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Home My WebLink About319551 12/12/17 "' '''• CITY OF CARMEL, INDIANA VENDOR: 362876 ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $****14,661,36* CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 319551 CHICAGO JL,,60693 CHECK DATE: 12/12/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER; AMOUNT DESCRIPTION 1205 4347500 000530494 6,909.60 GENERAL INSURANCE 1205 4347500 00529907 5,000.00 GENERAL, INSURANCE 1205 4347500 00530495 2,751.76 GENERAL INSURANCE VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 362876 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER TRAVELERS IN SUM OF$ CITY OF CARMEL 13607 COLLECTIONS CENTER DRIVE 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. CHICAGO, IL 60693 Payee $14,661.36 ON ACCOUNT OF APPROPRIATION FOR Purchase Order# General Administration 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 000530495 43-475.00 $2,751.76 1 hereby certify that the attached invoice(s),or 11/30/17 000530495 $2,751.76 1205 101 1205 101 000530494 43-475.00 $6,909.60 bill(s)is(are)true and correct and that the 11/30/17 000530494 $6,909.60 1205 101 materials or services itemized thereon for 1205 101 000529907 I 43-475.00 I $5,000.00 11/30/17 000529907 $5,000.00 1205 101 which charge is made were ordered and 1205 101 received except Monday, December 11,2017 /f L 4 -v cl. "Q �c Crider,James Administration I 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 .TRAVELERS] PAGE 1 DEDUCTIBLE / SELF-INSURED INVOICE POLICY NUMBERACCOUNT 3036P64A-810 5216X7087 11/30/2017 000530495 12/15/2017 2,751 .76 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 TOTAL D UE 303GP64A-8iO 5216X7087 11/30/2017 000530495 12/15/2017 2,751 .76 CURRENT CHARGES CLAIM#: ESM3159 DATE OF LOSS: 09/27/2017 DESCRIPTION: BAUT INSD DRIVER PAT RIGDON WAS AT 116TH AND RANGELINE WHEN ANOTHER VE CLAIMANT: MATTHEW PUMPHREY LOSS 208.62 CLAIM TOTAL 208.62 CLAIM#: ESM3855 DATE OF LOSS: 10/16/2017 DESCRIPTION: BAUT C - RANCOURT, JAMES IV WAS WB ON E MAIN ST STOPPED AND THEN MADE CLAIMANT: JAMES RANCOURT LOSS 1,858.33 CLAIM TOTAL 1,858.33 CLAIM#: ESM4777 DATE OF LOSS: 11/06/2017 DESCRIPTION: CARDONA, CHRIS VEHICLE WAS BACKED INTO BY INSURED VEHICLE. CLAIMANT: CHRIS CARDONA LOSS 684.81 CLAIM TOTAL 684.81 TOTAL CLAIM(S) DUE $2,751.76 k DEC 12 2017 TRAVELERS/ J PAGE 2 DEDUCTIBLE / SELF-INSURED INVOICE POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL 303GP64A-810 5216X7087 11/30/2017 000530495 12/15/2017 2,751 .76 ACCOUNT SUMMARY CURRENT CHARGES 2,751 .76 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 2,751.76 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 2,751 .76 CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE. FOR BILLING QUESTIONS, PLEASE CONTACT YOUR ACCOUNTING SPECIALIST ROSA TORRES AT 1-860-277-3284 OR EMAIL RTORRES@TRAVELERS.COM TRAVELERS PAGE 1 DEDUCTIBLE / SELF-INSURED INVOICE 'POLICY 14TG2033-ZLP 521GX7087 11/30/2017 000530494 12/15/2017 6,909.60 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL 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 J PAGE 1 POLICY NUMBER ACCOUNT NUMBER- _BILL DATE ___BILLNUMBER PAYMENT DUE TOTAL DUE 14T62033-ZLP 521GX7087 11/30/2017 000530494 12/15/2017 6,909.60 CURRENT CHARGES CLAIM#: , EXK7534 DATE OF LOSS: 07/04/2013 DESCRIPTION: GLIA C -GRAY, CHAD TORT NOTICE ALLEGING SEWAGE WATER FROM CLOGGED CITY CLAIMANT: CHAD GRAY LOSS 5,000.00 CLAIM TOTAL 5,000.00 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 184.80 CLAIM TOTAL 184.80 CLAIM#: FBU4031 DATE OF LOSS: 11/13/2017 DESCRIPTION: EPLI C - STEWART, LISA EEOC COMPLAINT ALLEGING VIOLATION OF THE ADAAA CLAIMANT: LISA STEWART EXPENSE 1,078.00 CLAIM TOTAL 1,078.00 CLAIM#: FBU4032 DATE OF LOSS: 11/03/2017 DESCRIPTION: EPLI C - SMITH, KYLE EEOC CLAIM ARISING OUT OF DISCRIMINATION BASED ON CLAIMANT: KYLE N SMITH EXPENSE 646.80 CLAIM TOTAL 646.80 TOTAL CLAIM(S) DUE '�-' 9n P $6,909.60 H DEC 112017 TRAVELERS PAGE 2 DEDUCTIBLE / SELF-INSURED INVOICE POLICY NUMBER ACCOUNT : TOTAL DUE 14T62033-ZLP 5216X7087 11/30/2017 000530494 12/15/2017 6,909.60 ACCOUNT SUMMARY CURRENT CHARGES 6,909.60 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 6,909.60 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 6,909.60 CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE. FOR BILLING QUESTIONS, PLEASE CONTACT YOUR ACCOUNTING SPECIALIST ROSA TORRES AT 1-860-277-3284 OR EMAIL RTORRES@TRAVELERS.COM TRAVELERS PAGE , DEDUCTIBLE / SELF- INSURED INVOICE • i : GP09309872 0018277203 11/30/2017 000529907 12/15/2017 5,000.00 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL 13607 COLLECTIONS CENTER DRIVE 1 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 , POLICY NUMBER ACCOUNT NUMBER- BILL -DATE BILL NUMBER PAYMENT DUE TOTAL DUE, GPO9309872 0018277203 11/30/2017 000529907 12/15/2017 5,000.00 CURRENT CHARGES CLAIM#: EGKO961 DATE OF LOSS: 09/01/2003 DESCRIPTION: PROPERTY CONTINUES TO FLOOD CLAIMANT: DEREK VANOSTRAND-FAKEHANY LOSS 5,000.00 CLAIM TOTAL 5,000.00 TOTAL CLAIMS) DUE $5,000.00 ACCOUNT SUMMARY CURRENT CHARGES 5,000.00 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 5,000.00 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 5,000.00 CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE. FOR BILLING QUESTIONS, PLEASE CONTACT YOUR ACCOUNTING SPECIALIST ROSA TORRES AT 1-860-277-3284. OR EMAIL RTORRES@TRAVELERS.COM F =fTe6Ro DEC 12 2017