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HomeMy WebLinkAbout253093 01/11/16 s® \ CITY OF CARMEL, INDIANA VENDOR: 00352999 ; ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $*1,004,276.20* s9 �; CARMEL, INDIANA 46032 PO BOX 638720 CHECK NUMBER: 253093 y,«oN..�o. CINCINNATI OH 45263-8720 CHECK DATE: 01/11/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1091 4347500 98732 54,457.00 GENERAL INSURANCE 1115 4347500 98732 5,000.00 GENERAL INSURANCE 1120 4347500 98732 125,000.00 GENERAL INSURANCE 1125 4347500 98732 18,685.00 GENERAL INSURANCE 1192 4347500 98732 7,500.00 GENERAL INSURANCE 1205 4347500 98732 680,580.00 GENERAL INSURANCE 1207 4347500 98732 10,000.00 GENERAL INSURANCE 302 5023990 98732 103,054.20 OTHER EXPENSES Hylant-Indianapolis Invoice# 98732 /,I H �TT /�Ld`-�jv�T� 301 Pennsylvania Pkwy,Ste 201 i Indianapolis,IN 46280 Date'; Balertce Due On, ; 12/11/2015 1/1/2016 hylant.com _ City of Carmel -Account.Numbee Amour t.Due. CARMELO-02 $103,054.20 City of Carmel One Civic Square Carmel,IN 46032 Please Return Top with Remittance To: PO Box 638720,Cincinnati,OH 45263-8720 ""NEW ADDRESS**' Item* -.Trans Eff Date Due Date. Trans:` , bescnption Amount Third Party Administrator-Commercia Policy# 0385 Effective: 111116 111117 Issuing Company Midwest Employers Casualty Co 694853 1/1/2016 1/1/2016 RENB 16-17 TPA 1 of 2 Installments 22,975.00 Crime Policy# 105696360 Effective: 1/1116 111117 Issuing Company Travelers Casualty&Surety Co 694865 1/1/2016 1/1/2016 RENB 16-17 Identity Fraud 2,344.00 Workers Compensation-Excess Policy# EWC008873 Effective: 1/1/16 1/1/17 Issuing Company Midwest Employers Casualty Co 694855 1/1/2016 1/1/2016 RENB 16-17 Excess Work Comp Layer 48,498.00 Agency Fee-Commercial Policy# WC RISK MGMT FEE Effective: 111/16 111/17 Issuing Company Hylant Group Fees 694856 1/1/2016 1/1/2016 AFEE 16-17 WC Risk Management Fee 10,000.00 Workers'Compensation Policy# BL0465905401 Effective: 1/1/16 1/1/17 Issuing Company Great American E&S Ins Co 694851 1/1/2016 1/1/2016 RENB 16-17 Occupational Accident Buffer Layer 18,768.00 694852 1/1/2016 1/1/2016 GTAX Surplus Lines Tax 469.20 -- ----- - — ----- - _- - --- - - - --- - Total-Invoice-Balance.- -- -$103,054.20-- — &HYLANT Hylant-Indianapolis 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280 12/11/2015 City of Carmel Loan# Invoice#98732 FARWE1 Page 1 of 2 Hylant-Indianapolis Invoice# 98732 III HYLANT 301 Pennsylvania Pkwy,Ste 201 Date ' Balance Due On_ Indianapolis,IN 46280 ;. - 12/11/2015 1/1/2016 hylant.com Insured City of Carmel CITY DEPTS /�r��® One Civic Square3ls J Carmel,IN 46032 �� Please Return Top with Remittance To: PO Box 6 3 � Item# an -'-m.- Trs Eff Date— Due Date'----_ Transmm � Amount ` Package-Commercial Policy# 630581 •, 17 Issuing Company Traveler 694871 1/1/2016 1/1/2016 RENB !V45 ( �(�r � 00 Business Auto Policy# 8103036 Issuing Company Charter " 694867 1/1/2016 1/1/2016 RENB �r=_ �: J0 Umbrella-Commercial Excess Policy# XC000003 "1 Effective: 1/1/16 111/17 Issuing Company National C- Company 694863 1/1/2016 1/1/2016 RENB 16-17 Umbrella Liability 55,438.00 Package-Commercial Policy# ZLP14T62033 Effective: 111116 111117 Issuing Company Charter Oak Fire Insurance Co 694870 1/1/2016 1/1/2016 RENB 16-17 Liability Package 280,672.00 Further Allocation i PACKAGE -^ LIABUNPACKAGE Total i Department`Property/Crime Inland Marine , GL, Liquor° Law-Enf Public Mg mt EPL 'Auto Umbrella'! By Dept Admin $ 9,180.00 is 6.538-0015 - s - is - Is - 1s - i$ 2,io5.00la Admin ICS $ 1,167-00 !$_2,340-00;$ - $_- $ - !$ - I$__ -_ $ 2,569.00 $ - 'DOC IS - $ 315.00 1$ _ $ —1,$ _ i$___. ---i$ - $ 9,458.0015 - Mug Task is - $ - ;$_ $ - $ - $ - is - 1$ 19,602.00 $ - GoIfCourse i$ _4,807.00 $ 13,654.00 i$ - —�$401.00 $ - $ _ - $ $ 501.00 is --- Engineering 1$ 4,626.001$ is - $_ - is $ - $ —!$ 4,698.00 is Fre_ 1$ 11,430.00 i$ 5,987.00 is - ,s - '$ - i$ $ -- - IS 46,286-00 $ - 1 'Police ---"Is 5,963.00 $ 6,875.001$ — ---is I$168,046.00 $ is is 88,684:00 $ - Street is 7,076.00 $ 3,971.00 i$ - $ 1 '13— _- -----, 'r------`$.-_..�_�__�$......._..�.-�-��------�-$ 44,568.00 -_� `City Total !S 44,249.0D 5 39,680.00 S75,209.00 S 401.00 f 5168,04fiM I S 7,098.00 529,918.00'S 218471.00 1 S55,4X00 1 S 638,510.0fl ./n HYLANT Hylant-Indianapolis 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280 F2:/11/2015 City of Carmel Loan# Invoice#98732 FARWE1 Page 1 of 1 Hylant-Indianapolis Invoice# 98732 III HYLANT 301 Pennsylvania Pkwy,Ste 201 Date Balance.Due On-' ` Indianapolis,IN 46280 . 12/11/2015 1/1/2016 hylant.com Insured City of Carmel 'AccountNumber 'Amount*Due__ . CARMELO-02 $189,570.00 City of Carmel CRC,4CQC,CGDC,CRA One Civic Square Carmel, IN 46032 Please Return Top with Remittance To: PO Box 638720,Cincinnati,OH 45263-8720 ***NEW ADDRESS Item# ;Trans EffDate Due Date Trans ^wDescription' Amount +__�__ _ Package-Commercial Policy# 630581 M4076 Effective: 111116 111/17 Issuing Company Travelers Prop Cas Co of Amer 694871 1/1/2016 1/1/2016 RENB 16-17 Property&IM 143,564.00 Business Auto Policy# 810303SP64A Effective: 1/1116 111117 Issuing Company Charter Oak Fire Insurance Co 694867 1/1/2016 1/1/2016 RENB 16-17 Auto 0.00 Umbrella-Commercial Excess Policy# XC00000374 Effective: 1/1/16 1/1/17 Issuing Company National Casualty Company 694863 1/1/2016 1/1/2016 RENB 16-17 Umbrella Liability 15,462.00 Package-Commercial Policy# ZLP14T62033 Effective: 111116 111117 Issuing Company Charter Oak Fire Insurance Co 694870 1/1/2016 1/1/2016 RENB 16-17 Liability Package 30,544.00 Further Allocation -PACKAGE Totals partment Praperty/Creme Inland.Marine Llab�lityu; Autd llnbrella By Dept -"'IDe ;CRC 4CDC1 $ 7,912.001, $ - ! $ 3,178-00 4 $ $ 1,550.00 SCGI)G j S -7,460_00 1 $ _ j $ 3,178.00 j $ $ 1,550.0_0 I CRA 1 $ 94,500.001 $ - $12,094-001 $ - ( $ 6,181.00 ICRC ( $ 33,042.00 j $ ^ 650.00 1 $12,094.001 $ _- $ 6,181.00 —� CRC Total LS 142,914.00 1 $ 650.01) 1 $30,544.00 1 $ - $15,462.00 , $189,570:D { Oh HYLANT Hylant-Indianapolis 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280 12/11/2015 City of Carmel Loan# Invoice#98732 FARWE1 Page 1 of 1 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 HYLANT Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 19111115 98739 2 Work Comp Fund $103,054.20 1 -1205-475 680,580.00 12.111.115 98739 Brookshmre - 1207 -475 10,000.00 1-2.111.115 98739 Communocation - 1115- 475 5,000.00 12.111115 98732 nocs - 1192 - 475 7,500.00 19 111115 98732 EIRE - 1120 - 475 125,000.00 Total $931,134.20 1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor- dance with IC 5-11-10-1.6. , 20 Clerk-Treasurer VOUCHER NQuo4m—WARRANT NO. ALLOWED 20 HYLANT IN SUM OF $ P.O. Box 638720 Cincinnati, OH 45263-8720 s$931,134.20 ON ACCOUNT OF APPROPRIATION FOR I I i Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT i DEPT.# I hereby certify that the attached invoice(s), 1 or bill(s) is (are) true and correct and that 98T32 302 $103,054.20 the materials or services itemized thereon 1205 98732 $680,580.00 for which charge is made were ordered and 1907 98732 475 S10 Onn On received except . I i 1 20 � h Signature Cost distribution ledger classification if Title claim paid motor vehicle highway fund Hylant-Indianapolis ] f 01"Iff x# "�873'2a. V ► 301 Pennsylvania Pkwy,Ste 201 1 r'I�I Indianapolis,IN 46280 Date _-Balartce Due,On 1f2/11°I2U55 1/1/2016 hylant.com "insured City of Carmel ,Account Number x-`=AmounfDue' CARM ELO-02 $73,142.00 �t�rchase City of Carmel=.PARKSi D.-crlpiion One Civic Square P.O. P or F RECEIVED Carmel, IN 46032 Du ' ��'_D EEC, Lina Descr 17 2015 Purchaser Date BY: Please Return Top with Remittance To: ox 6.1"Cincinnati OH 45263-8720 * *NEW ADDRESS Item# :, Trans EffiDate Due Date; TraDescription Amount Package-Commercial Policy# 630681M4076 Effective: 1/1/16 1/1/17 Issuing Company Travelers Prop Cas Co of Amer 694871 1/1/2016 1/1/2016 RENB 16-17 Property&IM 29,595.00 Business Auto Policy# 8103036P64A Effective: 1/1/16 1/1/17 Issuing Company Charter Oak Fire Insurance Co 694867 1/1/2016 1/1/2016 RENB 16-17 Auto 9,261.00 Umbrella-Commercial Excess Policy# XC00000374 Effective: 1/1/16 1/1/17 Issuing Company National Casualty Company 694863 1/1/2016 1/1/2016 RENB 16-17 Umbrella Liability 11,454.00 Package-Commercial Policy# ZLP14T62033 Effective: 1/1/16 1/1/17 Issuing Company Charter Oak Fire Insurance Co 694870 1/1/2016 1/1/2016 RENB 16-17 Liability Package 22,832.00 Further Allocation PACKttGE77 <Total 11,!epartmdntJiPtopert Mrime Inland arms Liability Auto Umbrei.la By dip M I. PJlonon...................._.._;._J.._...._......._23,590.00...;.._ . .....................................- ---....._�-20,517.00 :. ......................................_.._�_10,350.00.......$54,457.00.................. �V 9 .. i School $ - $ 'All Other �, 4 129- '_��..............1.�878_00 2,315.00 1 $9,25.................................00 1 $ 1,104.00 $J11fiI15-00 ;Parks Total $ 27,719.00 $ 1,876.00 : $22,832,00 '$9,26. $11,454.00 2. 1 - _ _n .... . , x..w».. - .. In HYLANT Hylant-Indianapolis 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280 12/11/2015 City of Carmel Loan# Invoice#98732 FARWE1 Page 1 of 1 ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. 00352999 Hylant Group Terms 301 Pennsylvania Parkway, Suite 201 Date Due Indianapolis, IN 46280-0925 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO# Amount 12/11/15 98732 Annual insurance premium $ 18,685.00 12/11/15 98732 Annual insurance premium $ 54,457.00 Total $ 73,142.00 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 i t Voucher-No. Warrant No. 00352999 Hylant Group Allowed 20 301 Pennsylvania Parkway, Suite 201 Indianapolis, IN 46280-0925 In Sum of$ $ 73,142.00 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund/109 -Monon Center -4: PO#or Board Members Dept# INVOICE NO. kCCT#/TiTLI AMOUNT 1125 98732 4347500 $ 18,685.00 i I hereby certify that the attached invoice(s), or 1091 98732 4347500 $ 54,457.00 bill(s)is(are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except C_ Signature $ 73,142.00 Accounts Payable Coordinator Cost distribution ledger classification If Title claim paid motor vehicle highway fund