251756 11/18/15 �/ \f� CITY OF CARMEL, INDIANA VENDOR: 362876
® "� ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $""""'8,012.14*
r.. �� CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 251756
+.�'��TON�� CHICAGO IL 60693 CHECK DATE: 11/18/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000492324 919.55 GENERAL INSURANCE
1205 4347500 000492967 30.60 GENERAL INSURANCE
1205 4347500 000492978 7,061.99 GENERAL INSURANCE
TRAVELERS PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
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303GP64A-810 521GX7087 10/30/2015 000492324 11/15/2015 2,638.43
CURRENT
CLAIM#: EZL7689 DATE OF LOSS: 09/21/2015
DESCRIPTION: BAUT C - BANCROFT, RACHEL IV WAS BACKING OUT OF A
PARKING SPACE AND ST
CLAIMANT: RACHEL C BANCROFT
LOSS 919.55
CLAIM TOTAL 919.55
CURRENT CHARGES $919.5--5
C
ACCOUNT SUMMARY
CURRENT CHARGES 919.55 INSURED NAME: CITY OF CARMEL,CARMEL CLAY
PAST DUE CHARGES 1,718.88 AGENT.-NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: OM 817-5000
TOTAL DUE 2,638.43
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 2,638.43
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
NOV 16 2015
Clerk Treasurer
'1
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00605 38759
CITY OF CARMEL,CARMEL CLAY
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS PAGE 1
THIS ACCOUNT IS SCHEDULED TO GO TO A COLLECTION AGENCY
IF PAYMENT IS NOT RECEIVED ON OR BEFORE THE DUE DATE.
• � glillill Em : : lfrfvim
14N99887-ZPP 5216X7087 10/30/2015 000492967 11/15/2015 3,325.20
CURRENT
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 30.60
CLAIM TOTAL 30.60
CURRENT CHARGES $30.60
ACCOUNT SUMMARY
CURRENT CHARGES 30.60 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 3,294.60 AGENT NAME: HYLANT GROUP INC
UNAPPLIED -PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 3,325.20
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 3.325.20
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
I
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00603 38764
CITY OF CARMEL, CARMEL CLAY PARKS BUIL
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS, PAGE 1
THIS ACCOUNT IS SCHEDULED TO GO TO A COLLECTION AGENCY
IF PAYMENT IS NOT RECEIVED ON OR BEFORE THE DUE DATE.
• i 1 . i
14TG2033-ZLP 521GX7087 10/30/2015 000492978 11/15/2015 9,504.79
CURRENT
CLAIM#: EY07995. . DATE OF LOSS: 10/11/2013
DESCRIPTION: PLAINTIFF ALLEGES FALSE ARREST.
CLAIMANT: CARL COOPER
EXPENSE 153.00
CLAIM TOTAL 153.00
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
CLAIM#: E4E1787 DATE OF LOSS: .03/07/2014
DESCRIPTION: CLAIMANT ALLEGES THAT POLICE USED AXCESSIVE FORCE
CAUSING BODILY INJUR
CLAIMANT: LOUIS R PASTORE
EXPENSE 489.60
CLAIM TOTAL 489.60
CLAIM#: E4E8260 DATE OF LOSS: 06/10/2015
DESCRIPTION: CLAIMANT TRIPPED AND FELL ON UNEVEN SIDEWALK.SEE
ATTACHED.
CLAIMANT: JUDITH SILENCE
LOSS 1,404.09
CLAIM TOTAL 1,404.09
CLAIM#: E4E8312 DATE OF LOSS: 07/31/2015
DESCRIPTION: ZHANG, RICHARD TORT NOTICE ALLEGING THAT CLAIMANT WAS
HIT BY A TREE WH
CLAIMANT: RICHARD ZHANG
LOSS 5,000.00
CLAIM TOTAL 5,000.00
CURRENT CHARGES $7,061.99
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00604 38762
CITY OF CARMEL
.ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS, PAGE 2
DEDUCTIBLE / SELF-INSURED INVOICE
POLICY NUMBER ACCOUNT NUMBERTOTAL
14TG2033-ZLP 521GX7087 10/30/2015 000492978 11/15/2015 9,504.79
ACCOUNT SUMMARY
CURRENT CHARGES 7,061 .99 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 0 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 9,504.79
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 9,504.79
CONTACT YOUR-AGENT LISTED ABOVE IF YOU -HAVE-QUESTIONS RELATED TO YOUR POLICY .OR- _COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-HELPDESK@TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-860-277-6812 ANTONIO CONTRERAS
Submitted To
NOV 1 6 2015
Clerk Treasurer
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00604 38761
CITY OF CARMEL
ONE CIVIC SQUARE
CARMEL IN 46032 z
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VOUCHER NO. WARRANT NO.
ALLOWED 20
TRAVELERS
13607 COLLECTIONS CENTER DRIVE IN SUM OF$ -
CHICAGO, IL 60693
$8,012.14
ON ACCOUNT OF APPROPRIATION FOR
PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT
Board Members
000492324 43-475.00 $619.55 1 hereby certify that the attached invoice(s), Or
1205 101
000492967 43-475.00 $30.60 bill(s) is (are)true and correct and that the
1205 101
000492978 43-475.00 $7,061.99 materials Or services itemized thereon for
1205 I I 101 I which charge is made were ordered and
received except
Monday, November 16, 2015
Steve Engelking, Direc r
Cost distribution ledger-.classification if
claim paid motor vehicle highway fund
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 Date Invoice# Description Arilount
Dept. Fund# (or note attached invoice(s)or bill(s))
10/30/15 000492324 $919:55-
1205 101
10/30/15 000492967 $30:601
1205 101
10/30/15 I 000492978 I I $7,061.99
1205 101
II
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 5711-10-1.6
, 20
Clerk-Treasurer