HomeMy WebLinkAbout249103 08/27/15 CITY OF CARMEL, INDIANA VENDOR: 362876
® i• ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $ .....630.81'
r ,?� CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 249103
CHICAGO IL 60693 CHECK DATE: 08/27/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 487322 601.32 GENERAL INSURANCE
1205 4347500 487324 29.49 GENERAL INSURANCE
TRAVLE®!S J PAGE 1
303GP64A-810 521GX7087 07/31/2015 000487324 08/15/2015 29.49
CURRENT
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 80.69
CLAIM TOTAL 80.69
CURRENT CHARGES $80.69
ACCOUNT SUMMARY
CURRENT CHARGES 80.69 INSURED NAME: CITY OF CARMEL,CARMEL CLAY
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 51 .20- AGENT PHONE: (317) 817-5000
TOTAL DUE 29.49
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 29.49
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
AUG 2 4 2015
Clerk Treasurer
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00666 38643
CITY OF CARMEL,CARMEL CLAY
ONE CIVIC SQUARE
CARMEL IN 46032
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TC\/°6i/ ELEIOSJ PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
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14N99887-ZPP 5216X7087 07/31/2015 000487322 08/15/2015 601 .32 ;
CURRENT
CLAIM#: EXK1029 DATE OF LOSS: 12/02/2012
DESCRIPTION: PLAINITIFF ALLEGES UNLAWFUL DETENTION DUE TO POLICE
RESPONDING TO THE
CLAIMANT: JAMES BECKETT
EXPENSE 5,393.02
CLAIM TOTAL 5,393.02
CURRENT CHARGES $5,393.02
ACCOUNT SUMMARY
CURRENT CHARGES 5,393.02 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 4,791 .70- AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 601.32
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 601 .32
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
AUG 2 4 2015
Clerk Treasurer
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00664 38647
CITY OF CARMEL, CARMEL CLAY PARKS BUIL
ONE CIVIC SQUARE
CARMEL IN 46032
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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))
07/31/15 000487324 $29.49
07/31/15 000487322 $601.32
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
Travelers
IN SUM OF $
13607 Collections Center Drive
Chicage, IL 60693
$630.81
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 000487324 43-475.00 $29.49 I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1205 000487322 43-475.00 $601.32
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, August 24, 2015
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund