HomeMy WebLinkAbout258695 05/13/16 9+W.CAq�
CITY OF CARMEL, INDIANA VENDOR: 362876
j ® ~; ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $*****1,556.86*
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 258695
9M�iTON�? CHICAGO IL 60693 CHECK DATE: 05/13/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000501838 1,556.86 GENERAL INSURANCE
VOUCHER NO. WARRANT NO.
ALLOWED 20
TRAVELERS
13607 COLLECTIONS CENTER DRIVE
IN SUM OF$
CHICAGO, IL 60693
$1,556.86
ON ACCOUNT OF APPROPRIATION FOR
General Administration
PO#/Dept. INVOICE NO. I ACCT#/Fund AMOUNT Board Members
000501838 I 43-475.00 I $1,556.86 1 hereby certify that the attached invoice(s), or
12.05 ll 101
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
Monday, May 09, 2016
i
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
04/29/16 000501838 $1,556.86
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
TRAVELERS PAGE ,
all 4 INK :
14TG2033-ZLP 5216X7087 04/29/2016 000501838 05/15/2016 1,556.86
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 977.76
CLAIM TOTAL 977.76
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 354.20
CLAIM TOTAL 354.20
CLAIM#: ESK2107 DATE OF LOSS: 08/18/2015
DESCRIPTION: EXCESSIVE FORCE
CLAIMANT: THOMAS BARNETT
EXPENSE 209.50
CLAIM TOTAL 209.50
CURRENT CHARGES $1,556.86
submftterl� To
MAY 0 9 2016
ler7 �§, �
TRAVELERS_J_
PAGE 2
DEDUCTIBLE / SELF-INSURED INVOICE
• i i � • �ijk 51111 pill Mi I i 177610
14TG2033-ZLP 5216X7087 04/29/2016 000501838 05/15/2016 1,556.86
ACCOUNT SUMMARY
CURRENT CHARGES 1,556.86 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 1.556.86
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 1 .556.86
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 1-800-277-2354 GREG POST
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00549 38882
CITY OF CARMEL, CARMEL CLAY PARKS
ONE CIVIC SQUARE
CARMEL IN 46032
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