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Home My WebLink About305307 11/14/16 `yup a*q,�f CITY OF CARMEL, INDIANA VENDOR: 362876 �/ j ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $*****3,331.05* f4 �� CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 305307 �.y;�TeN�` CHICAGO IL 60693 CHECK DATE: 11/14/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 000511009 77.00 GENERAL INSURANCE 1205 4347500 000511010 3,254.05 GENERAL INSURANCE VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) TRAVELERS ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 13607 COLLECTIONS CENTER DRIVE IN SUM OF$ 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. $3,331.05 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 000511010 43-475.00 $3,254.05 1 hereby certify that the attached invoice(s),or 10/31/16 000511010 $3,254.05 1205 101 1205 101 000511009 43-475.00 $77.00 bill(s)is(are)true and correct and that the 10/31/16 000511009 $77.00 1205 101 materials or services itemized thereon for 1205 101 which charge is made were ordered and received except Tuesday, November 08, 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 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. POLICY 3036P64A-810 5216X7087 10/31/2016 000511010 11/15/2016 ;,414.86 CURRENT CHARGES CLAIM#: E3Q9850 DATE OF LOSS: 08/25/2016 DESCRIPTION: BAUT C- - HUDSON, TORRIE IV CAME TO A STOP TO BACK INTO A PARKING STALL CLAIMANT: TORRIE W HUDSON LOSS 1, 144. 17 CLAIM TOTAL 1,144,. 17 CLAIM#: ESR0954 DATE OF LOSS: 10/01/2019,�,�,__,..,.,. _ DESCRIPTION: BAUT C - GREAVES, DANIEL IV WAS BACKING I, A DRIVEWAY AND DRIVER BACKE M1 ''fed To CLAIMANT: DANIEL GREAVES �i LOSSr2,109 N(�4 �y ;6 LAIM TOTAL PAST DUE CHARGES [� CLAIM#: E3Q7975 DATE OF LOSS: 06/27/2016 CI DESCRIPTION: BAUT C - ALESKA, JOHN IV WAS BACKING TRU g- T 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) WASPARKINGNEXT TO OV PARKED/UNOCCUPIED, IV CLAIMANT: TAO WANG LOSS ( 1,014.43 CLAIM TOTAL 1,014.43 TOTAL CLAIM(S) DUE $4,414.86 TRAVELERS, PAGE 2 DEDUCTIBLE / SELF-INSURED INVOICE POLICY NUMBER ACCOUNTTOTAL 3036P64A-810 5216X7087 10/31/2016 000511010 11/15/2016 4,414.86 ACCOUNT SUMMARY CURRENT CHARGES 3,254.05 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PAST DUE CHARGES 1 , 160.81 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 4,414.86 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 4,414.86 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 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. iPOLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE, 14T62033-ZLP 5216X7087 10/31/2016 000511009 11/15/2016 28, 140.67 CURRENT CHARGES 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 f77.00 CLAIM TOTAL PAST DUE CHARGES 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 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#: E7D0640 DATE OF LOSS: 06/03/2014 DESCRIPTION: PLAINTIFF IS ALLEGING THAT THE CARM L3RD=UNLAWFULL-Y--- PULLED HIM OVER AN CLAIMANT: JASON MARAMAN To[ EXPENSE 2,971 .27 NO V C, S T'S CLAIM TOTAL 2,971.27 TOTAL CLAIMS) DUE "' =;;.1�_ $28,140.67 U`6a U r C. 1',. TRAVELERS PAGE 2 DEDUCTIBLE / SELF- INSURED INVOICE illi 14TG2033-ZLP 521GX7087 10/31/2016 000511009 11/15/2016 28, 140.67 ACCOUNT SUMMARY CURRENT CHARGES 77.00 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 28,063.67 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 28.140.67 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 28, 140.67 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