319018 11/22/17 Cllq
CITY OF CARMEL, INDIANA VENDOR: 00352999
ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $...*""50.00'
CARMEL, INDIANA 46032 PO BOX 638720 CHECK NUMBER: 319018
o_roN CINCINNATI OH 45263-8720 CHECK DATE: 11/22/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER, AMOUNT DESCRIPTION
1701 4347500 149858 50.00 GENERAL INSURANCE
VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201 (Rev.1995)
vendor# 00352999 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
HYLANT GROUP IN SUM OF$ CITY OF CARMEL
PO BOX 638720 An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
CINCINNATI, OH 45263-8720
Payee
$50.00
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Clerk Treasurer Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
149858 43-475.00 $50.00 1 hereby certify that the attached invoice(s),or 11/16/17 149858 KAREN E.TAYLOR$5,000 E&0 NOTARY $50.00
1701 101 1701 101 BOND
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Friday, November 17,2017
Quinn,Jacob
Deputy Clerk of City Business
hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have
audited same in accordance with IC 5-11-10-1.6
20
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Bond-Notary Policy# 63237900N Effective: 111118 - 12/31/25
Issuing Company Western Surety Company
1131626 1/1/2018 1/1/2018 RENB Karen E.Taylor$5,000+$5,000 E&O 50.00
Total Invoice Balance: $50.00
hw, v\
4 HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290
6/13/2017 City of Carmel Loan# Invoice#149858 FARWE1 Page 1 of 1
Indiana
We A rn Surety Company A
A
n, NOTARIAL BOND
BOND No. 6323790ON
KNOW ALL MEN BY THESE PRESENTS,That we Karen E. Taylor
(Name of Applicant)
as principal (Applicant) and WESTERN SURETY COMPANY, of P. 0. Box 5077, Sioux Falls, SD
57117-5077, and Minnehaha County as corporate surety, are held and firmly bound unto the State of
Indiana, in the penal sum of Five Thousand and 00/100
DOLLARS(_$5,_9_Q_0a_00—------_), the payment of which,well and truly to be made, we bind ourselves,
our heirs, executors and administrators, firmly by these presents.
WITNESS our signatures as acknowledged below. THE CONDITION OF THE ABOVE OBLIGATION
IS AS FOLLOWS,TO-WIT:
WHEREAS, the above bound principal has applied for appointment by the Governor of the State of
Indiana as a Notary Public, in and for the State of Indiana, for an eight-year term.
Now, if the said principal shall truly and faithfully perform and discharge the duties of said office of
Notary Public, in all things according to law, then the above obligation to be null and void, otherwise to
remain in full force and virtue in law. The term of this bond is from the effective date of the principal's
commission to the expiration date of the same.
(Signature of Principal) WESTER3URETY COMPANY
By
Paul T.
Bruflat, Seor Vice President
June 13th, 2017
ti
tl
- Form 1090-8-2010
�
POLICY PE.RIOD:. This policy applies only to negligent acts, errors or omissions which occur durin ' the policy
'
OTHER INSURANCE: This insurance is excess over any other applicable insurance whether such insurance is
primary, excess, contributory, contingent, or otherwise and whether such insurance is collectible or not, unless such
other insurance is written to be specifically excess over the insurance provided by this policy.
INSURED'S DUTIES IN THE EVENT OF OCCURRENCE,CLAIM OR SUIT:
(a) Upon knowledge of any occurrence which may reasonably be expected to result in a claim or suit,written notice
containing particulars sufficient to identify the Insured and also reasonably obtainable information with respect
to the time, place and circumstances thereof, and the names and addresses of the potential claimant and of
available witnesses, shall be given by or for the Insured to the Company or any of its authorized agents as soon
as practicable,but in no event longer than forty-five(45)days after discovery.
(b) If claim is made or suit is brought against the Insured, the Insured shall immediately forward to the Company
every demand,notice,summons or other process received by it or its representative.
(c) The Insured shall cooperate with the Company and,upon the Company's request, assist in making settlements,
in the conduct of suits and in enforcing any right of contribution or indemnity against any person or
organization who may be liable to the Insured for acts, errors or omissions with respect to which insurance is
afforded under this policy; and the Insured shall attend hearings and trials and assist in securing and giving
evidence and obtaining the attendance of witnesses. The Insured shall not, except at his own cost, voluntarily
make any payment, admit any liability, assume any obligation or incur any expense except with. the prior
written consent of the Company.
. SUBROGATION: In the event of any payment for any loss under this insurance, the Company shall be subrogated
to all of the Insured's rights of recovery thereafter against any person or organization and the Insured shall execute and
deliver instruments and papers and do whatever else is necessary to secure such rights to the Company. The Insured
shall do nothing after loss to prejudice such rights.
ASSIGNMENT: This policy shall be void if assigned or transferred without the Company's written consent.
ACTION AGAINST COMPANY: No action shall lie against the Company unless, as a condition precedent'
thereto, there shall have been full compliance with all of the terms of this policy, nor.until the amount of the Insured's
obligation to pay shall have been finally determined either by judgment after actual trial or by written agreement of the
Insured,the claimant, and the Company.
Any person or organization or the legal representative thereof, who is signatory to such judgment or written
agreement,shall thereafter be able to recover under this policy to the extent of the insurance afforded by this policy. No
person or organization shall have any right under this policy to join the Company as a party to any action against the
Insured to determine the Insured's liability, nor shall the Company be impleaded by the Insured or the Insured's legal
representative.
CANCELLATION AND NONRENEWAL: This policy may be cancelled by the Insured by surrender hereof to the
Company or any of its authorized agents or by mailing to the Company written notice stating when thereafter the
cancellation shall be effective. If this policy has been in effect for ninety (90) days or less, it may be cancelled by the
Company for the following reasons and upon written notice provided to the Insured within the following time limits: if
the Insured has failed to pay a premium, at least ten (10) days; if the Insured has perpetrated a fraud or material
misrepresentation upon the Company, at least twenty(20) days;or for any other reason, at least thirty(30)days: If this
policy has been in effect for more than ninety (90) days, the Company may cancel it for the following reasons and upon
written notice provided to the Insured within the following time limits: if the Insured has failed to pay a premium, at
least ten (10) days; if the Insured has perpetrated a fraud or material misrepresentation upon the Company, at least
twenty(20) days;or if there is a substantial change in the scale of risk covered by the policy, if the Insured has failed to
comply with reasonable safety recommendations, or if reinsurance of the risk has been cancelled, at least forty-five (45)
days. The mailing of notice as aforesaid shall be sufficient proof of notice. The time of surrender or the effective date
and hour of cancellation stated in the notice shall become the end of the policy period and the end of the annual period.
Delivery of such written notice by either the Insured or the Company shall be equivalent to mailing. Upon cancellation
by either the Insured or the Company,earned premium shall be computed pro rata. Premium adjustment may be made
either at the time cancellation is effected or as soon as practicable after cancellation becomes effective, but payment of
unearned premium is not a condition of cancellation. The Company may refuse to renew this policy by providing
written notice of nonrenewal to the Insured at least forty-five (45) days before the expiration or anniversary date of the
policy.
Dated,signed and sealed this 13th day of June 2017
Address claims to: W E S T E R O R E T Y O M P A N Y
Western Surety Company B
P.0.Box 5077 Y -----
Sioux Falls,77 57117 5077 Paul T.Bruflat,Senior ice President