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Home My WebLink About308279 02/13/17 CITY OF CARMEL, INDIANA VENDOR: 362876 1. ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $****22,293.00* CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 308279 9�, o CHICAGO IL 60693 CHECK DATE: 02/13/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 000515545 10,363.65 GENERAL INSURANCE 1205 4347500 000515546 11,929.35 GENERAL INSURANCE VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 362876 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER TRAVELERS IN SUM OF$ CITY OF CARMEL 13607 COLLECTIONS CENTER DRIVE An invoice or bill to be properly itemized must show:kind of service,when:performed,dates service rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. CHICAGO, IL 60693 Payee $22,293.00 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 000515546 43-475.00 $11,929.35 1 hereby certify that the attached invoice(s),or 1/31/17 000515546 $11,929.35 1205 101 1205 101 000515545 43-475.00 $10,363.65 bill(s)is(are)true and correct and that the 1/31/17 000515545 $10,363.65 1205 101 materials or services itemized thereon for 1205 101 which charge is made were ordered and received except Tuesday, February 07,2017 Lamb, Barbara Director 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 DEDUCTIBLE / SELF- INSURED INVOICE ITJ nowrlyrIgHm 3036P64A-810 5216X7087 01/31/2017 000515545 02/15/2017 10,363.65 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 3036PG4A-810 521GX7087 01/31/2017 000515545 02/15/2017 10,363.65 CURRENT CHARGES CLAIM#: E3Q9166 DATE OF LOSS: 08/07/2016 DESCRIPTION: BAUT C - MILLER, MICHAEL IV AND OV WAS PASSING ON W 136TH ST WHEN THEI CLAIMANT: MICHAEL H MILLER LOSS 401 .79 CLAIM TOTAL 401.79 CLAIM#: EBRO954 DATE OF LOSS: 10/01/2016 DESCRIPTION: BAUT C - GREAVES, DANIEL IV WAS BACKING IN A DRIVEWAY AND DRIVER BACKE CLAIMANT: DANIEL GREAVES LOSS 38. 14- CLAIM TOTAL 38.14- CLAIM#: EOR3309 DATE OF LOSS: 12/22/2016 DESCRIPTION: IN THREE LANE ROAD, IV IN MIDDLE LANE, OV IN LEFT LANE, IV MADE A SUDD CLAIMANT: STEVEN STOESZ LOSS 10,000.00 CLAIM TOTAL 10,000.00 TOTAL CLAIM(S) DUE $10,363.65 Submitted To FEB.0 7 2017 Clerk TreaSurer TRAVELERS, PAGE 2 DEDUCTIBLE / SELF-INSURED INVOICE 303GP64A-810 521GX7087 01/31/2017 000515545 02/15/2017 10,363.65 ACCOUNT SUMMARY CURRENT CHARGES 10,363.65 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 10,363.65 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 10 363.65 _------------------------------------------ CONTACT ------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 , DEDUCTIBLE / SELF- INSURED INVOICE 14TG2033-ZLP 521GX7087 01/31/2017 000515546 02/15/2017 11 ,929.35 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL 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 , AIT1141301 NERTIMMIM 14T62033-ZLP 5216X7087 01/31/2017 000515546 02/15/2017 11,929.35 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 4,596.25 CLAIM TOTAL 4,596.25 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#: E7D0640 DATE OF LOSS: 06/03/2014 DESCRIPTION: PLAINTIFF IS ALLEGING THAT THE CARMEL PD UNLAWFULLY PULLED HIM OVER AN CLAIMANT: JASON MARAMAN EXPENSE 7,348.50 CLAIM TOTAL 7,348.50 TOTAL CLAIMS) DUE $11,975.55 Submitted To FEB_0 7 2017 Clerk Treasurer TRAVELERS PAGE 2 DEDUCTIBLE / SELF- INSURED INVOICE • i14 IWMO 0]IT11:1 twAglilillilki 14TG2033-ZLP 521GX7087 01/31/2017 000515546 02/15/2017 11,929.35 ACCOUNT SUMMARY CURRENT CHARGES 11,975.55 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 46.20- AGENT PHONE: (317) 817-5000 TOTAL DUE 11,929.35 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 11 929.35 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