HomeMy WebLinkAbout303129 09/15/16 (9,
CITY OF CARMEL, INDIANA VENDOR: 362876
ONE CIVIC SQUARE TRAVELERS CHECKAMOUNT: $*******929.91*
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 303129
CHICAGO IL 60693 CHECK DATE: 09/15/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000507964 837.51 GENERAL INSURANCE
1205 4347500 00507963 92.40 GENERAL INSURANCE
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
TRAVELERS ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
13607 COLLECTIONS CENTER DRIVE IN SUM OF$ 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.
$929.91 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
000507964 43-475.00 $837.51 1 hereby certify that the attached invoice(s),or 8/31/16 000507963 $92.40
1205 101 1205 101
000507963 43-475.00 $92.40 bill(s)is(are)true and correct and that the 8/31/16 000507964 $837.51
1205 101 materials or services itemized thereon for 1205 1 101
which charge is made were ordered and
received except
Monday,September 12,2016
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
TRAVELERS` PAGE 1
3036PG4A-810 521GX7087 08/31/2016 000507964 09/15/2016 837.51
CURRENT
CLAIM#: E307759 DATE OF LOSS: 06/21/2016
DESCRIPTION: BAUT C - GORSUCH, CHELSEA IV WAS BEHIND CV STOPPED IN
ROUNDABOUT. IV
CLAIMANT: CHELSEA GORSUCH
LOSS 272.80
CLAIM TOTAL 272.80
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 564.71
CLAIM TOTAL 564.71
CURRENT CHARGES $837.51
ACCOUNT SUMMARY
CURRENT CHARGES 837.51 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 837.51
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 837.51
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
F
mitted To
P 12 2016
`treasurer
TRAVELERS PAGE 1
• I 1 i
14T62033-ZLP 521GX7087 08/31/2016 000507963 09/15/2016 92.40
CURRENT
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 92.40
CLAIM TOTAL 92.40
CURRENT CHARGES $92.40
ACCOUNT SUMMARY
CURRENT CHARGES 92.40 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 92.40
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 92.40
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
SEP 12 2016
Clerk Treasurer