307420 01/20/17 .4a"`-��qMt
CITY OF CARMEL, INDIANA VENDOR: 362876
} CHECK AMOUNT: $********46.20*
' ONE CIVIC SQUARE TRAVELERS
ra; CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 307420
' .. CHICAGO IL 60693 CHECK DATE: 01/20/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000514060 46.20 GENERAL INSURANCE
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TRAVELERS PAGE ,
14T62033-ZLP 5216X7087 12/30/2016 000514060 01/15/2017 46.20
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 46.20
CLAIM TOTAL 46.20
TOTAL CLAIMS) DUE $46.20
ACCOUNT SUMMARY
CURRENT CHARGES 46.20 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 46.20
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 46.20
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
Submitted To
JAN 10 2011
Clerk Treasurer