HomeMy WebLinkAbout313809 07/18/17 Cqq
<1�. "f. CITY OF CARMEL, INDIANA VENDOR: 00352999
ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: S""`10,523.00'
�3 _� CARMEL, INDIANA 46032 PO BOX 638720 CHECK NUMBER: 313809
�y CINCINNATI OH 45263-8720 CHECK DATE: 07/18/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 151379 10,423.00 GENERAL INSURANCE
1801 4347500 151973 100.00 GENERAL INSURANCE
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Hylant-Indianapolis Invoice # 151973
OAP HYLANT India North Meridian St,Ste 200 Date Balance Due On
Indianapolis,IN 46290
P-(800)678-0361 7/5/2017 7/14/2017
hylant.com F-(317)817-5151 Insured
Carmel Redevelopment Commission
Account Number Amount Due
CARMRED-01 $100.00
Carmel Redevelopment Commission
Attn: Michael Lee
30 West Main St.Ste.220
Carmel,IN 46032
Please Return Top with Remittance To: PO Box 638720,Cincinnati,OH 45263-8720
Item# Trans Eff Date Due Date Trans Description Amount
Bond-Public Official(Specify) Policy# 106157029 Effective: 6/10/17 - 6/10/18
Issuing Company Travelers Casualty&Surety Co
1148146 6/10/2017 7/14/2017 RENB 17/18 POB William Brooks 100.00
Total Invoice Balance: $100.00
*HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290
7/5/2017 Carmel Redevelopment Commission Loan# Invoice#151973 FARWEI Page 1 o
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Please Return Top with Remittance To: PO Box 638720,Cincinnati,OH 45263-8720
kern# Trans Eff tato Due Date Trans Description Amount
Workers Compensation-Excess Policy# EWC008873 Effective: 1/1/16 - 1/1/17
Issuing Company Midwest Employers Casualty Co
1146251 1/1/2016 7/10/2017 AUDI 16/17 Excess Work Comp Audit 10,423.00
Total Invoice Balance: $10,423.00
Sobm ¢ted To
JUL 1 12017
C1erk Treasurer
A HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290
6/30/2017 City of Carmel Loan# Invoice#151379 FARWEI Page 1 of 1
Midwest Employers Casualty Company
Audit Statement
Insured: City of Carmel
Policy No. EWC008873
Policy Term: 01/01/2015.to 01/01/2017
Audit Period: 01/01/201.6 - 01/01/20-17
State Code Classification Audited Rate per Audited
Payroll 5100 of Premlurri
Payroll
IN 5506 -STREET OR ROAD CONSTRUCTION $2,990,363 5..42 $162,078
IN 7520 WATERWORKS OPERATION 53,186,664 2.80 589,227
IN 7$80 .SEWAGE DISPOSAL PLANT OPER $1,995.;37.6 2.45 $48,887
IN 7699 FIREFIGHTERS&DRIVERS $13,965,604 2.42 $337,968.
IN 772.0 POLICE OFFICERS&DRIVERS $0. 2.57 :SO
IN 7725 POLICE OFFICERS-MEDICAL ONLY 59,2461398 2.04 $188,627
IN 8742 SALESPERSONS $506,430 .32 $1,621
IN 8810 CLERICAL OFFICE OR LIBRARIES 559832,450 .19 $11,082
IN 8820 ATTORNEY $424,796 .13 $5$2.
IN 8869 CHILD.DAYCARE CENTER-PROF/CLER $2,024,701 1,14 $23,082
IN .9060 CLUBS- COUNTRY GOLFIFISHING $449,769. 1:39 $6,82.
IN 91:02. PARK-7ALL EMPLOYEES& DRIVERS S3.,801,828 2.84 $107;972
IN 9410 'MUNICIPAL EMPLOYEE NOC. $2,813,804 2.86 $80,475.
Total Payroll: $47,238,183
Total.Audited Premium: $1,057,823
(a) Experience Modification Factor: 1..000000000
(b) Other Modificaddh Factor: 1:000000000.
Audited Normal Premlum: $1,057;823
Rate.as a Percentage of Normal Premium Multiplied.By. 5.57%.
Earned Premium: 3.58,921
AUD_ONE-2 Page i of 1 Date Printed: 06/26/2017
Midwest EMployers Casualty Company
Audit Statement
.Insured: City of Carmel
Policy No.: EWC008873
Pbll�cyT.-erft 01./0112015 to 01/01.1.2017
..Au*dft Period: 01/01/2015- 0-1/011/20.116
State Code Classification Audited ted Rate pet Audited
Payroll $160 of Premium
Payroll
IN 5506 STREET OR ROAD CONSTRUCTION $2,850,15.5 5.42 $154,511
IN 7520 WATERWORKS OPERATION 52j267,104. 2.80 $61,799
IN 7580' SEWAGE DISPOSAL PLANT OPER $2,782,720 2.45 $68,177
IN 7699 FIREFIGHTERS.&DRIVERS $1.3,142i152 2.4.2 $318,040
IN 7720 POLICE-OFFICERS&DRIVERS $298,017 2.57 $7,682
IN 7725 P01JCE OFFICERS-MEDICAL ONLY $80968,904 2.04 $182;.966
IN 8380 AUTO SERVICE OIL REPAIR CENTER $245,289 2.38 $5,838
IN 8742 SALESPERSONS $o .32 $o
IN 8810 CLERICAL OFFICE-011 LIBRARIES $6,140,409- .19 $11,667
IN 8820 ATTORNEY $274,849 .13 $357
IN 8869. -CHILD DAYCARE CENTER7PROF/CLER $2,121,115 1.14 524,1-81
IN 9015 BUILDINGS $178'961 3630 $5,906
IN 906.0. -CLUBS- COUNTRY.GOLFIFISHING $4300623 1.39 $5,98.6
IN 9102 PARK-ALL.EMPLOYEES&-DRIVERS 43,283-937 2:.84 $93,264
IN 0410 MUNICIPAL.EMPLOYEE NOC $1,728,479 2.96 $49,434
Total Payroll: $44,654,214:
Total Audited Premium: $989,800
(a). Experiefice Modification Factor: 1.000000000
(b) Other Modification Factor: 1.000000000
Audited Normal Premium: 5989,808
Rate as a Percentage'of Normal Premium-Multiplied By:' 5.57%
Earned Premium: $55,132
AUD-ONE-2 Page I of 1 Date Printed: 66/.2.6/2017
Wd west Employers Casualty Company
Audit Statement
.insured: City. of Carmel'
Policy No:: F-WCO088-73
Policy Tetrn` 01/01/2.015 to 01101/2.01.7-
SUMMARY of BOTH YEARS
Earned Flat Total
Audit Period Premium Charges Premium
01/01/2615 to 01[01/201-6 $55,132 $-0. $55.1.32
01/0.11201..6 to '01/61/2017 $.54,9.21 $0 -$58.,921
Total Earned Premium $1.14.0.53 $0 $114,053
Less Ptemium Collected $103.,'6-30
Additional (.Return)Ptimium.Due $10,42.3
AUD-S-IJIVI-2 Page 1 of 1 Date Printed: 06/2.6/201.7