246161 06/16/15 �/ �� CITY OF CARMEL, INDIANA VENDOR: 362876
`• ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $****26,685.37*
9 ® ;ro, CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 246161
M,�TON�. CHICAGO IL 60693 CHECK DATE: 06/16/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 483938 1,604.40 GENERAL INSURANCE
1205 4347500 483939 4,780.27 GENERAL INSURANCE
1205 4347500 483940 20,300.70 GENERAL INSURANCE
. i Imo.
TRAVELERS J PAGE 1
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE'
14T62033-ZLP 5216X7087 05/29/2015 000483938 06/15/2015 1,604.40
CURRENT
CLAIM#: EYQ7995 DATE OF LOSS: 10/11/2013
DESCRIPTION: PLAINTIFF ALLEGES FALSE ARREST.
CLAIMANT: CARL COOPER
EXPENSE 1,589.10
CLAIM TOTAL 1,589.10
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 15.30 ,
CLAIM TOTAL 15.30
CURRENT CHARGES $1,604.40
ACCOUNT SUMMARY
CURRENT CHARGES 1 ,604.40 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: (800) 678-0361
TOTAL DUE 1,604.40
DISPUTED. ITEMS 0.00
ACCOUNT BALANCE 1,604.40
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 1-850-277-6812 ANTONIO CONTRERAS
Submitted To
JUN 15 2015
Clerk Treasurer
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9C-R
HARTFORD, CT 06183
00682 39281
CITY OF CARMEL
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS PAGE 1
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE,
14N99887-ZPP 5216X7087- 05/29/2015 000483940 06/15/2015 20,300.70
CURRENT
CLAIM#: EXK1029 DATE OF LOSS: 12/02/2012
DESCRIPTION: PLAINITIFF ALLEGES UNLAWFUL DETENTION DUE TO POLICE
RESPONDING TO THE
CLAIMANT: JAMES BECKETT
EXPENSE 1,494.20
,rj/-)�vl1cs-- CLAIM TOTAL 1,494.20
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
LOSS 15,000.00
EXPENSE 2,472. 10
CLAIM TOTAL 17,472.10
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 45.90
CLAIM TOTAL 45.90
CLAIM#: ElE6133 DATE OF LOSS: 07/01/2012
DESCRIPTION: ALLEGATION THAT A CITY OF CARMEL POLICE OFFICER RAN
THE CLMT'S PERSONA
CLAIMANT: NICOLE RYERSON
EXPENSE 1,288.50
CLAIM TOTAL 1,288.50
CURRENT CHARGES $20,300.70
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00681 39283
CITY OF CARMEL, CARMEL CLAY PARKS BUIL
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS PAGE 2
DEDUCTIBLE / SELF-INSURED INVOICE
POLICY NUMBER ACCOUNT NUMBER BILL. DATE BILL NUMBER PAYMENT DUE TOTAL
14N99887-ZPP 5216X7087 05/29/2015 000483940 06/15/2015 20,300.70
ACCOUNT SUMMARY
CURRENT CHARGES 20,300.70 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 20,300.70
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 20,300.70
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
JUN 15 2015
Clerk Treasurer
I
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00681 39282
CITY OF CARMEL, CARMEL CLAY PARKS- BUIL
ONE CIVIC SQUARE
CARMEL IN 46032
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............. .....------------..._......_.--.._.....------------ .: -. _ - ......---.... ---------- ---
..... .. .... __-
TRAVELERS, PAGE 1
3036P64A-810 5216X7087 05/29/2015 000483939 06/15/2015 4,780.27
CURRENT
CLAIM#: EZL4253 DATE OF LOSS: 05/04/2015
DESCRIPTION: BAUT C- MUNDAY JAY IV WAS ATTEMPTING TP MAKE .A TURN
AND HAD TO BACK UP
CLAIMANT: JAY M MUNDY
LOSS 967.71
CLAIM TOTAL 967.71
CLAIM#: EOT5436 DATE OF LOSS: 05/13/2015
DESCRIPTION: MATTOX, ASHLEY #1, JAMESON, JENNIFER #2. IV DID NOT
SEE VEH2 SLOWING T
CLAIMANT: ASHLEY D MATTOX
LOSS 1,001 .22
CLAIMANT: JENNIFER L JAMESON
LOSS 2,811 .34
CLAIM TOTAL 3,812.56
CURRENT CHARGES $4,780.27
ACCOUNT SUMMARY
CURRENT CHARGES 4,780.27 INSURED NAME: CITY OF CARMEL,CARMEL CLAY
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (800) 678-0361
TOTAL DUE 4,780.27
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 4,780.27
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-HELPDESK@TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-860-277-6812 ANTONIO CONTRERAS
Submitted To
JUN 1 5 2015
Clerk Treasurer
TRAVELERS
NON-FUNDED DEPARTMENT ;
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00683 39280
CITY OF CARMEL,CARMEL CLAY
ONE CIVIC SQUARE
CARMEL IN 46032
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF$
13607 Collections Center Drive
Chicage, IL 60693
$26,685.37
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 000483938 43-475.00 $1,604.40 I hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1205 000483940 43-475.00 $20,300.70
materials or services itemized thereon for
1205 I 000483939 I 43-475.00 I $4,780.27 which charge is made were ordered and
received except
Monday, June 15, 2015
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
i
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))
05/29/15 000483938 $1,604.40
05/29/15 000483940 $20,300.70
05/29/15 I 000483939 I I $4,780.27
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