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HomeMy WebLinkAbout259433 06/10/16 (9, CITY OF CARMEL, INDIANA VENDOR: 362876 ONE CIVIC SQUARE TRAVELERS CHECKAMOUNT: $****16,014.22* CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 259433 CHICAGO IL 60693 CHECK DATE: 06/10/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 503317 3,702.05 5216X7087 1205 4347500 503318 6,350.17 5216X7087 1205 4347500 H810303GP64A 5,962.00 GENERAL INSURANCE VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) TRAVELERS ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 13607 COLLECTIONS CENTER DRIVE IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service CHICAGO, IL 60693 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $16,014.22 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 503318 43-475.00 $6,350.17 1 hereby certify that the attached invoice(s),or 5/31/16 503317 $3,702.05 1205 101 1205 101 503317 43-475.00 $3,702.05 bill(s)is(are)true and correct and that the 5/31/16 503318 $6,350.17 1205 101 materials or services itemized thereon for 1205 101 H-810-3036P64A-I 43-475.00 I $5,962.00 6/7/16 I H-810-3036P64A-I I $5,962.00 INDA-15 which charge is made were ordered and INDA-15 1205 101 1205 101 received except Tuesday,June 07,2016 ZZL-la-Z r 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 TRAVELERS J� PAGE 1 DEDUCTIBLE / SELF- INSURED INVOICE POLICY : TOTAL 14TG2033-ZLP 5216X7087 05/31/2016 000503317 06/15/2016 3,702.05 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL, CARMEL CLAY PARKS 13607 COLLECTIONS CENTER DRIVE ONE CIVIC SQUARE CHICAGO, IL 60693 CARMEL IN 46032 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE WRITE THE POLICY & ACCOUNT NUMBER ON YOUR CHECK. --------------------------------- - TRAVELERSJ PAGE 1 POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE 14TG2033-ZLP 521GX7087 05/31/2016 000503317 06/15/2016 3,702.05 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 30.80 C��U1'tc� 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 1,062.60 CLAIM TOTAL 1,062.60 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 EXPENSE 1,878.80 CLAIM TOTAL 1,878.80 CLAIM#: ESK2107 DATE OF LOSS: 08/18/2015 DESCRIPTION: EXCESSIVE FORCE CLAIMANT: THOMAS BARNETT EXPENSE 598.90 CLAIM TOTAL 598.90 CLAIM#: ESK7258 DATE OF LOSS: 04/02/2016 DESCRIPTION: GLIA C - LOPEZ, LINDSEY TORT NOTICE ALLEGING DAMAGE TO A MAILBOX WHEN CLAIMANT: LINDSEY LOPEZ Submitted T® LOSS 130.95 CLAIM TOTAL 130.95 JUN 0 6 2016 CURRENT CHARGES $3,702.05 TRAVELERS.1 PAGE 2 DEDUCTIBLE / SELF- INSURED INVOICE : i 14T62033-ZLP 521GX7087 05/31/2016 000503317 06/15/2016 3,702.05 ACCOUNT SUMMARY CURRENT CHARGES 3,702.05 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 3.702.05 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 3,702.05 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 1-860-277-2354 GREG POST TRAVELERS J PAGE 1 DEDUCTIBLE / SELF-INSURED INVOICE 3036P64A-810 5216X7087 05/31/2016 000503318 06/15/2016 6,350. 17 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL,CARMEL CLAY 13607 COLLECTIONS CENTER DRIVE ONE CIVIC SQUARE CHICAGO, IL 60693 CARMEL IN 46032 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE WRITE THE POLICY & ACCOUNT NUMBER ON YOUR CHECK. TRAVELERS/ J PAGE 1 3036P64A-810 5216X7087 05/31/2016 000503318 06/15/2016 6,350. 17 CURRENT CLAIM#: E3K1860 DATE OF LOSS: 04/06/2016 DESCRIPTION: BAUT C - JEWELL, CHRISTOPHER IV FOOT SLIPPED OFF THE BRAKE AND SHE STR CLAIMANT: CHRISTOPHER JEWELL LOSS 1,506.65 CLAIM TOTAL 1,506.65 CLAIM#: E3Q1143 DATE OF LOSS: 11/15/2015 DESCRIPTION: 3 VEH ACC - IV REARENDED OV1 STOPPED - OV1 WAS PUSHED INTO OV2 STOPPED CLAIMANT: FRANK C WILLOUGHBY LOSS 1,016.32 CLAIM TOTAL 1,016.32 CLAIM#: E3Q6036 DATE OF LOSS: 04/27/2016 DESCRIPTION: BAUT C - UTKEN, MELINDA IV WAS BACKING OUT OF A PARKING SPACE WHEN OV CLAIMANT: MELINDA UTKEN LOSS 2,255.00 CLAIM TOTAL 2,255.00 CLAIM#: E3Q6266 DATE OF LOSS: 05/06/2016 DESCRIPTION: IV WAS BACKING INTO A PARKING SPOT AND THE IV MIRROR HIT THE OV THAT W CLAIMANT: KELLY BOUCHEZ LOSS 1 ,572.20 CLAIM TOTAL 1,572.20 CURRENT CHARGES $6,350.17 Submitted To S"b N 0 6 2016[JU rk Treasurer TRAVELERS J PAGE 2 DEDUCTIBLE / SELF-INSURED INVOICE 1211 qDymillillyj Il I 3036P64A-810 521GX7087 05/31/2016 000503318 06/15/2016 6,350.17 ACCOUNT SUMMARY CURRENT CHARGES 6,350. 17 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 6,350.17 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 6,350. 17 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 1-860-277-2354 GREG POST �Tzs' �C Premium Audit'. /� 'PO.Box 2927 : . '.. . . TRAVELERS.) Hartford;CT'.06104-2927 THE TRAVELERS INDEMNITY COMPANY Premium Ad ustment:Notice. fH/s fS;aora eaL • 4 CITY OF CARMEL olicy.Number H=810-3036P64A-IND-15 ONE:CIVIC SQUARE . . Submitted To: Policy Period:.01/01/2015 to 01/0:1/2016: CARMEL,:IN 46032 Audit Period: 01/0172015 to 01%01/2016 JUN 0 6:2016 Issue Office: 24717 G8433 Date,of This Notice: 2/2912016 Clerk p. asuc� HYLANT.GROUP INC. . Mode of Adjustment ANNUAL AUDIT. 301:PENNSYLVANIA PKWYa. . . .INDIANAPOLIS,:IN 46280 '.Total Eemed:Premium $: 213;449:00 ' Audit Contact: 'Pr'e'mium Prior to Audit : $ 267,487.00 CUSTOMER SERVICE'(GL) Additional Premium Due', 1-800=842;4271 : : Return:Premium $ uo "Premium Prior to Audit"includes the original policy premium and.any: • endorsements•d uring'the,policy term This does not reflect actual,payments made. THIS ADJUSTMENT STATEMENT.WAS:PREPARED FROM:A ReportYou;Submitted: ' ra4� �ra x ca E "ALA 1—LEARNED PREMI-Tci,r- s ,CLASS PREMIUM COMff. PaD COMP.O,TIONS� CODES I<EY {v BASIS B^I;LIAB LItiBtMB!Ij'16B� IIA COMPOSITE RATED ,. POLICY AS ISSUED. LIABILITY POWER UNITS U 426.00 509.000 212,412.00 COMPREHENSWE. OCN F• 18,457,159:00 0:122 27,492:00 COLLISION OCN'.: F 18,457,159.00 0.149 27,583:00 AUDITED RESULTS' . . '.. LIABILITY,POWER UNITS U : 8.50 '509.000 4,327.00 COMPREHENSIVE,OCN. '.: F: 603,500.00 . . 0.122 736.00. COLLISION OCN . F 603;500:00 0.149