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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 m 0 m n m v 0 0 0 0 a 0 0 AM TC\/°6i/ ELEIOSJ PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. • � 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 m m 0 m m a 0 0 0 N O Q O O 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