HomeMy WebLinkAbout324007 04/10/18 oi,
CITY OF CARMEL, INDIANA VENDOR: 362876:.:,
ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: S""'"'785.40'
CARMEL, INDIANA 46032 13607 cb'[EgCTIONS CENTER DRIVE CHECK NUMBER: 324007
cHlcnGolL 60693 CHECK DATE: 04/10/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000536532 785.40 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
$785.40
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
000536532 43-475.00 $785.40 1 hereby certify that the attached invoice(s),or 3/30/18 000536532 $785.40
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
Arc
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
14T62033-ZLP 5216X7087 03/30/2018 000536532 04/15/2018 785.40
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 PAGE 1
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE'
14TG2033-ZLP 5216X7087 03/30/2018 000536532 04/15/2018 785.40
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 584.20
CLAIM TOTAL 584.20 .
CLAIM#: FBU4031 DATE OF LOSS: 11/13/2017
DESCRIPTION: EPLI C - STEWART, LISA EEOC COMPLAINT ALLEGING
VIOLATION OF THE ADAAA
CLAIMANT: LISA STEWART
EXPENSE 131 .80
CLAIM TOTAL 131.80
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 69.40
CLAIM TOTAL 69.40
TOTAL CLAIM(S) DUE $785.40
k
r
APR 10 2018
Chea k Treasurer
TRAVELERS PAGE 2
DEDUCTIBLE / SELF-INSURED INVOICE
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL
14TG2033-ZLP 5216X7087 03/30/2018 000536532 04/15/2018 785.40
ACCOUNT SUMMARY
CURRENT CHARGES 785.40 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 785.40
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 785.40
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