301 Pennsylvania Pkwy,,,Ste 201
U�V�U� HYLANT Invoice # 79755
mu�nvno/o�|muV000
P-(800)678-0361 5/8/2015 5/31/2015
»y|am.00m | F-(317)817-5151
Carmel Farmers Market, Inc.
CARMFAR-01 $4,525.00
Carmel Farmers Market, Inc.
Attn: SteveEnQe|kinQ
One Civic Square
Carmel, |N4GD32
PleaseReturn Top with Remittance To: PO Box 638720,Cincinnati,OH 45263-8720 ***NEWADDRESS***
Amount
Directors&Officers Liab. Policy# 105770103 Effective: 4/12/14 - 4/12/17
Issuing Company Travelers Cas&Surety ofAmer
528871 4/12/2014 5/31/2015 REN8 2O15'2O1OD&O(3year policy invoiced annually) 1.195.00
General Liability Policy ' ~~^~^------'--
Effective: 4/12/15 - 4/12/16
|uouingCompany Travelers Prop Cas CoofAmer
526807 4/12/2015 5/31/2015 RENB 2O15'2O10General Liability Policy 3.330.00
Total Invoice Balance: $4.525.00
.after 5-1-15:please forward paymentm
HylamGroup PO Box o38720Cincinnati,o* 452e3-8720
"PLEASE NOTE REMITTANCE ADDRESS CHANGE**
Submitted To
MAY 18 2 015
Clerk Treasurer
O HYLANT oylam'Indianapolis 301 Pennsylvania Pkwy,Swum Indianapolis IN 46280
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))
05/08/15 79755 $4,525.00
1 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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Hylant Group
IN SUM OF $
PO Box 638720
Cincinnati, OH 45263-8720
$4,525.00
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 I 79755 43-475.00 I $4,525.00 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
Monday, May 18, 2015
Director, A ministratio
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund