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Home My WebLink About317697 10/19/17 CITY OF CARMEL, INDIANA VENDOR: 362876 ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $*****3,300.31* *1 ?Q; CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 317697 ' CHICAGO IL 60693 CHECK DATE: 10/19/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 000526009 -3,859.02 GENERAL INSURANCE 1205 4347500 000526663 5,861.14 GENERAL INSURANCE 1205 4347500 000527509 1,298.19 GENERAL INSURANCE 0 ? w < « \ \ \ > -40 7 0 S q m ® m :3 0 m ® k $ / / \ \ CD Z k 0 / ) ) ) k # k CA. _ W c # - a CL -0 / 3 \ m � X D E \ e ) e ) � \ O m 2 )8 8 8 o CL m z 0 0 ( z < 7 > -n 0 � OD 0 \ § Ln 0 z | 6 } a & 2 9 — z > _ $ 0 ( / « ? CD § CL $ cu K CD 0) a n -n o § & Q / 7 i - E } — m / f k 2 ) 0 0 ( I E a E f k a \ qCD 9 \ 0 An § @ ` / E § I \ 0)CD CL / \ 2 E § ƒ f CD CPO 0 CY k Z � 2 # 7 # 7 q o i f ƒ \ \ \ \j ) k P { \/ cr � 0 \ 0 E 0 8 8 8 -n < a m 0 co 8 \ AkeGeG § g $ /] §GQ, 2 q J% ) i ] § / 0>; = wo E f< \ } § \7a & 0 > / ( 9/ / o a 7 � > �� gq 0 \ n ? 0 0 U / ¥ ¥_ ƒ C 2CD m CD R w CL M / CO) G m X ] # EF 0 pC % 5 00 0 . ƒ / 7 (nz @ # f ® o TRAVELERS J PAGE 1 THIS ACCOUNT HAS A CREDIT BALANCE. PLEASE CONTACT THE ACCOUNTING SPECIALIST LISTED BELOW. iPOLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE 3036P64A-810 521GX7087 08/31/2017 000526009 DO NOT PAY 3,859.02- CURRENT CHARGES CLAIM#: E6R2587 DATE OF LOSS: 01/28/2015 DESCRIPTION: BAUT POLICE VEHICLE WAS STOPPED IN LANE TO ASSIST ANOTHER OFFICER WITH CLAIMANT: DANNY N DENT LOSS 5,000.00- CLAIM TOTAL 5,000.00- CLAIM#: ESR8421 DATE OF LOSS: 06/02/2017 DESCRIPTION: BAUT SAFETY 304 WAS ON AN EMERGENCY RUN WITH ALL LIGHTS AND SIRENS CLAIMANT: JOHN MITCHELL LOSS 269. 17 CLAIM TOTAL 269.17 PAST DUE CHARGES CLAIM#: ESR9565 DATE OF LOSS: 07/04/2017 DESCRIPTION: BAUTC- WATSON, JERRY IV REAR ENDED OV. CLAIMANT: JERRY WATSON LOSS 871 .81 CLAIM TOTAL 871.81 TOTAL CLAIMS) DUE Submit-ted To To OCT 17 2017 Clerk Treasurer TRAVELERS PAGE 2 DEDUCTIBLE / SELF- INSURED INVOICE POUCYRIUMBER ACCOUNT : TOTAL OUtl 303GP64A-810 5216X7087 08/31/2017 000526009 DO NOT PAY 3,859.02- ACCOUNT SUMMARY CURRENT CHARGES 4,730.83- INSURED NAME: CITY OF CARMEL,CARMEL CLAY PAST DUE CHARGES 871 .81 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 3,859.02- DISPUTED ITEMS 0.00 ACCOUNT BALANCE 3,859.02- 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 TRAVELERS J� PAGE 1 THIS ACCOUNT IS SCHEDULED TO GO TO A COLLECTION AGENCY AS A RESULT OF UNPAID CHARGES. PLEASE REMIT PAYMENT IMMEDIATELY. 711 - 14TG2033-ZLP 521GX7087 08/31/2017 000526663 UPON RECEIPT 5,861 . 14 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 77.00 CLAIM TOTAL 77.00 CLAIM#: E7C4309 DATE OF LOSS: 06/16/2017 DESCRIPTION: RAYAN,RICHARD TORT NOTICE ALLEGING THERE WAS AN OBSTRUCTION INTHE ROAD CLAIMANT: RICHARD RYAN LOSS 285.30 CLAIM TOTAL 285.30 CLAIM#: E7C5119 DATE OF LOSS: 07/19/2017 DESCRIPTION: GLIA C - BELL, DARRYL EMPLOYEE TIM BROWNING DRIVING A BACK HOE AT THE CLAIMANT: DARRYL BELL LOSS 502.29 CLAIM TOTAL 502.29 CLAIM#: E9T3205 DATE OF LOSS: 01/30/2017 DESCRIPTION: COMPLAINT ALLEGES A PATTER ON RACKETEERING ACTIVITY AND HATE CRIMES BY CLAIMANT: CAROLYN W HERZ r�. Submitted a o EXPENSE 372.00 CLAIM TOTAL 372.00 OCT 17 2017 Clerk Treasurer TRAVEL.ERSJ PAGE 2 DEDUCTIBLE / SELF-INSURED INVOICE IPOLICY NUMBER ACCOUNT : TOTAL OUE 14TG2033-ZLP 5216X7087 08/31/2017 000526663 UPON RECEIPT 5,861 . 14 PAST DUE 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 4, 162.55 CLAIM TOTAL 4,162.55 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 462.00 CLAIM TOTAL 462.00 TOTAL CLAIM(S) DUE $5,861.14 ACCOUNT SUMMARY CURRENT CHARGES 1,236.59 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 4,624.55 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 5,861.14 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 5,861 . 14 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 TRAVELERS) PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. POLICY NUMBER ACCOUNT NUMBER BILL DATE 14TG2033-ZLP 5216X7087 09/29/2017 000527509 10/15/2017 1,298. 19 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 61 .60 CLAIM TOTAL 61.60 PAST DUE 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 77.00 CLAIM TOTAL 77.00 CLAIM#: E7C4309 DATE OF LOSS: 06/16/2017 DESCRIPTION: RAYAN,RICHARD TORT NOTICE ALLEGING THERE WAS AN OBSTRUCTION INTHE ROAD CLAIMANT: RICHARD RYAN LOSS 285.30 CLAIM TOTAL 285.30 CLAIM#: E7C5119 DATE OF LOSS: 07/19/2017 DESCRIPTION: GLIA C - BELL, DARRYL EMPLOYEE TIM BROWNING -RIVING-A BACK HOE AT THE CLAIMANT: DARRYL BELL Submitted To LOSS 502.29 OCT 17 2017 CLAIM TOTAL 502.29 Clerk Treasurer TRAVELERS JM PAGE 2 DEDUCTIBLE / SELF- INSURED INVOICE i111 iTil: T 14TG2033-ZLP 5216X7087 09/29/2017 000527509 10/15/2017 1,298. 19 PAST DUE CHARGES CONTINUED CLAIM#: E9T3205 DATE OF LOSS: 01/30/2017 DESCRIPTION: COMPLAINT ALLEGES A PATTER ON RACKETEERING ACTIVITY AND HATE CRIMES BY CLAIMANT: CAROLYN W HERZ EXPENSE 372.00 CLAIM TOTAL 372.00 TOTAL CLAIM(S) DUE $1,298.19 ACCOUNT SUMMARY CURRENT CHARGES 61 .60 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 1 ,236.59 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 1.298.19 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 1 ,298. 19 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