The URL can be used to link to this page

Home My WebLink About311750 05/30/17 4�''''� CITY OF CARMEL, INDIANA VENDOR: 00352999 ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $**.....540.00* ? r CARMEL, INDIANA 46032 PO BOX 638720 CHECK NUMBER: 311750 'M,i�eN�. CINCINNATI OH 45263-8720 CHECK DATE: 05/30/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 147418 540.00 GENERAL INSURANCE og -u I < « , m 0 2 O « §O A § � 2 2 co kCL ° o } ^ / x a # 2 / q q k % E m ' ® O w 2 $ { \ c CD ? o % 2 O t e m & 2 co m k O-n 7 k 7 C % 6 3 o , / 3 / { k $ � \ @ ;um $ 2 2 ? 2 g > O CD j \ § z ° ® / a g E z > LD 0 1W\ k 0 / v \K \ [ J 0 a ; k q r k C d 3 f 2 / J r I + - C 0) 3 ) J " m n m / o E R = J ƒ 7 [ E : / 0 \ CL § k I § ° ' % \ E ; k I e M o C 7 § # -0 \ 0. 2 \� ° - ® k 3G CD \ 0 -4 Z � \ Q ( g� � k0 ) 2 C 20 m 0 f ƒ / o %E g % § /0. 0 > �ƒ (D / \ §0 ) 0 CL 7 6E g3 -cobC > 4 } § M � _ / j � r / ¥ ƒ % ] i CD{ C % \ G � / } n B � k 2 � M C: § m 7 \ § CD 7 2 p } k k \ \ m P § � ® k Hylant-Indianapolis Invoice # 147418 04 HYLANT India North Meridian St,Ste 200 Indianapolis,IN 46290 P-(800)678-0361 5/12/2017 5/27/2017 hylant.com F-(317)817-5151 kisiltred City of Carmel ACCfllilllt NWkIbAr, �NI!tl►iN1t CARMELO-02 $540.00 City of Carmel Attn: Steve Engelking One Civic Square Carmel, IN 46032 Please Return Top with Remittance To: PO Box 638720,Cincinnati,OH 45263-8720 Item# Tmw Eff Oafs Due Daft Trans Description Amount Package-Commercial Policy# 630581 M4076 Effective: 1/1/17 - 1/1/18 Issuing Company Travelers Prop Cas Co of Amer 1106675 2/3/2017 5/27/2017 ENDT Add Eagle Air Breathing Air Trailer 540.00 Total Invoice Balance: $540.00 Submitted To MAY 0 9 2017 Clerk Treasurer A)HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290 5/12/2017 City of Carmel Loan# Invoice#147418 FARWE1 Page 1 of 1 CHANGE EFFECTIVE DATE:02-03-17 CHANGE ENDORSEMENT NUMBER:0006 TRAVELERS One Tower Square, Hartford,Connecticut 06183 CHANGE ENDORSEMENT Named Insured: CITY OF CARMEL Policy Number: H-630-581144076-TIL-17 Policy Effective Date: 01/01/17 Issue Date: 05/02/17 Additional Premium $ 540 INSURING COMPANY: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA Effective from 02/03/17 at the time of day the policy becomes effective. THIS INSURANCE IS AMENDED AS FOLLOWS: THE COMMERCIAL INLAND MARINE COVERAGE PART IS AMENDED AS FOLLOWS: AMENDING CONTRACTORS EQUIPMENT AS FOLLOWS: AMENDING LISTED ITEMS LIMIT OF INSURANCE TO $2,941,061. AMENDING MAXIMUM AMOUNT OF PAYMENT LIMIT OF INSURANCE TO $3,191,061. AMENDING CM TO 28 08 96 - CONTRACTORS EQUIPMENT SCHEDULE AS PER ATTACHED. ***AMENDING CONTRACTORS EQUIPMENT SCHEDULE TO ADD: EAGLE AIR, INC, HARRIER BREATHING AIR TRAILER VEH ID#75307401 $83,352*** AMENDING CM T8 94 09 93 - LOSS PAYABLE PROVISIONS TO ADD THE FOLLOWING LOSS PAYEE(S) AS PER ATTACHED: (REGIONS CAPITAL ADVANTAGE, INC.) NAME AND ADDRESS OF AGENT OR BROKER: COUNTERSIGNED BY: HYLANT GROUP INC (G8433) 10401 N MERIDIAN ST STE 200 INDIANAPOLIS, IN 46280 Authorized Representative DATE: IL TO 07 09 87 PAGE 1 OF 1 OFFICE: SAN ANTONIO-EAST CHANGE EFFECTIVE DATE:02-03-17 CHANGE ENDORSEMENT NUMBER:0006 TRAVELERSJ� POLICY NUMBER: H-630-581M4076-TIL-17 EFFECTIVE DATE: 01-01-17 ISSUE DATE: 05-02-17 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS. IL TO 07 09 87 CHANGE ENDORSEMENT IL T8 01 10 93 FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS INLAND MARINE CM TO 28 08 96 IM PAR COV CONTRACTORS EQUIP SCHEDULE CM T8 94 09 93 LOSS PAYABLE PROVISIONS IL T8 01 10 93 PAGE: 1 OF 1 COMMERCIAL INLAND MARINE ......... .................. .................. .................. .................. ` ' COMMERCIAL INLAND MARINE TRAVELERS lOne Tower Square, Hartford,Connecticut 06183 IM PAK COVERAGE POLICY NUMBER:H-630-581M4076-TIL-17 "CONTRACTORS EQUIPMENT" ISSUE DATE: 05-02-17 SCHEDULE ITEM DESCRIPTION OF ITEMS LIMIT OF INSURANCE 001 LISTED ITEMS & LIMITS OF INSURANCE $ 2,941,061 SHOWN IN THE SCHEDULE ON FILE WITH US, RECEIVED 09/28/2016 002 LEASED OR RENTED ITEMS $250,000 PER ITEM TOTAL LIMIT OF INSURANCE FOR ALL LISTED ITEMS $ 2,941,061 CM TO 28 08 96 Page 1 (END) COMMERCIAL INLAND MARINE POLICY NUMBER: H-630-581144076-TIL-17 ISSUE DATE: 05-02-17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LOSS PAYABLE PROVISIONS This endorsement modifies insurance under the following: IM PAR COVERAGE FORM Loss Payable—For Covered Property in which both you and a Loss Payee shown in the Schedule or in the Declarations have an insurable interest,we will: 1. Adjust losses with you; and 2. Pay any claim for loss or damage jointly to you and the loss payee, as interest may appear. SCHEDULE Form or Endorsement No. Item No. , If any or Loss Payee Description of Property (Name and Address) SCHEDULED ITEMS MACALLISTER MACHINERY CO., INC. 7515 E. 30TH STREET INDIANAPOLIS IN 46219 CM T8 94 09 93 Page 1 of 1 COMMERCIAL INLAND MARINE POLICY NUMBER:H-630-581M4076-TIL-17 ISSUE DATE: 05-02-17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LOSS PAYABLE PROVISIONS This endorsement modifies insurance under the following: IM PAR COVERAGE FORM Loss Payable—For Covered Property in which both you and a Loss Payee shown in the Schedule or in the Declarations have an insurable interest,we will: 1. Adjust losses with you; and 2. Pay any claim for loss or damage jointly to you and the loss payee, as interest may appear. SCHEDULE Form or Endorsement No. Item No. , If any or Loss Payee Description of Property (Name and Address) EAGLE AIR, INC REGIONS CAPITAL ADVANTAGE, INC. HARRIER BREATHING AIR TRAILER VEH ID#75307401 COST NEW $83,352 1900 FIFTH AVENUE NORTH SUITE 2400 BIRMINGHAM AL 35203 CM T8 94 09 93 Page 1 of 1 CHANGE EFFECTIVE DATE:02-03-17 CHANGE ENDORSEMENT NUMBER:0006 OVERPRINT/CHANGE SLIP PAGE 1 OF 1 POLICY NUMBER: H-630-581M4076-TIL-17 RATER: AK3E ISSUE DATE: 05/02/17 MUNICIPALITIES GUAR COST EFFECTIVE DATE: 01/01/17 EXPIRATION DATE: 01/01/18 CHANGE EFFECTIVE DATE: 02/03/17 INSUREDS NAME: CITY OF CARMEL PRORATA FACTOR: 0.910 SHORT RATE FACTOR: 0.910 NEW/RENEWAL: R PAYMODE: P SOLICITOR CODE: AUDIT FREQUENCY: N SAI: 5216X7087 RESPONSIBILITY: H MSI: WATCH FILE: 0 RATING MODE: G SURVEY CODE: 2 SPECIAL CODE: REINSURANCE: N PROGRAM CODE: S4M AUTO FILINGS: FEDERAL TAX ID: PREMIUM SUMMARY ACCOUNT EFF. NON S.B. MONTH DATE PREMIUM PREMIUM TOTAL 0517 02/03/17 540.00 0.00 540.00 TOTAL: 540.00 0.00 540.00 OFFICE: SAN ANTONIO-EAST 24T PRODUCER NAME: HYLANT GROUP INC G8433 CHANGE EFFECTIVE DATE:02-03-17 CHANGE ENDORSEMENT NUMBER:0006 TRAVELERS PREMIUM SPLIT FORM PAGE 1 OF 1 POLICY NUMBER: H-630-581M4076-TIL-17 RATER: AK3E ISSUE DATE: 05/02/17 COMM ITEM COMM ITEM COMM ITEM COMM ITEM .1000 PREM ACCOUNT EFFECTIVE MONTH DATE PREMIUM PREMIUM PREMIUM PREMIUM 0517 02/03/17 540 OFFICE: SAN ANTONIO-EAST 24T PRODUCER NAME: HYLANT GROUP INC G8433