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309111 03/07/17 CITY OF CARMEL, INDIANA VENDOR: 362876 (9) ONE CIVIC SQUARE TRAVELERS CHECKAMOUNT: S""`6,746.44` CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 309111 CHICAGO IL 60693 CHECK DATE: 03/07/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 000517030 7,148.23 GENERAL INSURANCE 1205 4347500 000517031 -401.79 GENERAL INSURANCE nQ -u 0 n w $ « \ � > m \ 7 \ 0 R q m m \ Oe e \ m 0 0 2 D C o n \ \ 0 ® k A § CDk # k o # - f 2 _0 k z } � § � § ƒ / k � m / 0 e ) e ) CLq J O m / E E 0 > 7 > C ® m 2 9 2 7 6q > O m k § 3 CD K) Q z W 3 ® 6 ) $ 2 7 - 2 R e K g E y ( ) § % i 2 7 § K 2 ] ° \k r A \ CD § 2 f f 2 a ° [ - A I Cl. k � 0 � CD } § ) ƒ -4i E 2 0 o 4 / \ \ \ CL f 7 � 7 § \ E ; kƒ � K i3 q o i = 7 /ƒ 3 � § k \ ) k \ I D / �® 0 \ 0 7 § k 8 8 � a m 0 03 a 7 G G § Q E ] O k ƒCDk j e j 2 k ƒ C OR R g § e # % Z > m0 CD } ) N) %E k k Cf)cr g | �/ / \/ r (D )o } o a E a� + q f § \ \ � M / ( � O % { G Q o m § r O £ ¥ % ] i E (D C CD / § § a \ p d k 2 2. CD � M \ CA k CD CL CD it } © D ° & z § } CD \ 4, \ < OD E ° 9 k ® k TRAVELERS PAGE , DEDUCTIBLE / SELF- INSURED INVOICE 303GP64A-810 521GX7087 02/28/2017 000517031 DO NOT PAY 401 .79- MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL,CARMEL CLAY 13607 COLLECTIONS CENTER DRIVE ONE CIVIC SQUARE CHICAGO, IL 60693 CARMEL IN 46032 TRAVELERS PAGE , THIS ACCOUNT HAS A CREDIT BALANCE. PLEASE CONTACT THE ACCOUNTING SPECIALIST LISTED BELOW. 111c1que IN 303GP64A-810 521GX7087 02/28/2017 000517031 DO NOT PAY 401 .79- 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- TOTAL CLAIMS) DUE $401.79- ACCOUNT SUMMARY CURRENT CHARGES 401 .79- 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 401.79- DISPUTED ITEMS 0.00 ACCOUNT BALANCE 401 .79- 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 MAR 0 12017 Clerk Treasurer TRAVELERS J� PAGE , DEDUCTIBLE / SELF- INSURED INVOICE 14TG2033-ZLP 5216X7087 02/28/2017 000517030 03/15/2017 7, 148.23 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 , lilliT11:14 Al 14TG2033-ZLP 521GX7087 02/28/2017 000517030 03/15/2017 7, 148.23 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 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 7, 117.43 CLAIM TOTAL 7,117.43 TOTAL CLAIM(S) DUE $7, 148.23