HomeMy WebLinkAbout257645 04/15/16 (9,
CITY OF CARMEL, INDIANA VENDOR: 362876
ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: S""""7,722.42•
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 257645
CHICAGO IL 60693 CHECK DATE: 04/15/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000500323 3,834.60 000500323
1205 4347500 000500324 3,887.82 5216X7087
VOUCHER NO. WARRANT NO.
ALLOWED 20
TRAVELERS
13607 COLLECTIONS CENTER DRIVE IN SUM OF$
CHICAGO, IL 60693
$7,722.42
ON ACCOUNT OF APPROPRIATION FOR
General Administration
PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Members
000500324 43-475.00 $3,887.82 1 hereby certify that the attached invoice(s), or
1205 101
000500323 43-475.00 $3,834.60 bill(s) is (are)true and correct and that the
1205 101 materials or services itemized thereon for
which charge is made were ordered and
received except
Monday,April 11, 2016
Cost distribution ledger classification if
claim paid motor vehicle highway fund
TRAVELERS PAGE 1
14N99887-ZPP 5216X7087 03/31/2016 000500324 04/15/2016 3,887.82
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 3,887.82
CLAIM TOTAL 3,887.82
CURRENT CHARGES $3,887.82
ACCOUNT SUMMARY
CURRENT CHARGES 3,887.82 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 3,887.82
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 3,887.82
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
APR 11 2016
Clerk Treasurer
TRAVELERS PAGE 1
POLICY NUMBER ACCOUNTNUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE
14T62033-ZLP 5216X7087 03/31/2016 000500323 04/15/2016 3,834.60
CURRENT
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 15.40
CLAIM TOTAL 15.40
CLAIM#: E4E1787 DATE OF LOSS: 03/07/2014
DESCRIPTION: CLAIMANT ALLEGES THAT POLICE USED AXCESSIVE FORCE
CAUSING BODILY INJUR
CLAIMANT: LOUIS R PASTORE
EXPENSE 1,016.40
CLAIM TOTAL 1,016.40
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 2,602.60
CLAIM TOTAL 2,602.60
CLAIM#: ESK2107 DATE OF LOSS: 08/18/2015
DESCRIPTION: EXCESSIVE FORCE
CLAIMANT: THOMAS BARNETT
EXPENSE 200.20
CLAIM TOTAL 200.20
Submitted To CURRENT CHARGES $3,834.60
APR 1 2016
Clerk Treasurer
TRAVELERS J PAGE 2
DEDUCTIBLE / SELF-INSURED INVOICE
all i
14T62033-ZLP 521GX7087 03/31/2016 000500323 04/15/2016 3,834.60
ACCOUNT SUMMARY
CURRENT CHARGES 3,834.60 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 3,834.60
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 3,834.60
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