317697 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
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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