HomeMy WebLinkAbout303416 09/26/16 + '��`" CITY OF CARMEL, INDIANA VENDOR: 00352999
® a ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $*****7,312.55*
s. ,?a CARMEL, INDIANA 46032 PO BOX 638720 CHECK NUMBER: 303416
vy__ _�. CINCINNATI OH 45263-8720 CHECK DATE: 09/26/16
BION
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 124857 6,634.00 GENERAL INSURANCE
1205 4347500 124898 678.55 GENERAL INSURANCE
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
HYLANT GROUP ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
PO BOX 638720 IN SUM OF$ 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.
$6,634.00 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
124857 43-475.00 $6,634.00 1 hereby certify that the attached invoice(s),or 9/13/16 124857 $6,634.00
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
Tuesday,September 13,2016
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
Midwest Employers Casualty Company
Audit Statement
Insured: City of Carmel
Policy No.: EWC008873
Policy Term: 01/01/2015 to 01/01/2017
Audit Period: 01/0112015 -01101/2016
State Code Classification Audited Rate per Audited
Payroll $100 of Premium
Payroll
IN 5506 STREET OR ROAD CONSTRUCTION $2,850,755 5.42 $154,511
IN 7520 WATERWORKS OPERATION $2,207,104 2.80 $61,799
IN 7580 SEWAGE DISPOSAL PLANT OPER $2,782,720 2.45 368,177
IN 7699 FIREFIGHTERS&DRIVERS $13,142,152 2.42 $318,040
IN 7720 POLICE OFFICERS&DRIVERS $298,917 2.57 $7,682
IN 7725 POLICE OFFICERS-MEDICAL ONLY $8,968,904 2.04 $182,966
IN 8380 AUTO SERVICE OR REPAIR CENTER $245,289 2.38 55,838
IN 8742 SALESPERSONS $0 .32 $0
IN 8810 CLERICAL OFFICE OR LIBRARIES $6,140,409 .19 $11,667
IN 8820 ATTORNEY $274,849 .13 $357
IN 8869 CHILD DAYCARE CENTER-PROF/CLER $2,121,115 1.14 $24,181
IN 9015 BUILDINGS $178,961 3.30 $5,906
IN 9060 CLUBS-COUNTRY GOLF/FISHING $430,623 1.39 $5,986
IN 9102 PARK ALL EMPLOYEES&DRIVERS $3,283,937 2.84 $93,264
IN 9410 MUNICIPAL EMPLOYEE NOC $1,728,479 2.86 $49,434
Total Payroll: $44,654,214
Total Audited Premium: $989,808
(a) Experience Modification Factor: 1.000000000
(b) Other Modification Factor 1.000000000
Audited Normal Premium: $989,808
Rate as a Percentage of Normal Premium Multiplied By: 5.57%
Earned Premium: $55,132
Minimum Premium: 343,588
Flat Charges: s0
Earned Premium &Charges after Audit: $55,132
Less Deposit Premiums Collected: $48,498
Additional(Return)Premium Due: $6,634
AUD-ONE-2 Page 1 of 1 Date Printed: 09/08/2016
em#, Trans;Eff Date _ Due Date Trans s.,,Description 3�s -_� _ ;, x Amount
Workers Compensation-Excess Policy# EWC008873 Effective: 1/1/15 - 1/1/16
Issuing Company Midwest Employers Casualty Co
911847 1/1/2015 9/23/2016 AUDI 15/16 Excess Work Comp Audit 6,634.00
Total Invoice Balance: $6,634.00
Submitted To
SEP 13 2016
Clerk Trc-e urer
In HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 280 Indianapolis IN 46290
9/13/2016 City of Carmel Loan# Invoice#124857 FARWEI Page1 of 1
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
HYLANT GROUP ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
PO BOX 638720 IN SUM OF$ 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.
$678.55 Payee
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
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
124898 43-475.00 $678.55 1 hereby certify that the attached invoice(s),or 9/14/16 124898 $678.55
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,September 14,2016
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
Trans Eff Date Due Date Trans Description Amount
General Liability Policy# 27713511414 Effective: 9118116 - 9119116
Issuing Company Burlington Insurance Company
912293 9/18/2016 9/28/2016 NEWB 2016 Special Event GL 627.00
912294 9/18/2016 9/28/2016 CTAX Surplus Lines Tax 16.55
912295 9/18/2016 9/28/2016 CFEE Policy Fee 35.00
Total Invoice Balance: $678.55
E
r
In HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 280 Indianapolis IN 46290
9/14/2016 Carmel Porch Fest,Inc. Loan# Invoice#124898 FARWE1 Page 1 of 1