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Home My WebLink About259580 06/14/16 (9, CITY OF CARMEL, INDIANA VENDOR: 00352999 ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $****28,937.00* CARMEL, INDIANA 46032 PO BOX 638720 CHECK NUMBER: 259580 CINCINNATI OH 45263-8720 CHECK DATE: 06/14/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 114708 5,962.00 GENERAL INSURANCE 302 5023990 98733 22,975.00 OTHER EXPENSES VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) HYLANT GROUP ALLOWED 20 ACCOUNTS PAYABLE VOUCHER PO BOX 638720 IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service CINCINNATI, OH 45263-8720 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $5,962.00 Payee ON ACCOUNT OF APPROPRIATION FOR Purchase Order# General Administration Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 114708 43-475.00 $5,962.00 1 hereby certify that the attached invoice(s),or 6/2/16 114708 $5,962.00 1205 101 1205 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 Wednesday,June 08,2016 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 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Hylant-Indianapolis Invoice # 114708 At HYLANT 301 Pennsylvania Pkwy,Ste 201 Due Date= Bal Indianapolis,IN 46280 �_�.� m_f.., .. ariCe i P-(800)678-0361 6/2/2016 6/2/2016 hylant.com F-(317)817-5151. 411 Insured y RS City of Carmel Accourit°Number =' Amount Due J"I'A' CARMELO-02 $5,962.00 City of Carmel ATTN: STEVE ENGELKING One Civic Square Carmel, IN 46032 Please Return Top with Remittance To: PO Box 638720,Cincinnati,OH 45263-8720 Fe # Trans Eff Date, Due Date Trans Description Amount Business Auto Policy# H8103036P64ACOF15 Effective: 1/1/15 - 1/1/16 Issuing Company Charter Oak Fire Insurance Co 826354 1/1/2015 6/2/2016 AUDI 15-16 Composite Rate Auto Audit 5,962.00 Total Invoice Balance: $5,962.00 Submitted T® JUN 0 6 2016 Clerk Treasurer At HYLANT Hylant-Indianapolis 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280 6/2/2016 City of Carmel Loan# Invoice#114708 FARWEI Page 1 of 1 VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) HYLANT GROUP ALLOWED 20 ACCOUNTS PAYABLE VOUCHER PO BOX 638720 IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service CINCINNATI, OH 45263-8720 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $22,975.00 Payee Purchase Order# ON ACCOUNT OF APPROPRIATION FOR Human Resources Terms 302 Work Comp Fund Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 98733 50-239.90 $22,975.00 I hereby certify that the attached invoice(s),or 6/8/16 98733 $22,975.00 302 302 302 302 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 Wednesday,June 08,2016 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— Cost 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Hylant-Indianapolis Invoice # 98733 II HYLANT 301 Pennsylvania Pkwy,Ste 201 Indianapolis,IN 46280 Date Balance Due an P-(800)678-0361 61l/2016 7/1/2016 hylant.com F-(317)817-5151 :Insured Ll7s City of Carmel Account N��nber ': t Ar�nount Due s CARMELO-02 $22,975.00 City of Carmel One Civic Square Carmel, IN 46032 Please Return Top with Remittance To: PO Box 638720, Cincinnati,OH^45263-8720 Item# Trans Eff Dafe Due Dateux Trans - Descriptions Third Party Administrator-Commercial Policy# 0385 Effective: 1/1/16 - 1/1/17 Issuing Company Midwest Employers Casualty Co 694854 1/1/2016 7/1/2016 RENB 16-17 TPA 2 of 2 Installments 22,975.00 Total Invoice Balance: $22,975.00 Submitted To JUN 0 6 2016 Clerk Treasurer II►HYLANT Hylant-Indianapolis 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280 6/1/2016 City of Carmel Loan# Invoice#98733 FARWE1 Page 1 of 1