HomeMy WebLinkAbout247512 07/15/15 os CSN.
�' '� CITY OF CARMEL, INDIANA VENDOR: 362876
d ''-'r ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $*****7,171.18*
�. a` CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 247512
''fit�N.�o� CHICAGO IL 60693 CHECK DATE: 07/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 485621 3,927.78 GENERAL INSURANCE
1205 4347500 485622 3,243.40 GENERAL INSURANCE
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TRAVELERS J PAGE 1
303GP64A-810 521GX7087 06/30/2015 000485621 07/15/2015 3,927.78
CURRENT
CLAIM#!: EZL4263 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 264.80
CLAIM TOTAL 264.80
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 457.05
CLAIMANT: JENNIFER L JAMESON
LOSS 836.90
CLAIM TOTAL 1,293.95
CLAIM#: E3P9736 DATE OF LOSS: 04/20/2015
DESCRIPTION: CV ALLEGES IV HIT HER CAR.
CLAIMANT: /ENTERPRISE RENTAL CAR
LOSS 734.00
CLAIM TOTAL 734.00
CLAIM#: E4W0611 DATE OF LOSS: 04/26/2015
DESCRIPTION: BAUT C-GLAZE,SARAH. BOTH IV AND CV WERE BACKING OUT OF
PARKING SPACES
CLAIMANT: NEIL F GLAZE
LOSS 302.36
CLAIM TOTAL 302.36
CLAIM#: E4W4038 DATE OF LOSS: 05/14/2015
DESCRIPTION: COOK, SHANNON IV WAS BACKING AND DID NOT SEE OV
CAUSING COLLISION.
CLAIMANT: SHANNON M COOK
LOSS 1 ,332.67
CLAIM TOTAL 1,332.67
CURRENT CHARGES $3,927.78
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00659 39305
CITY OF CARMEL,CARMEL CLAY
ONE CIVIC SQUARE
CARMEL IN 46032
0
0
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0
0
0
0
a
0
TRAVELERSJW PAGE 2
DEDUCTIBLE / SELF- INSURED INVOICE
303GP64A-810 5216X7087 06/30/2015 000485621 07/15/2015 3,927.78
ACCOUNT SUMMARY
CURRENT CHARGES 3,927.78 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 3,927.78
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 3,927.78
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 PAGE 1
14TG2033-ZLP 5216X7087 06/30/2015 000485622 07/15/2015 3,243.40
CURRENT
CLAIM#: EYQ7995 DATE OF LOSS: 10/11/2013
DESCRIPTION: PLAINTIFF ALLEGES FALSE ARREST.
CLAIMANT: CARL COOPER
EXPENSE 1 ,242. 10
CLAIM TOTAL 1,242.10
CLAIM#: E2S0202 DATE OF LOSS: 12/29/2014
DESCRIPTION: EPLI C- THOMPSON, JAMES L JR. EEOC COMPLAINT ALLEGING
RETALLIATION DUE
CLAIMANT: JAMES L THOMPSON
EXPENSE 30.60
CLAIM TOTAL 30.60
CLAIM#: E4E1787 DATE OF LOSS: 03/07/2014
DESCRIPTION: CLAIMANT ALLEGES THAT POLICE USED AXCESSIVE FORCE
CAUSING BODILY INJUR
CLAIMANT: LOUIS R PASTORE
EXPENSE 1 ,970.70
CLAIM TOTAL 1,970.70
CURRENT CHARGES $3,243.40
ACCOUNT SUMMARY
CURRENT CHARGES 3,243.40 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 3.243.40
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 3,243.40
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
00658 39306
CITY OF CARMEL
ONE CIVIC SQUARE
CARMEL IN 46032
0
0
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Spelbring, James P - HR
From: Lori Hood <Lori.Hood@Hylant.com>
Sent: Wednesday, July 8, 2015 2:59 PM
To: Spelbring, James P - HR
Subject: RE: City of Carmel Credit
I have ordered the check. Thanks
Lori Hood—CLCS Senior Claims Specialist
301 Pennsylvania Parkway I Suite 2011 Indianapolis, IN 46280
P 317-817-5153 1 F 317-817-5151 1
E Iori.hoodAhylant.com I www.hylant.com
Nonecure
�BESTrOWLAQRK 2014 �. EHYLANT
For all the latest information on Health Care Reform,please visit our website at www.hylant.com
From:Spelbring,James P- HR [mailto:ipspelbring@carmel.in.gov]
Sent:Tuesday,July 07, 2015 3:40 PM
To: Lori Hood
Subject: City of Carmel Credit
Lori,
Can you apply$3,243.40 to bill number 485622 and take the remaining$51.20 and apply it to bill number 485621. 1 will
process a claim for the remaining$3,876.58 for claim 485621.
Thanks,
Jim Spelbring
Office Administrator
City of Carmel - Human Resources Department
One Civic Square
Carmel, IN 46032
ipspelbring@carmel.in.gov
0: 317-571-2465
F: 317-571-2409
Notice: The contents of this communication are privileged and confidential. ff you are not the intended recipient
of this transmission,you are hereby notified that distributing, copying, or disclosing this communication, or
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))
06/30/15 000485621 $3,927.78
06/30/15 000485622 $3,243.40
07/08/15 07.08.15 Credit on Account Applied ($3,294.60)
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF $
13607 Collections Center Drive
Chicage, IL 60693
$3,876.58
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 000485621 43-475.00 $3,927.78 I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1205 000485622 43-475.00 $3,243.40
materials or services itemized thereon for
12 - which charge is made were ordered and
received except
Monday, July 13, 2015
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund