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