The URL can be used to link to this page

Home My WebLink About323996 04/10/18 _G5q CITY OF CARMEL, INDIANA VENDOR: 00352999 ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $"'"'5,101.00' CARMEL, INDIANA 46032 PO BOX 638720 CHECK NUMBER: 323996 9M,TON CINCINNATI OH 45263-8720 CHECK DATE: 04/10/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 171803 5,101.00 GENERAL INSURANCE VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 00352999 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER HYLANT GROUP IN SUM OF$ 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 $5,101.00 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 171803 43-475.00 $5,101.00 1 hereby certify that the attached invoice(s),or 1/31/18 171803 Travelers Composite Rate Auto Audit $5,101.00 1205 101 1205 101 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,April 10, 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 distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer � rr -0u0 Gn:vase vua uatu I Fdnb - ut;SGfIpLIVf1 Amount Business Auto Policy# 81030361364A Effective: 1/1/16 - 1/1/17 Issuing Company Charter Oak Fire Insurance Co 1323062 1/1/2016 2/9/2018 AUDI 16/17 Composite Rate.Auto Audit 5,101.00 Total Invoice Balance: $5,101.00 �`�'l.Y.ta'i3`'xunJIt4✓ti..§ T APP, 10 2018 yr z �� .'..2�fse�{a�•64y�r HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290 1/31/2018 City of Carmel Loan# Invoice#171803 FARWE1 Page 1 of 1 //�� Premium Audit AW PO Box 2927 TRAVELERS Hartford,CT 06104-2927 THE TRAVELERS INDEMNITY_COMP_ANY Premium Adjustment-Noticdv(4r IKS orA_E iL�) CITY OF CARMEL Policy Number: H-810-3036P64A-IND-16 ONE CIVIC SQUARE Policy Period: 01/01/2016 to 0110112017 CARMEL, IN 46032 Audit Period: 01/01/2016 to 01/01/2017 Issue Office: 24T G8433 Date of This Notice: 10/17/2017 HYLANT GROUP INC Mode of Adjustment: ANNUAL AUDIT 10401 N MERIDIAN ST STE 200 INDIANAPOLIS, IN 46280 Total Earned Premium $ 283,742.00. Audit Contact: 'Premium Prior to Audit $ 278,641.00 CUSTOMER SERVICE(MO) Ad"difional_Pr emilam Duey $ _x.10,.00 1-800-842-4271 Return Premium $ 0.00 "Premium Prior to Audit'includes the original policy premium and any endorsements during the policy term. This does not reflect actual payments made. THIS ADJUSTMENT STATEMENT WAS PREPARED FROM:A Report You Submitted. ,RATE' MANUAL PREM. EARNED PREMIUM CLASS. PREMIUM 1COMP.ORI P.D. SUBJECT. COMP.OR P.D. , STATE CLASSIFICATIONS '- CODE KEY BASIS B.I.LIAB. I LIAB TO MOD. B.I.LIAB: LIAB COMPOSITE RATED POLICY AS ISSUED LIABILITY POWER UNITS U 443.00 511.000 226,712.00 COMPREHENSIVE OCN F 19,664,158.00 0.119 23,400.00 COLLISION OCN F 19,664,158.00 0.145 27,598.00 MISCELLANEOUS COVERAGES 931.00 AUDITED RESULTS LIABILITY POWER UNITS U 2.50 511.000 1,278.00 COMPREHENSIVE Premium Audit PO Box 2927 TRAVELERSJ Hartford,CT 06104-2927 THE TRAVELERS INDEMNITY COMPANY Premium Adjustment Notice THIS IS NOTA BILL CITY OF CARMEL Policy Number: H-810-3036P64A-IND-16 ONE CIVIC SQUARE Policy Period: 01/01/2016 to 01/01/2017 CARMEL, IN 46032 Audit Period: 01/01/2016 to 01/01/2017 OCN F 1,448,194.00 0.119 1,723.00 COLLISION OCN F 1,448,194.00 0.145 2,100.00 Premium Audit AW PO ox 2927 TRA 1��/Gr LERS Hartford,CT 06104-2927 CITY OF CARMEL ONE CIVIC SQUARE CARMEL, IN 46032 USE THE TABLES BELOW WHEN REVIEWING THE BASIS OF PREMIUM USED ON THE ATTACHED VOUCHER(S). NON-SIMPLIFIED POLICY .. KEY TO PREMIUM BASIS If key shown is... BASIS-IS... Al _Area per,100 sq.ft. B ` -Frontage per linear:foot Cl -Payrollper$100 D Each or Units E -Per Landing' F -Costper.$100 G -Receipts per$1,000. H -Receipts per$100 I -Per 100 admissions:' Any other Basis is shown on Premium Adjustment Statement. SIMPLIFIED POLICY KEY TO PREMIUM BASIS If key shown is:.. BASIS IS... A -Area per 1,000 sq.,% C -Costper$1,000 M Admissions per 1,0.00 P Payroll per$1,000 S, -Gross Sales per$1,000. U -Per Unit