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Home My WebLink About304793 10/13/16 %'�,A,,F� - CITY OF CARMEL, INDIANA VENDOR: 362876 ® ; ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $****29,335.48* ia� CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 304793 y��ioN�°. CHICAGO IL 60693 CHECK DATE: 10/31/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 000509513 28,063.67 GENERAL INSURANCE 1205 4347500 000509514 1,160.81 GENERAL INSURANCE 1205 4347500 101016 111.00 GENERAL INSURANCE VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) TRAVELERS ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 13607 COLLECTIONS CENTER DRIVE IN SUM OF$ 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. $111.00 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 08.31.16 43-475.00 $111.00 1 hereby certify that the attached invoice(s),or 9/12/16 08.31.16 Policy Number H-360-581M4076-TIL-16 $111.00 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, October 11,2016 �i 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 r PRODUCER CHANGE EFFECTIVE DATE:08-31-16 CHANGE ENDORSEMENT NUMBER:0013 �. TRAVELERS One Tower Square, Hartford,Connecticut 06183 CHANGE ENDORSEMENT Named Insured: CITY OF CARMEL Policy Number: H-630-581M4076-TIL-16 Policy Effective Date: 01/01/16 Issue Date: 09/12/16 Additional Premium $ 111 INSURING COMPANY: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA Effective from 08/31/16 at the time of day the policy becomes effective. THIS INSURANCE IS AMENDED AS FOLLOWS: THE COMMON POLICY DECLARATIONS IS AMENDED AS FOLLOWS: AMENDING IL TO 03 04 96 - LOCATION SCHEDULE AS FOLLOWS: ADDING LOCATION 168, BUILDING 168 OCCUPIED AS APARTMENTS LOCATED AT: 30 E . MAIN STREET, CARMEL IN 46033. THE DELUXE PROPERTY COVERAGE PART IS AMENDED AS FOLLOWS: AMENDING DX 00 03 07 94 - DELUXE PROPERTY COVERAGE PART SCHEDULE - SPECIFIC LIMITS AS FOLLOWS: . ADDING BUILDING COVERAGE AT LOCATION 168, BUILDING 168 SUBJECT TO A LIMIT OF $541 ,500. AMENDING DELUXE BUSINESS INCOME (AND EXTRA EXPENSE) COVERAGE FORM TO ADD LOCATION 168, BUILDING 168. AMENDING CAUSES OF LOSS - EARTHQUAKE TO ADD THE FOLLOWING BUILDINGS) NUMBERED: 168. o AMENDING DEDUCTIBLE BY EARTHQUAKE IN ANY ONE OCCURRENCE TO ADD THE FOLLOWING BUILDING NUMBERED: 168. o� o� �c NAME AND ADDRESS OF AGENT OR BROKER: ' COU T R_ IGNED BY- GROUP INC (G8433) r 301 PENNSYLVANIA PKWY STE 201 INDIANAPOLIS, IN 46280 AuthorizedRepresentative/ ,I7—& /,( DATE: ./ IL TO 07 09 87 PAGE 1 OF 1 OFFICE : SAN ANTONIO-EAST Sub OCT 11 2016 002325 Clerk T ra8SUrer r CHANGE EFFECTIVE DATE:08-31-16 i A► CHANGE ENDORSEMENT NUMBER:0013 TRAVELERSJ PREMIUM SPLIT FORM PAGE 1 OF 1 POLICY NUMBER: H-630-581M4076-TIL-16 RATER: OK39 ISSUE DATE : 09/12/16 COMM ITEM COMM ITEM COMM ITEM COMM ITEM .1000 PREM ACCOUNT EFFECTIVE MONTH DATE PREMIUM PREMIUM PREMIUM PREMIUM 0916 08/31/16 111 o� o o oC . o o OFFICE : SAN ANTONIO-EAST 24T PRODUCER NAME : HYLANT GROUP INC G8433 002327 VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) TRAVELERS ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 13607 COLLECTIONS CENTER DRIVE IN SUM OF$ 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. $29,224.48 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 000509514 43-475.00 $1,160.81 1 hereby certify that the attached invoice(s),or 9/30/16 000509514 $1,160.81 1205 101 1205 101 000509513 43-475.00 $28,063.67 bill(s)is(are)true and correct and that the 9/30/16 000509513 $28,063.67 1205 101 materials or services itemized thereon for 1205 1 101 which charge is made were ordered and received except Monday, October 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 distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer TRAVELERS PAGE 1 :I I : 14T62033—ZLP 521GX7087 09/30/2016 000509513 10/15/2016 28,063.67 CURRENT CHARGES CLAIM#: E4EB697 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 CLAIM#: ESK0133 DATE OF LOSS: 12/11/2015 DESCRIPTION: CLASS ACTION SUIT FILED IN FEDERAL COURT ARISING OUT OF A TRAFFIC VIOL CLAIMANT: LAWRENCE B LENNON EXPENSE 25,000.00 CLAIM TOTAL 25,000.00 CLAIM#: E7DO640 DATE OF LOSS: 06/03/2014 DESCRIPTION: PLAINTIFF IS ALLEGING THAT THE CARMEL PD UNLAWFULLY PULLED HIM OVER.AN CLAIMANT: JASON MARAMAN EXPENSE 2,971 .27 CLAIM TOTAL 2,971.27 TOTAL CLAIM(S) DUE $28,063.67 Submitted To OCT 10 2016 Vie, =-�' .;�a �,s� ulsm t reSso-5read TRAVELERS/ J PAGE 2 DEDUCTIBLE / SELF- INSURED INVOICE i i I 14T62033-ZLP 521GX7087 09/30/2016 000509513 10/15/2016 28,063.67 ACCOUNT SUMMARY CURRENT CHARGES 28,063.67 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 28,063.67 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 28,063.67 CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE. FOR BILLING QUESTIONS, PLEASE CONTACT YOUR ACCOUNTING SPECIALIST GEORGIE RUSSO AT 1-860-277-9781 OR EMAIL GRUSSO@TRAVELERS.COM TRAVELERS PAGE 1 :14,101H. 3036P64A-810 521GX7087 09/30/2016 000509514 10/15/2016 1, 160.81 CURRENT CHARGES 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 146.38 CLAIM TOTAL 146.38 CLAIM#: E3Q9083 DATE OF LOSS: 08/04/2016 DESCRIPTION: WHEN IV (POLICE VEHICLE) WAS PARKING NEXT TO OV PARKED/UNOCCUPIED, IV CLAIMANT: TAO WANG LOSS 1,014.43 CLAIM TOTAL 1,014.43 TOTAL CLAIMS) DUE $1,160.81 ACCOUNT SUMMARY CURRENT CHARGES 1 , 160.81 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 1.160.81 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 1. 160.81 CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE. FOR BILLING QUESTIONS, PLEASE CONTACT YOUR ACCOUNTING SPECIALIST GEORGIE RUSSO AT 1-860-277-9781 OR EMAIL GRUSSO@TRAVELERS.COM `,C'r OCT 10 2016