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Home My WebLink About256021 03/01/16 ��(.GiN,,,?! CITY OF CARMEL, INDIANA VENDOR: 362876 w ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $****17,235.20* =9 ?� CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 256021 +,ETON�o. CHICAGO IL 60693 CHECK DATE: 03/01/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 000497232 3,968.80 GENERAL INSURANCE 1205 4347500 000497233 10,711.40 GENERAL INSURANCE 1205 4347500 000497234 2,555.00 GENERAL INSURANCE VOUCHER NO. WARRANT NO. ALLOWED 20 TRAVELERS 13607 COLLECTIONS CENTER DRIVE IN SUM OF$ CHICAGO, IL 60693 $17,235.20 ON ACCOUNT OF APPROPRIATION FOR General Administration PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Members 000497233 43-475.00 $10,711.40 1 hereby certify that the attached invoice(s), or 1205 101 000497234 43-475.00 $2,555.00 bill(s) is (are)true and correct and that the 1205 101 000497232 I 43-475.00 I $3,968.80 materials or services itemized thereon for 1205 101 which charge is made were ordered and received except Monday, February 08, 2016 r Cost distribution ledger classification if claim paid motor vehicle highway fund TRAVELERS PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. 14N99887-ZPP 5216X7087 01/29/2016 000497234 02/15/2016 2,785.00 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 2,555.00 CLAIM TOTAL 2,555.00 CURRENT CHARGES �lsss-00 ACCOUNT SUMMARY CURRENT CHARGES 2,555.00 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 230.00 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 2,785.00 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 2,785.00 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 FEB 0 8 2016 Clerk. Treasurer TRAVELERS J PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. 303GPG4A-810 521GX7087 01/29/2016 000497232 02/15/2016 5,051 .55 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 4,812.80 CLAIM TOTAL 4,812.80 CLAIM#: E3Q0215 DATE OF LOSS: 10/15/2015 DESCRIPTION: TRAFFIC STOPPED AND IV R/E OV CLAIMANT: JOHN KENNELLY LOSS 844.00- CLAIM TOTAL 844.00- .CURRENT CHARGES' 3,968. ACCOUNT SUMMARY CURRENT CHARGES 3,968.80 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PAST DUE CHARGES 1,082.75 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 5,051.55 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 5,051 .55 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 ANT&LO CO&TWR,4S_ Submitted To FEB 0 8 2016 Clerk Tre urer TRAVELERS/- PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. 'POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE 14TG2033-ZLP 521GX7087 01/29/2016 000497233 02/15/2016 16,676.91 CURRENT CLAIM#: EY07995 DATE OF LOSS: 10/11/2013 DESCRIPTION: PLAINTIFF ALLEGES FALSE ARREST. CLAIMANT: CARL COOPER LOSS 8,000.00 EXPENSE 1,033.00 CLAIM TOTAL 9,033.00 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 30.80 CLAIM TOTAL 30.80 CLAIM#: E4E1787 DATE OF LOSS: 03/07/2014 DESCRIPTION: CLAIMANT ALLEGES THAT POLICE USED AXCESSIVE FORCE CAUSING BODILY INJUR CLAIMANT: LOUIS R PASTORE EXPENSE 61 .60 CLAIM TOTAL 61.60 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 S ubmi t,e T® EXPENSE 1,586.00 CLAIM TOTAL 1,586.00 FEB 0 8 2016 CURRENT CHARGES $10,711.40 Clerk T gip.-` sure ' TRAVELERS PAGE 2 DEDUCTIBLE / SELF-INSURED INVOICE POLICY i BILL NUMBER PAYMENT DUE TOTAL 14TG2033-ZLP 5216X7087 01/29/2016 000497233 02/15/2016 16,676.91 ACCOUNT SUMMARY CURRENT CHARGES 10,711 .40 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 5,965.51 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 16,676.91 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 16,676.91 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