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CITY OF CARMEL, INDIANA VENDOR: 00352999 CHECK AMOUNT: $***402,075.13*
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ONE CIVIC SQUARE HYLANT GROUP CHECK NUMBER: 306835
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s ? CARMEL, INDIANA 46032 BOX 638720
CINCINNATI OH 45263-8720 CHECK DATE: 01/06/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
GENERAL INSIIRANCE
1205 4347500 130916 195,931.00 OTHER EXPENSES
302 5023990 130916 94,680.95 INSURANCE
1205 R4347500 33150 130916 38,913.18 GENERAL INSURANCE
1205 R4347500 33904 130916 72,550.00
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Hylant-Indianapolis Invoice# 130916
At HYLANT 10401 North Meridian St,Ste 200 08% . �
Indianapolis,IN 46290
P-(800)678-0361 11/22/2016 1/1/2017
hylant.com F-(317)817-5151
llt$11118d.
City of Carmel
CARMELG-02 $643,269.00
City of Carmel 3g C//3 /?
CITY DEPARTMENTS p 3 3i SU
One Civic Square 7a,rQ °O
Carmel,IN 46032 °y
Please Return Top with Remittance To: PO Box 638720,Cincinnati,OH 45263-8720
Ibbnttl Trans Eff rata >Due Date, Trans bescription l wnt
Package-Commercial Policy# 630581M4076 Effective: 111117 - 111/18
Issuing Company Travelers Prop Cas Co of Amer
964285 1/1/2017 1/1/2017 RENB 17/18 Property Package 89,202.00
Umbrella-Commercial Excess Policy# 5111007800 Effective: 111/17 - 1/1/18
Issuing Company National Casualty Company
964288 1/1/2017 1/1/2017 RENB 17/18 Umbrella/Excess Liability 55,428.00
Business Auto Policy# 8103036P64A Effective: 111/17 - 111/18
Issuing Company Charter Oak Fire Insurance Co
964287 1/1/2017 1/1/2017 RENB 17/18 Auto&Garagekeepers 221,157.00
Package-Commercial Policy# ZLP14T62033 Effective: 111/17 - 1/1118
Issuing Company Charter Oak Fire Insurance Co
964286 1/1/2017 1/1/2017 RENB 17/18 Liability Package 277,482.00
Invoice Total 643,269.00
Detailed Allocation
PACrfAOE LIABUMPACKAC
Dwwwwm Prope�tiylCriiKrlr ow Maxim GL UWwr I=EM Pubft MOM EPL IGMb"' tkmwe a
CITY
Admin S 9,858.00 S 6,538.00 S S S S S S 2,135.00 S
Admin4CS S 1,280.00 $ 2,340.00 S S $ $ $ S 2,590.00 $
DOC $ - S 315.00 S S $ S $ $ 9,558.00 $
Dnig Task S - $ - $ $ $ $ S $ 19,60200 $
Golf Course S 4,807.00 S 13,654.00 S $ 373.00 S $ $ $ 510.00 $
Ergi wmwV $ 4,626.00 $ - $ S S S S $ 4,698.00 S
Fire S 15,400.00 S 6,317.00 S S S $ S S 48,506.00 $
Poke $ 5,963.00 $ 6,875.00 S S S 164,349.00 S E $ 88,950.00 $
Street S 7,258.00 $ 3,971.00 S $ $ - $ $ $ 44,608.00 S
City Total S 49,192.00 S 40,010.00 $ 74,775.00-$ 373.00 $ 164,349.00 $ 6,785.00 S 31,200.00 $ 221,157.00 S 55,426.00
/A HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290
11/22/2016 City of Carmel Loan# Invoice#130916 FARWEI
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Hylant-Indianapolis Invoice# 130916
00P HYLANT 10401 North Meridian St,Ste 200
Indianapolis,IN 46290 ..,.,.-,> ��" , �,r ,.�.t,x x , •, •�
P-(800)678-0361 11/22/2016 1/1/2017
hylant.com F-(317)817-5151
City of Carmel
CARMELO-02 ;643,269.00
City of Carmel 3g 9/3
CITY DEPARTMENTSD 3 SU
1
One Civic Square 3 . a a
Carmel,IN 46032 PD 3390't/ 7 a SSp
" 75 -5.3✓ gas- �z-
Please Return Top with Remittance To: PO Box 638720,Cincinnati,OH 45263-8720
Package-Commercial Policy# 630681M4076 Effective: 1/1117 - 1/1/18
Issuing Company Travelers Prop Cas Co of Amer
964285 1/1/2017 1/1/2017 RENB 17/18 Property Package 89,202.00
Umbrella-Commercial Excess Policy# 5111007800 Effective: 111117 - 111118
Issuing Company National Casualty Company
964288 1/1/2017 1/1/2017 RENB 17/18 Umbrella/Excess Liability 55,428.00
Business Auto Policy# 8103036P64A Effective: 1/1/17 - 1/1/18
Issuing Company Charter Oak Fire Insurance Co
964287 1/1/2017 1/1/2017 RENB 17/18 Auto&Garagekeepers 221,157.00
Package-Commercial Policy# ZLP14T62033 Effective: 1/1/17 - 111118
Issuing Company Charter Oak Fire Insurance Co
964286 1/1/2017 1/1/2017 RENB 17/18 Liability Package 277,482.00
Invoice Total 643,269.00
Detailed Allocation
.PAp A E L All WYPACMGe r
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CITY
Amin S 9,858.00 S 6,538.00 s s s s s s 2,*.00 3
ndr,,-ics S 1,280.00 $ 2,34000 3 - S s S s s 2,590.00 S -
DOC s - S_ 315.00 S - S S S $ $ 9,558.00 $
Drug Task S - $ S - S S S S $ 19,60200 $
Got Course S 4,807.00 S 13,654.00 S - $ 373.00 $ S S - $ 510.00 3
Engineering S 4,626.00 $ - S - $ - $ S S S 4,69890 $
Fre S 15,400.00 S 6,317.00 S - S $ - S S $ 48,506.00 S
Police $ 5,963.00 S 6,875.00 $ - $ S 164,349.00 $ S S _88,950.00 S
Street S 7,258.00 S 3,971.00 S - $ S $ - S - S 44,608.00 $
Ckty Total S 48,182.00 S 40,010.00 S 74,775.00'S 373.00 S 164,548.00 S 6,785.00 $ 31,200.00 S 221,157.00 $ 55,422.00
0*HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290
1122/2016 City of Carmel Loan# Invoice#130916 FARWEI
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Hylant-Indianapolis Invoice # 130916
At HYLANT India North Meridian St,Ste 200 Dat
Indianapolis,IN 46290
P-(800)678-0361 11/22/2016 1/1/2017
hylant.com F-(317)817-5151 1nStrtsd
City of Carmel
A"!*ftditr Aixiount DU*
CARMELO-02 $97,024.95
City of Carmel
Attn: Steve Engelking
One Civic Square cyf G�
Carmel,IN 46032 302—
Please
p2—Please Retum Top with Remittance To: PO Box 638720,Cincinnati,OH 45263-8720
Trans Eff Date Due Date Trans Description Amount
Crime Policy# 105696360 Effective: 111117 - 1/1/18
Issuing Company Travelers Casualty&Surety Co _ �J
'S 964289 1/1/2017 1/1/2017 RENB 17/18 Identity Fraud C� i =1W-00,)
Workers Compensation-Excess Policy# EWC008873 Effective: 111117 - 111/18
y, Issuing Company Midwest Employers Casualty Co
964312 1/1/2017 1/1/2017 RENB 17/18 Excess Work Comp Layer 52,617.00
Third Party Administrator-Commercial Policy# 6268 Effective: 1/1/17 - 111118
Issuing Company Midwest Employers Casualty Co a Z
964359 1/1/2017 1/1/2017 RENB 17/18 TPA Admin Service Fee 10,500.00
Agency Fee-Commercial Policy# WC RISK MGMT FEE Effective: 1/1117 - 111/18
Issuing Company Hylant Group Fees
964290 1/1/2017 1/1/2017 RENB 17/18 Hylant Risk Management Fee 10,000.00
Workers'Compensation Policy# BLO4659054 Effective: 1/1/17 - 1/1/18
1� Issuing Company Great American E&S Ins Co
964314 1/1/2017 1/1/2017 RENB 17/18 Occupational Accident Buffer Layer 21,038.00
964315 1/1/2017 1/1/2017 GTAX Surplus Lines Tax 525.95
p,
/A HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290
11/22/2016 City of Carmel Loan# Invoice#130916 FARWEI
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Hylant-Indianapolis Invoice # 130916
I/i► HYLANT 290
10401 North Meridian St,Ste 200 Date Balance Due On
Indianapolis,IN 46
P-(800)678-0361 11/22/2016 1/1/2017
hylant.com F-(317)817-5151 Insured
City of Carmel
Account Number Amount Due
CARMELO-02 $193,587.00
City of Carmel
CRC DEPARTMENTS
One Civic Square y
Carmel,IN 46032 `7
Please Return Top with Remittance To: PO Box 638720,Cincinnati,OH 45263-8720
Item# Trans Eff Date Due Date Trans Description Amount
Package-Commercial Policy# 630581M4076 Effective: 1/1/17 - 111/18
Issuing Company Travelers Prop Cas Co of Amer
964285 1/1/2017 1/1/2017 RENB 17/18 Property Package 147,495.00
Umbrella-Commercial Excess Policy# 5111007800 Effective: 111/17 - 1/1118
Issuing Company National Casualty Company
964288 1/1/2017 1/1/2017 RENB 17/18 Umbrella/Excess Liability 15,412.00
Business Auto Policy# 8103036P64A Effective: 111117 - 1/1/18
Issuing Company Charter Oak Fire Insurance Co
964287 1/1/2017 1/1/2017 RENB 17/18 Auto&Garagekeepers 0.00
Package-Commercial Policy# ZLP14T62033 Effective: 111117 - 1/1/18
Issuing Company Charter Oak Fire Insurance Co
964286 1/1/2017 1/1/2017 RENB 17/18 Liability Package 30,680.00
Invoice Total 193,587.00
Detailed Allocation
PACKAGE LMBLJTYPACKAGE
Depminerd ProperWCrkm Inland Marine GL Liquor Law Enf Pubile Mgmt EPL Au1rt Umbrella
CRC
4CDC $ 8,425.00 $ $ 2,105.00 $ $ $ 230.00 S 825.00 $ $ 1,525.00
CGDC $ 8,358.00 S $ 2,105.00 $ $ $ 230.00 S 825.00 $ $ 1,525.00
CRA S 95,200.00 $ S 7,820.00 S $ $ 960.00 $ 3,400.00 S $ 6,181.00
CRC S 34,862.00 $ 650.00 $ 7,820.00 S S S 960.00 $ 3,400.00 S $ 6,181.00
CRC Total $ 146,845.08 $ 650.88 $ 19,850.00 $ - $ $ 2,380.88 S 8,460.00 $ - $ 15,412.00
A►HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290
11/22/2016 City of Carmel Loan# Invoice#130916 FARWEI
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Hylant-Indianapolis Invoice# 130916
04 HYLANT 10401 North Meridian St,Ste 200 Date Balance Due O„
Indianapolis,IN 46290
P-(800)678-0361 11/22/2016 1/112017
hylant.com F-(317)817-5151 Insured
City of Carmel
Account Number Amount Due
CARMELO-02 $97,024.95
City of Carmel
Attn: Steve Engelking 1 v 5 yds 23Ud
`r7'
One Civic Square
Carmel,IN 46032 3 0 2-- �
Please Return Top with Remittance To: PO Box 638720,Cincinnati,OH 45263-8720
Rom# Tram Eff Date Due Date Trans Description Amount
Crime Policy# 105696360 Effective: 111117 - 111/18
Issuing Company Travelers Casualty&Surety Co
)" 55 964289 1/1/2017 1/1/2017 RENB 17/18 Identity Fraud �� �7'� 2,344.00
Workers Compensation-Excess Policy# EW 00 873 Effective: 111/17 - 111/18
�t Issuing Company Midwest Employers Casualty Co
964312 1/1/2017 1/1/2017 RENB 17/18 Excess Work Comp Layer 52,617.00
Third Party Administrator-Commercial Policy# 6268 Effective: 111117 - 1/1118
Issuing Company Midwest Employers Casualty Co 30 Z
964359 1/1/2017 1/1/2017 RENB 17/18 TPA Admin Service Fee 10,500.00
j Agency Fee-Commercial Policy# WC RISK MGMT FEE Effective: 111/17 - 111/18
Issuing Company Hylant Group Fees
964290 1/1/2017 1/1/2017 RENB 17/18 Hylant Risk Management Fee 10,000.00
Workers'Compensation Policy# BLO4659064 Effective: 1/1/17 - 111/18
Issuing Company Great American E&S Ins Co
964314 1/1/2017 1/1/2017 RENB 17/18 Occupational Accident Buffer Layer 21,038.00
964315 1/1/2017 1/1/2017 GTAX Surplus Lines Tax 525.95
A/HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290
11/22/2016 City of Carmel Loan# Invoice#130916 FARWEI