HomeMy WebLinkAbout306209 12/12/16 w c��MF
CITY OF CARMEL, INDIANA VENDOR: 362876 CHECK AMOUNT: $`"'"'5,257.35"
ONE CIVIC SQUARE TRAVELERS13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 306209
s„ ?� CARMEL, INDIANA 46032 CHICAGO IL 60693 CHECK DATE: 12/12/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
000512560 4,758.30 GENERAL INSURANCE
1205 4347500 499.05 GENERAL INSURANCE
1205 4347500 000512561
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TRAVELERS` PAGE ,
DEDUCTIBLE / SELF- INSURED INVOICE
iNEEMYETIPIM
3036P64A-810 521GX7087 11/30/2016 000512561 12/15/2016 499.05
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL,CARMEL CLAY
13607 COLLECTIONS CENTER DRIVE ONE CIVIC SQUARE
CHICAGO, IL 60693 CARMEL IN 46032
RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS.
PLEASE WRITE THE POLICY & ACCOUNT NUMBER ON YOUR CHECK.
TRAVELERS PAGE 1
303GPG4A-810 5216X7087 11/30/2016 000512561 12/15/2016 499.05
CURRENT CHARGES
CLAIM#: E3Q8576 DATE OF LOSS: 07/16/2016
DESCRIPTION: BAUT C - CINERGY; AT&T POLICE OFFICER MUST NOT HAVE
PUT CAR IN PARK UP
CLAIMANT: /DUKE ENERGY
LOSS 499.05
CLAIM TOTAL 499.05
TOTAL CLAIMS) DUE $499.05
ACCOUNT SUMMARY
CURRENT CHARGES 499.05 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 499.05
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 499.05
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`; t i
TRAVELERS Jli%, PAGE 1
DEDUCTIBLE / SELF— INSURED INVOICE
l;Lll4_[WM0llhTil'-jljE1i : i
14TG2033-ZLP 5216X7087 11/30/2016 000512560 12/15/2016 4,758.30
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL, CARMEL CLAY PARKS
13607 COLLECTIONS CENTER DRIVE ONE CIVIC SQUARE
CHICAGO, IL 60693 CARMEL IN 46032
RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS.
PLEASE WRITE THE POLICY & ACCOUNT NUMBER ON YOUR CHECK.
TRAVELERS PAGE ,
14TG2033-ZLP 521GX7087 11/30/2016 000512560 12/15/2016 4,758.30
CURRENT CHARGES
CLAIM#: E2U8101 DATE OF LOSS: 07/25/2014
DESCRIPTION: PROF C-LEY, LARRY J. MD TORT NOTICE ALLEGING CLAIMANT
WAS FALSELY AND
CLAIMANT: LARRY LEY
EXPENSE 4,348.00
CLAIM TOTAL 4,348.00
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 30.80
CLAIM TOTAL 30.80
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 379.50
CLAIM TOTAL 379.50
TOTAL CLAIM(S) DUE $4,758.30
F'F 4 C ZO'o
TRAVELERS) PAGE 2
DEDUCTIBLE / SELF- INSURED INVOICE
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT OUE TOTAL OUE
14TG2033-ZLP 521GX7087 11/30/2016 000512560 12/15/2016 4,758.30
ACCOUNT SUMMARY
CURRENT CHARGES 4,758.30 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 4,758.30
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 4,758.30
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