HomeMy WebLinkAbout301869 08/11/16 t Coq-
.'4� +•�f! CITY OF CARMEL, INDIANA VENDOR: 362876
d ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $*****5,051.70*
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 301869
M«oN. CHICAGO IL 60693 CHECK DATE: 08/11/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 00506388 77.00 GENERAL INSURANCE
1205 4347500 00506389 4,974.70 GENERAL INSURANCE
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
TRAVELERS ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
13607 COLLECTIONS CENTER DRIVE IN SUM OF$ 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.
$5,051.70 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
000506389 43-475.00 $4,974.70 1 hereby certify that the attached invoice(s),or 7/29/16 000506388 $77.00
1205 101 1205 101
000506388 43-475.00 $77.00 bill(s)is(are)true and correct and that the 7/29/16 000506389 $4,974.70
1205 101 materials or services itemized thereon for 1205 1 101
which charge is made were ordered and
received except
Wednesday,August 10,2016
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
Aim
TRAVELERS J PAGE 1
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE,
3036P64A-810 5216X7087 07/29/2016 000506389 08/15/2016 4,974.70
CURRENT
CLAIM#: E3K3157 DATE OF LOSS: 05/24/2016
DESCRIPTION: COLLISION; C - REEVE, LESLIE; OV STARTED TO PROCEED
INTO INTERSECTION
CLAIMANT: LESLIE REEVE
LOSS 368.43
CLAIM TOTAL 368.43
CLAIM#: E3K3499 DATE OF LOSS: 06/07/2016
DESCRIPTION: BAUT C - VASQUEZ, RAUL IV WAS TRYING TO PARK AND
STRUCK A PARKED UNOCC
CLAIMANT: RAUL VASQUEZ
LOSS 747.94
CLAIM TOTAL 747.94
CLAIM#: E3Q7759 DATE OF LOSS: 06/21/2016
DESCRIPTION: BAUT C - GORSUCH, CHELSEA IV WAS BEHIND CV STOPPED IN
ROUNDABOUT. IV
CLAIMANT: CHELSEA GORSUCH
LOSS 2,782.64
CLAIM TOTAL 2,782.64
CLAIM#: E3Q7975 DATE OF LOSS: 06/27/2016
DESCRIPTION: BAUT C - ALESKA, JOHN IV WAS BACKING TRUCK OUT OF
PARKING SPOT AND DID
CLAIMANT: JOHN ALESKA
LOSS 1,075.69
CLAIM TOTAL 1,075.69
CURRENT CHARGES $4,974.70
Submitted To
AUG 10 2016
Clerk 1"rasurer
TRAVELERS J PAGE 2
DEDUCTIBLE / SELF-INSURED INVOICE
POLICY NUMBER ACCOUNTBILL NUMBER PAYMENT DUE TOTAL
303GP64A-810 5216X7087 07/29/2016 000506389 08/15/2016 4,974.70
ACCOUNT SUMMARY
CURRENT CHARGES 4,974.70 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 4.974.70
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 4,974.70
CONTACT-YOUR- AGENT- LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE. - ----- -----------
i
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-HELPDESK@TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-860-277-9781 GEORGIE RUSSO
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00593 38789
CITY OF CARMEL,CARMEL CLAY
ONE CIVIC SQUARE
CARMEL IN 46032
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..__._.. __ .__ ..___. .....__..__........_ .__...._._ ... ................. .._..._..__.______....._.
TRAVELERS J�
Ir
14T62033-ZLP 5216X7087 07/29/2016 000506388 08/15/2016 77.00
CURRENT
CLAIM#: E4E1787 DATE OF LOSS: 03/07/2014
DESCRIPTION: CLAIMANT ALLEGES THAT POLICE USED AXCESSIVE FORCE
CAUSING BODILY INJUR
CLAIMANT: LOUIS R PASTORE
EXPENSE 30.80
CLAIM TOTAL 30.80
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 46.20
CLAIM TOTAL 46.20
CURRENT CHARGES $77.00
ACCOUNT SUMMARY
CURRENT CHARGES 77.00 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 77.00
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 77.00
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 1-860-277-9781 GEORGIE RUSSO
Submitted To
AUG 10 2016
Clerk Treasurer
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
00592 38792
CITY OF CARMEL, CARMEL CLAY PARKS
ONE CIVIC SQUARE
CARMEL IN 46032
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