322356 02/27/18 0]!-
DEPARTMENT
CITY OF CARMEL, INDIANA VENDOR: 00352999
ONE CIVIC SQUARE HYLANT GROUP CHECKAMOUNT: $*1,012,187.83*
CARMEL, INDIANA 46032 PO BOX 638720 CHECK NUMBER: 322356
CINCINNATI OH 45263-8720 CHECK DATE: 02/27/18
ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 167883 23,191.50 GENERAL INSURANCE
302 5023990 167883 88,441.33 OTHER EXPENSES
1205 4347500 167888 683,387.00 GENERAL INSURANCE
1205 4347500 167889 217,168.00 GENERAL INSURANCE
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 00352999 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
HYLANT GROUP IN SUM OF$ CITY OF CARMEL
PO BOX 638720 An invoice or bill to be properly itemized must show:kind of service,when;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
$923,746.50
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
167889 43-475.00 $217,168.00 1 hereby certify that the attached invoice(s),or 12/15/17 167889 $217,168.00
1205 101 Prior Year 1205 101
167888 43-475.00 $683,387.00 bills)is(are)true and correct and that the 12/15/17 167888 $683,387.00
1205 101 1 Prior Year materials or services itemized thereon for 1205 1 101
I 167883 I 43-475.00 I $23,191.50 12/15/17 I 167883 I I $23,191.50
1205 101 Prim-Year which charge is made were ordered and 1205 101
received except
Tuesday, February 20,2018
Crider,James
Administration
I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have
audited same in accordance with IC 5-11-10-1.6
,20—
Cost
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995)
Vendor# 00352999 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
HYLANT GROUP IN SUM OF$ CITY OF CARMEL
PO BOX 638720 An invoice or bill to be property 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
$88,441.33
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
302 Workers Comp Fund Terms
302 Work Comp Fund Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
167883 50-239.90 $88,441.33 1 hereby certify that the attached invoice(s),or 12/15/17 167883 Work Comp Fund $88,441.33
302 302 Prior Year 302 302
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
Tuesday, February 20,2018
A4--.01
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
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Please Return Top with Remittance To: PO Box 638720, Cincinnati, OH 45263-8720
Item# Trans Eff Date Due Date Trans Description _. -- Amount
L
Umbrella-Commercial Excess Policy# 5111007800 Effective: 1/1/18 - 1/1/19
Issuing Company
1286157 1/1/2018 1/1/2018 RENB 18/19 Umbrella 56,585.00
Package-Commercial Policy# 630581M4076 Effective: 1/1/18 - 1/1/19
Issuing Company
1286090 1/1/2018 1/1/2018 RENB 18/19 Property Package 79,847.00
Business Auto Policy# 81030361264A Effective: 1/1/18 - 1/1/19
Issuing Company
1286153 1/1/2018 1/1/2018 RENB 18/19 Automobile 252,924.00
Package-Commercial Policy# ZLP14T62033 Effective: 111/18 - 1/1/19
Issuing Company
1286141 1/1/2018 1/1/2018 RENB 18/19 Liability Package 294,031.00
Total Invoice Balance: $683,387.00
----------------------- adg---------------------------------------------------------------------------------------------------------
I- FAGKAGE UAB/UTYPACKAGE Total ;
(Department_- _Property/Crime.Inland Marine _ GL Liquor Lave Enr Public¢9gmt EPL Auto UmbreOa 8y Dept
(CITY —`-1-`. I r I 1-- --- - -- -- --I
Admin S 10,472200.15,9479.00 I_S __ Is_ 5 - S 15 15 1.141,00 1 S
Admin-ICS 5 1,335A0 j_5_9 T41.AQ_L5__ - 5 - 5 - 15 -_ S I S. 1456.00. S�
1DOC _�.S 5 392.00 15 5 s__ 5 S _ _: - S 4,750 00 1 S
Drug Tas k .- 5 S 1 5 -__ ;5 $ Is �_ 5 S 4,156 00 1 5 _ _
jGogCdurse 5 -2404.00 S_541300 S _ IS ,.392.00 S i_S__ 1 S - i 5. 51000 1.5 _—I
Engineering _ i 5 723.00 15 i 5 -- 5 i S _I
(Fire _ 5 16,039.00 15 72.00 I S S is I 5 5 - S. 10D,746 00 I$
(Police $ 4449.00 I S 100.00 1 S _ 5 16166 477.00 5 5 1S_56,_81100 1 S _
Street 5 4 947.00 I'S J274TOOTS_ i S I S - is T - 1 S
CityTotal $ 40,369.00 1 S 39,478.00 1 S 84,144.00,'S 392.00 1 S.166,477.00 1 S 9,114,00 FS 33;904:00 S- 252,924.00 1 S 56,585.00 1$ 683,387:00
LFEBd To
' 5s
2 0 2018
reasu
HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 IndianapolisY IN 46290
12/15/2017 City of Carmel Loan# Invoice#167888 FARWE1 Page 1 of 1
-- -WN..I.11 namuLance i o: ru tiox 638720, Cincinnati,OH 45263-8720
item# -Tra
ns
—
t� - Trans Description - -
Amount
Crime Policy# 105696360 Effective: 1/1/18 - 1/1/19
Issuing Company Travelers Casualty$Surety Co
1286083 1/1/2018 1/1/2018 RENB 18/19 ID Fraud
2,344.00
Third Party Administrator-Commercial Policy# 6268
Issuing Company Com an Effective: 1/1/18 - 1/1/19
Midwest Employers Casualty Co
1286079 1/1/2018 1/1/2018 RENB 18/191 of 2 TPAC Service Contract Fee
10,847.50
Workers'Compensation Policy# BL04659054 Effective: 1/1/18 - 1/1/19
Issuing Company Great American E&S Ins Co
1286084 1/1/2018 1/1/2018 RENB 18/19 Occupational Buffer Layer
1286085 1/1/2018 1/1/2018 GTAX Surplus Lines Tax 23,973.00
599.33
Workers Compensation-Excess Policy# EWC008873 Effective: 1/1/18 - 1/1/19
Issuing Company Midwest Employers Casualty Co
1286078 1/1/2018 1/1/2018 RENB 18/19 Excess Workers Comp
63,869.00
Agency Fee-Commercial Policy# WC RISK MGMT FEE Effective: 1/1/18 - 1/1/19
Issuing Company Hylant Group Fees
1286081 1/1/2018 1/1/2018 AFEE 18/19 Hylant WC Risk Management Fee
10,000.00
Total Invoice Balance: $111,632.83
77-7-1
F FEB 2 0 2018
lel �3 z 0-21
HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290
12/15/2017 City of Carmel Loan# Invoice#167883 FARWEI Page 1 of 1
Item# Trans Eff Date 'Due Dater Trans-- Description T -- - - T- _ ---�' — _Amount
Umbrella-Commercial Excess Policy# 5111007800 Effective: 1/1/18 - 1/1/19
Issuing Company
1286158 1/1/2018 1/1/2018 RENB 18/19 Umbrella 15,717.00
Package-Commercial Policy# 630581 M4076 Effective: 1/1/18 - 1/1/19
Issuing Company
1286091 1/1/2018 1/1/2018 RENB 18/19 Property Package 169,891.00
Package-Commercial Policy# ZLP14T62033 Effective: 1/1/18 - 1/1/19
Issuing Company
1286142 1/1/2018 1/1/2018 RENB 18/19 Liability Package 31,560.00
Total Invoice Balance: $217,168.00
PACKAGE lJABWYPACKAGE Total
Department -PropertytCrime inland ftlarine_ GL Liquor _ Law Ed _Public P,hgmt EPL Auto. Umbrella By Dept- I
CRC_ �- _ I __ ` -- �- -- - 1
40DC 1$ 8,974 00 1 1_1,200.00L'$ Is - 13 250.00 1$ 850.00( $ - :$ 1,525.001 -
GGDC 8 8,514.00'1 S - S 21200.00 - 5 250.00 S _850.0109_$_IS 1,525.001
CRA'_ _ $ 106,419 00 $ 8,000:aO $ 1$ - 990.00 -3,500: $ _ S 6581.00
CRC_ —�-S 45,606.00_i S 378:00 S 8,000.OD $ - (5 _ $ 980 00 (_$_ 3,500.00 ;$ - $ 6,086.00]v
CRC Total I$ 169,513.00 1$ 378.00 1$ 20,400,001$ 1$ 1$ 2,460.60 1$ 8,700:00 1 $ $ 15,717.00 1$ 217,168.00
�T
�t��c lim of
IS EfP,&!'. To,
FEB 2 0 2018
HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290
12/15/2017 City of Carmel Loan# Invoice#167889 FARWE1 Page 1 of 1
Please Return Top with Remittance To: PO Box 638720,Cincinnati,OH 45263-8720
Item# Trans Eff bate _Due Date ��Trans �' Description - '— 'Amount
Crime Policy# 105696360 Effective: 1/1/18 - 1/1/19
Issuing Company Travelers Casualty&Surety Co
1286083 1/1/2018 1/1/2018 RENB 18/19 ID Fraud 2,344.00
Third Party Administrator-Commercial Policy# 6268 Effective: 1/1/18 - 1/1/19
Issuing Company Midwest Employers Casualty Co
1286079 1/1/2018 1/1/2018 RENB 18/19 1 of 2 TPAC Service Contract Fee 10,847.50
Workers'Compensation Policy# BL04659054 Effective: 1/1/18 - 1/1/19
Issuing Company Great American E&S Ins Co
1286084 1/1/2018 1/1/2018 RENB 18/19 Occupational Buffer Layer 23,973.00
1286085 1/1/2018 1/1/2018 GTAX Surplus Lines Tax 599.33
Workers Compensation-Excess Policy# EWC008873 Effective: 1/1/18 - 111/19
Issuing Company Midwest Employers Casualty Co
1286078 1/1/2018 1/1/2018 RENB 18/19 Excess Workers Comp 63,869.00
Agency Fee-Commercial Policy# WC RISK MGMT FEE Effective: 1/1/18 - 1/1/19
Issuing Company Hylant Group Fees
1286081 1/1/2018 1/1/2018 AFEE 18/19 Hylant WC Risk Management Fee 10,000.00
Total Invoice Balance: $111,632.83
/gds
HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290
112/15/2017 City of Carmel Loan# Invoice#167883 FARWE1 Page 1 of 1