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312743 06/16/17 ��u ��'"f• CITY OF CARMEL, INDIANA VENDOR: 362876 a: 9 t: ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $■k k k M 5,643.33" rq CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 312743 +.y. CHICAGO IL 60693 CHECK DATE: 06/16/17 Brox�O DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 000521495 7,907.43 GENERAL INSURANCE 1205 4347500 000521496 -2,264.10 GENERAL INSURANCE 0 n w < « S m O I $ q O \ \ * 2 0 q« o C > Q n r # ? c $ _ _ q / r, k% m $ k j \ : k q _ \ O n § e @ ® © O E � m @ O 2 -n 7 ® � m \ ) t -n > k m / £ . § $ § J E 4 7 Q X § 0 0 # m X m k ° ° < k \ k 2 f q > O \ § o 0 O 7 CD 4 c X | o r $ , / $ $ [ f I / § ` m = o % i = :3. / ƒ § m ° a \ ƒ n 0 0 CD CD CD ' r ) 2 � f 2 7 CD 7 9 $ C- + » C — co E ) ( § \ ° + N m ; o R 2 I » § % R § / 7 w % 2 E g 7 7 'R ƒ U CD / f ; i£ m a o o f e Cl) m z , Y) 4 \ j m \ PD k m ƒ$ 47 k D A ) \ E ) \ \ , \ § % k k k k e k 2 k ƒ C o ° 0 § $ # # 2 z 10 /a �k \� \ CD T �ƒ a g - m §o K a E 0 D �E ; q D co ƒ e r / -5 / \ 0 0 0) CD ` ] \ / k / ƒ C C R � � / k ° o \ -CD /CD 0 $ n a CD M 7 ) CD \ } . aCD w CL \ f \ 7 2 f o e § / ® A At W_ �1� � TRAVELERS J PAGE , DEDUCTIBLE / SELF- INSURED INVOICE i 3036P64A-810 521GX7087 05/31/2017 000521495 06/15/2017 7,907.43 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 POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTM PL15- 3036P64A-810 521GX7087 05/31/2017 000521495 06/15/2017 7,907.43 CURRENT CHARGES CLAIM#: EGR0401 DATE OF LOSS: 09/12/2016 DESCRIPTION: OV1 CAME TO STOP, OV2 R/E OV1 , IV THEN R/E OV2 CLAIMANT: AARON CAMPBELL LOSS 3,410.08 CLAIM TOTAL 3,410.08 CLAIM#: ESR2587 DATE OF LOSS: 01/28/2015 DESCRIPTION: BAUT POLICE VEHICLE WAS STOPPED IN LANE - GTGT ANOTHER OFFICER WITH CLAIMANT: DANNY N DENT Submitted To LOSS 5,000.00 JUN 13 2017 CLAIM TOTAL 5,000.00 TOTAL CLAIMS) DUE Clerk Treasurer 1 $8,410.08 ACCOUNT SUMMARY CURRENT CHARGES 8,410.08 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 502.65- AGENT PHONE: (317) 817-5000 TOTAL DUE 7,907.43 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 7,907.43 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 GRUSSOPTRAVELERS.COM AM / TRAVELERS J ,,�� PAGE 1 DEDUCTIBLE / SELF- INSURED INVOICE i llME 1=3 1112 14TG2033-ZLP 5216X7087 05/31/2017 000521496 DO NOT PAY 2,264. 10- MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL 13607 COLLECTIONS CENTER DRIVE ONE CIVIC SQUARE CHICAGO, IL 60693 CARMEL IN 46032 TRAVELERS PAGE 1 THIS ACCOUNT HAS A CREDIT BALANCE. PLEASE CONTACT THE ACCOUNTING SPECIALIST LISTED BELOW. 14TG2033-ZLP 5216X7087 05/31/2017 000521496 DO NOT PAY 2,264. 10- CURRENT CHARGES 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 7.30 CLAIM TOTAL 7.30 CLAIM#: EST3205 DATE OF LOSS: 01/30/2017 DESCRIPTION: COMPLAINT ALLEGES A PATTER ON RACKETEER Mn ArTT AND HATE CRIMES BY CLAIMANT: CAROLYN W HERZ Submitted To EXPENSE 1,643.00 JUN 13 2017 CLAIM TOTAL 1,643.00 TOTAL CLAIMS) DUE Clerk Treasurer $1,650.30 ACCOUNT SUMMARY CURRENT CHARGES 1,650.30 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 3,914.40- AGENT PHONE: (317) 817-5000 TOTAL DUE 2,264.10- DISPUTED ITEMS 0.00 ACCOUNT BALANCE 2,264. 10- 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 GROSSO@TRAVELERS.COM