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Home My WebLink About253771 01/22/16 (9, CITY OF CARMEL, INDIANA VENDOR: 362876 ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $*****4,835.46* 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 253771 CARMEL, INDIANA 46032 CHICAGO IL 60693 CHECK DATE: 01/22/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 00495595 230.00 GENERAL INSURANCE 1205 4347500 00495596 1,082.75 GENERAL INSURANCE 1205 4347500 00495597 3,522.71 GENERAL INSURANCE TRAVELERS, PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. • � : ISM, 14TG2033-ZLP 521GX7087 12/31/2015 000495597 01/15/2016 5,965.51 CURRENT CLAIM#: EYQ7995 DATE OF LOSS: 10/11/2013 DESCRIPTION: PLAINTIFF ALLEGES FALSE ARREST. CLAIMANT: CARL COOPER EXPENSE 2,456.71 CLAIM TOTAL 2,456.71 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 205.90 CLAIM TOTAL 205.90 CLAIM#: E4E8697 DATE OF LOSS: 12/29/2013 DESCRIPTION: GLIA C-REED, ANTHONY TORT NOTICE ALLEGING THAT HIS VEHICLE AND PERSONA CLAIMANT: ANTHONY W REED EXPENSE 244.80 CLAIM TOTAL 244.80 Submitted To JAN 19 2016 Clergy_ =3 r ensurer TRAVELERS NON-FUNDED DEPARTMENT ONE TOWER SQUARE -9CR HARTFORD, CT 06183 00618 38727 CITY OF CARMEL ONE CIVIC SQUARE CARMEL IN 46032 N r 0 r m m m a 0 0 0 N O Q O O t TRAVELERS J PAGE 2 DEDUCTIBLE / SELF-INSURED INVOICE 1 1 I 1EffiTiffJORTM 14TG2033-ZLP 521GX7087 12/31/2015 000495597 01/15/2016 5,965.51 CURRENT CLAIM#: E5J6444 DATE OF LOSS: 10/25/2015 DESCRIPTION: GLIA C - BARBERIO, GREG TORT NOTICE ALLEGING DAMAGE TO YARD AND IRRIGA CLAIMANT: GREG BARBERIO LOSS 600.00 CLAIM TOTAL 600.00 CURRENT CHARGES $3,522.71 ACCOUNT SUMMARY CURRENT CHARGES 3,522.71 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 2,442.80 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 5.965.51 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 5.965.51 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 00618 38726 CITY OF CARMEL -ONE- -CIVIC SQUARE - --- -- - -- - CARMEL IN 46032 N n 0 r m a 0 0 0 N a 0 0 onk TRAVELERS/ J PAGE 1 : 14N99887-ZPP 5216X7087 12/31/2015 000495595 01/15/2016 230.00 r7�o�ICL 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 230.00 CLAIM TOTAL 230.00 CURRENT CHARGES �t�9;23000 ACCOUNT SUMMARY CURRENT CHARGES 230.00 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: (317) 817-5000 TOTAL DUE 230.00 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 230.00 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 JAN 19 2016 Clerk Treasurer Adw TRAVELERSJ PAGE I 111 I : : I 11MN11114 3036P64A-810 5216X7087 12/31/2015 000495596 01/15/2016 1,082.75 CURRENT CLAIM#: E3Q1143 DATE OF LOSS: 11/15/2015 DESCRIPTION: 3 VEH ACC - IV REARENDED OV1 STOPPED - OV1 WAS PUSHED INTO OV2 STOPPED CLAIMANT: HARSHA V SUBBAGARI LOSS 1.082.75 CLAIM TOTAL 1,082.75 CURRENT CHARGES ACCOUNT SUMMARY CURRENT CHARGES 1,082.75 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 1,082.75 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 1,082.75 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 JAN A AN 19 2016 Clerk Trotaasurer TRAVELERS NON-FUNDED DEPARTMENT ONE TOWER SQUARE -9[R HARTFORD, CT D6183 00619 38724 ' CITY OF CXRMEL,CARMEL CLAY ONE CIVIC SQUARE CARMEL /N 46032 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' Amount_ Dept. Fund# (or note attached invoice(s)or bill(s)) 12/31/15 000495597 $3,522.71 1205 101 12/31/15 000495595 $230.00 1205 101 12/31/15 I 000495596 I - I $1,082.75 1205 101 I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 , 20 Clerk-Treasurer VOUCHER NO. WARRANT NO. ALLOWED, 20 TRAVELERS 13607 COLLECTIONS CENTER DRIVE IN SUM OF$ CHICAGO, IL 60693 $4,835.46 ON ACCOUNT OF APPROPRIATION FOR General Administration PO#/Dept. = INVOICE NO. ACCT#/Fund AMOUNT I Board Member: 000495597 43-475.00 $3,522.71 1 hereby certify that the attached invoice(s), or 1205 101 Prior Year 000495595 43-475.00 $230.00 bill(s) is (are)true and correct and that the 1205 101 Prior Year 000495596 43-475.00 $1,082.75 materials or services itemized thereon for 1205 I I 101 I Prior Year _ which charge is made were ordered and received except Tuesday, January 19, 2016 n Cost distribution ledger classification if claim paid motor vehicle highway fund