The URL can be used to link to this page

310695 04/24/17 d C 1qM CITY OF CARMEL, INDIANA VENDOR: 362876 CHECK AMOUNT: S""""4,417.05' ONE CIVIC SQUARE TRAVELERS =Q CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 310695 CHICAGO IL 60693 CHECK DATE: 04/24/17 MroH io DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 000518521 502.65 GENERAL INSURANCE 1205 4347500 000518522 3,914.40 GENERAL INSURANCE n ? " w « « > m / 7 0 S q m m / q m / m 2 f ) ) / / R / \ E § § k A O e CD k -n (n k q ] 0 2 ) X O / @ § -4e -4 E \ O m CD 0& \ \ z 2 o z < 7 > - O Ul O C 0) / } CD | _ Ul w 6 J a $ 2 7 - 2 A < g E /? § ( E =g J § m CD 2 0 -n Q cm § CD - m } / f E E eC J § , $ E » i 7 K E k ! N § k R + _ � � m n m o E R = a / ƒ - E C? Z § _ w � § 2 [ [ 7 a E § , C g o / \ \ o \ -0 g: $ $ mtyj )\l ;§ ty {� 0 0 0 � o o f [ 0§ kQ ] Q§ CA t k e $ q ƒ C a ( 0 ~ � \ ( o f� \ \ \k / / - D , E \ ; -n � §/ ) c@ E 66 g � 2 t � § ]; M n C0) © ` IE k /2 \ ] i { 7 c + £ \ 0 / CD 0 m CD o \ } \ a M CD ] \ 9 / \ f Nri } CD Ln \ k < E CD � :N ® k TRAVELERS PAGE , DEDUCTIBLE / SELF- INSURED INVOICE . � , . 14TG2033-ZLP 521GX7087 03/31/2017 000518522 04/15/2017 3,914.40 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 , 14TG2033-ZLP 5216X7087 03/31/2017 000518522 04/15/2017 3,914.40 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 2,097.20 CLAIM TOTAL 2,097.20 CLAIM#: E4E8897 DATE OF LOSS: 12/29/2013 DESCRIPTION: GLIA C-REED, ANTHONY TORT NOTICE ALLEGING THAT HIS VEHICLE AND PERSONA CLAIMANT: ANTHONY W REED EXPENSE 1,817.20 CLAIM TOTAL 1,817.20 TOTAL CLAIMS) DUE $3,914.40 TRAVELERS PAGE , DEDUCTIBLE / SELF- INSURED INVOICE iiTill tWil4julli 303GP64A-810 521GX7087 03/31/2017 000518521 04/15/2017 502.65 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 , 3036P64A-810 5216X7087 03/31/2017 000518521 04/15/2017 502.65 CURRENT CHARGES CLAIM#: E3Q9166 DATE OF LOSS: 08/07/2016 DESCRIPTION: BAUT C - MILLER, MICHAEL IV AND OV WAS PASSING ON W 13GTH ST WHEN THEI CLAIMANT: MICHAEL H MILLER LOSS 502.65 CLAIM TOTAL 502.65 TOTAL CLAIM(S) DUE $502.65 ACCOUNT SUMMARY CURRENT CHARGES 502.65 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 502.65 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 502.65