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325501 05/23/18
0t�! 4°� CITY OF CARMEL, INDIANA VENDOR: 00352999 d 3} ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $""""3,332.00' x. a4 CARMEL, INDIANA 46032 PO Box 636720 CHECK NUMBER: 325501 9M�TOX�� CINCINNATI OH 45263.8720 CHECK DATE: 05/23/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 172408 698.00 GENERAL, INSURANCE 1205 4347500 173151 969.00 GENERAL INSURANCE 1205 4347500 177318 183.00 GENERAL INSURANCE 1205 4347500 180495 1,482.00 GENERAL INSURANCE VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 00352999 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER HYLANT GROUP IN SUM OF$ 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 $3,149.00 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 172408 43-475.00 $698.00 1 hereby certify that the attached invoice(s),or 2/6/18 172408 $698.00 1205 101 1205 101 173151 43-475.00 $969.00 bill(s)is(are)true and correct and that the 2/20/18 173151 $969.00 1205 1 1 101 materials or services itemized thereon for 1205 101 I 180495 I 43-475.00 I $1,482.00 5/1/18 180495 $1,482.00 1205 101 which charge is made were ordered and 1205 101 received except Monday, May 221,2018 A4_0' 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 ••�•••R .-a-�.-u.vnw vuo vaw Sana. v�scnpiwn Amount Package-Commercial Policy# 630581M4076 Effective: 1/1/17 - 1/1/18 Issuing Company Travelers Prop Cas Co of Amer 1325393 9/1/2017 2/21/2018 ENDT Add Several Locations for Utilities Dept 733.00 1325394 9/25/2017 2/21/2018 ENDT Delete 37 W. Main Street (35.00) Total Invoice Balance: $698.00 E itted To 66 2018 erV rer rreasu] HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290 2/6/2018 City of Carmel Loan# Invoice#172408 FARWE1 Page 1 of 1 CHANGE EFFECTIVE DATE:09-25-17 CHANGE ENDORSEMENT NUMBER:0028 TRAVELERS J One Tower Square, Hartford, Connecticut 06183 CHANGE ENDORSEMENT Named Insured: CITY OF CARMEL Policy Number: H-630-581M4076-TIL-17 Policy Effective Date: 01/01/17 Issue Date: 02/02/18 Return Premium $ 35 INSURING COMPANY: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA Effective from 09/25/17 at the time of day the policy becomes effective. THIS INSURANCE IS AMENDED AS FOLLOWS: THE COMMON POLICY DECLARATIONS IS AMENDED AS FOLLOWS: AMENDING IL TO 03 04 96 - LOCATION SCHEDULE AS FOLLOWS: DELETING LOCATION 149, BUILDING 149 AND ALL APPLICABLE COVERAGES AND FORMS LOCATED AT: 37 W MAIN STREET, CARMEL, IN 46032. THE DELUXE PROPERTY COVERAGE PART IS AMENDED AS FOLLOWS: DELETING DX 00 01 07 94 - MORTGAGE HOLDER SCHEDULE. NAME AND ADDRESS OF AGENT OR BROKER: COUNTERSIGNED BY: HYLANT GROUP INC (G8433) 10401 N MERIDIAN ST STE 200 INDIANAPOLIS, IN 46280 Authorized Representative DATE: IL TO 07 09 87 PAGE 1 OF 1 OFFICE: SAN ANTONIO-EAST CHANGE EFFECTIVE DATE:09-01-17 CHANGE ENDORSEMENT NUMBER:0025 TRAVELERS J One Tower Square, Hartford, Connecticut 06183 CHANGE ENDORSEMENT Named Insured: CITY OF CARMEL Policy Number: H-630-58lM4076-TIL-17 Policy Effective Date: 01/01/17 Issue Date: 02/01/18 Additional Premium $ 733 INSURING COMPANY: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA Effective from 09/01/17 at the time of day the policy becomes effective. THIS INSURANCE IS AMENDED AS FOLLOWS: THE COMMON POLICY DECLARATIONS IS AMENDED AS FOLLOWS: AMENDING IL TO 03 04 96 - LOCATION SCHEDULE AS FOLLOWS: ADDING LOCATION 173, BUILDING 173 OCCUPIED AS UV DISINFECTION BUILDING LOCATED AT: 9609 HAZEL DELL ROAD, CARMEL, IN 46032. ADDING LOCATION 174, BUILDING 174 OCCUPIED AS LIFT STATION #28 LOCATED AT: 640 3RD AVE SW, CARMEL, IN 46032. ADDING LOCATION 175, BUILDING 175 OCCUPIED AS LIFT STATION #29 LOCATED AT: 14282 COMMUNITY DRIVE, CARMEL, IN 46032. ADDING LOCATION 176, BUILDING 176 OCCUPIED AS HOUSEHOLD HAZARDOUS WASTE BUILDING LOCATED AT: 901 N. RANGELINE ROAD, CARMEL, IN 46032. ADDING LOCATION 177, BUILDING 177 OCCUPIED AS D&C STORAGE BUILDING LOCATED AT: 901 N. RANGELINE ROAD, CARMEL, IN 46032 . ADDING LOCATION 178, BUILDING 178 OCCUPIED AS OFFICE LOCATED AT: 130 1ST AVENUE SW, CARMEL, IN 46032. ADDING LOCATION 179, BUILDING 179 OCCUPIED AS EQ BASIN LOCATED AT: 891 N. RANGELINE ROAD, CARMEL, IN 46032. THE DELUXE PROPERTY COVERAGE PART IS AMENDED AS FOLLOWS: AMENDING BLANKET BUILDING AND YOUR BUSINESS PERSONAL PROPERTY LIMIT TO $443,185,416. AMENDING DELUXE BUSINESS INCOME COVERAGE FORM (AND EXTRA EXPENSE) NAME AND ADDRESS OF AGENT OR BROKER: COUNTERSIGNED BY: HYLANT GROUP INC (G8433) 10401 N MERIDIAN ST STE 200 INDIANAPOLIS, IN 46280 Authorized Representative DATE: IL TO 07 09 87 PAGE 1 OF 2 OFFICE: SAN ANTONIO-EAST CHANGE EFFECTIVE DATE:09-01-17 CHANGE ENDORSEMENT NUMBER:0025 AA*k TRAVELERS J One Tower Square, Hartford, Connecticut 06183 CHANGE ENDORSEMENT Policy Number: H-630-581M4076-TIL-17 Policy Effective Date: 01/01/17 Issue Date: 02/01/18 TO ADD LOCATION(S) 173-179 BUILDING(S) 173-179. ADDING CAUSES OF LOSS - EARTHQUAKE OCCURRENCE LIMIT AND ANNUAL AGGREGATE LIMIT FOR $10,000,000 AT THE FOLLOWING BUILDING(S) NUMBERED: 173-179. ADDING CAUSES OF LOSS - BROAD FORM FLOOD OCCURRENCE LIMIT AND ANNUAL AGGREGATE LIMIT FOR $10,000,000 AT THE FOLLOWING BUILDING(S) NUMBERED: 174,178. AMENDING DEDUCTIBLE BY EARTHQUAKE IN ANY ONE OCCURRENCE LIMIT FOR $50,000 TO ADD THE FOLLOWING BUILDING(S) NUMBERED: 173-179. AMENDING DEDUCTIBLE BY FLOOD IN ANY ONE OCCURRENCE LIMIT FOR $50,000 TO ADD THE FOLLOWING BUILDINGS) NUMBERED: 174,178. r IL TO 07 09 87 PAGE 2 OF 2 OFFICE: SAN ANTONIO-EAST 24T PRODUCER NAME: HYLANT GROUP INC G8433 VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 00352999 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER HYLANT GROUP IN SUM OF$ 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 $183.00 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 177318 43-475.00 $183.00 1 hereby certify that the attached invoice(s),or 4/17/18 177318 1375770-1376676-1376677 $183.00 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 Monday, May 21,2018 AC-0 cl� 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 Package-Commercial Policy# 630581M4076 Effective: 1/1/18 - 1/1/19 Issuing Company Travelers Prop Cas Co of Amer 1375770 1/1/2018 4/17/2018 ENDT Add Mobile Vehicle Lifts; Remove Forklift 58.00 1376676 1/17/2018 4/18/2018 ENDT Add Christkindlmarkt Storage Space 69.00 1376677 2/6/2018 4/18/2018 ENDT Add Zamboni for CRC 56.00 Package-Commercial Policy# ZLP14T62033 Effective: 1/1/18 - 1/1/19 Issuing Company Charter Oak Fire Insurance Co 1375771 1/1/2018 4/2/2018 RENB Correct 18/19 GLIA Premium (556.00) Total Invoice Balance: ($373.00) Er HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290 4/3/2018 City of Carmel Loan# Invoice#177318 FARWE1 Page 1 of 1 PRODUCER CHANGE EFFECTIVE DATE:01-17-18 CHANGE ENDORSEMENT NUMBER:0004 TRAVELERS One Tower Square, Hartford,Connecticut 06183 CHANGE ENDORSEMENT Named Insured: CITY OF CARMEL Policy Number: H-630-581M4076-TIL-18 Pol 1 cy Effective Date: 01/01/18 Issue Date: 03/21/18 Additional Premium $ 69 INSURING COMPANY: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA Effective from 01/17/18 at the time of day the policy becomes effective. THIS INSURANCE IS AMENDED AS FOLLOWS: THE. COMMON POLICY DECLARATIONS IS AMENDED AS FOLLOWS: AMENDING IL TO 03 04 96 - LOCATION SCHEDULE AS FOLLOWS: ADDING LOCATION 150, BUILDING 150 OCCUPIED AS CARPORT BUILDING LOCATED AT: 765 W CARMEL DR CARMEL, IN 46032 150/150 THE DELUXE PROPERTY COVERAGE PART IS AMENDED AS FOLLOWS: AMENDING BLANKET BUILDING AND YOUR BUSINESS PERSONAL PROPERTY LIMIT TO $468,914,501 . AMENDING DELUXE BUSINESS INCOME COVERAGE FORM (AND EXTRA EXPENSE) TO ADD LOCATION150 BUILDING 150. ADDING CAUSES OF LOSS - EARTHQUAKE OCCURRENCE LIMIT AND ANNUAL AGGREGATE LIMIT FOR $10,000,000 AT THE FOLLOWING BUILDINGS) NUMBERED:. 150. ADDING CAUSES OF LOSS - BROAD FORM FLOOD OCCURRENCE LIMIT AND ANNUAL AGGREGATE LIMIT FOR $10,000,000 AT THE FOLLOWING BUILDINGS) NUMBERED: a� 150. AMENDINGDEDUCTIBLE BY EARTHQUAKE IN ANY ONE OCCURRENCE LIMIT FOR $50,000 TO ADD THE FOLLOWING BUILDING(S) NUMBERED: 150.' AMENDING DEDUCTIBLE BY FLOOD IN ANY ONE OCCURRENCE LIMIT FOR $50,000 TO ADD THE FOLLOWING BUILDING(S) NUMBERED: 150. NAME AND ADDRESS OF AGENT OR BROKER: COUNTERSIGNED BY: HYLANT GROUP INC (G8433) 10401 N MERIDIAN ST STE 200 INDIANAPOLIS, IN 46280 Authorized Representative DATE: IL TO 07 09 87 PAGE 1 OF 1 OFFICE : SAN ANTONIO-EAST 000592 CHANGE EFFECTIVE DATE:01-17-18 CHANGE ENDORSEMENT NUMBER:0004 OVERPRINT/CHANGE SLIP PAGE 1 OF i POLICY NUMBER: H-630-581M4076—TIL-18 RATER: GW3F ISSUE DATE : 03/21/18 MUNICIPALITIES GUAR COST EFFECTIVE DATE : 01/01/18 EXPIRATION DATE : 01/011/19 CHANGE EFFECTIVE DATE : 01/17/18 INSUREDS NAME : CITY OF CARMEL PRORATA FACTOR: 0.956 SHORT RATE FACTOR: 0.956 NEW/RENEWAL: R PAYMDDE: P SOLICITOR CODE : AUDIT FREQUENCY: N SAI : 5216X7087 RESPONSIBILITY: H MST : WATCH FILE : 0 RATING MODE : G SURVEY CODE : 2 SPECIAL CODE : REINSURANCE : N PROGRAM CODE : S4M AUTO FILINGS: FEDERAL TAX ID.: a� PREMIUM SUMMARY ACCOUNT EFF. NON S.B. MONTH DATE PREMIUM PREMIUM TOTAL 0318 01/17/18 69.00 0.00 69.00 AM TOTAL: 69.00 0.00 69.00 OFFICE : SAN ANTONIO—EAST 24T PRODUCER NAME : HYLANT GROUP INC G8433 000503 CHANGE EFFECTIVE DATE:01-17-18 CHANGE ENDORSEMENT NUMBER:0004 TRAVELERS PREMIUM SPLIT FORM PAGE 1 OF 1 POLICY NUMBER: H-630-581M4076—TIL-18 RATER: GW3F ISSUE DATE: 03/21/i 8 COMM ITEM COMM ITEM COMM ITEM COMM ITEM .1000 PREM ACCOUNT EFFECTIVE MONTH, DATE PREMIUM PREMIUM PREMIUM PREMIUM 0318 01/17/18 69 a� OFFICE : SAN ANTONIO—EAST 24T PRODUCER NAME : HYLANT GROUP INC G8433 OCON4 CHANGE EFFECTIVE DATE:01-01-18 CHANGE ENDORSEMENT NUMBER:0003 TRAVELERS J One Tower Square, Hartford,Connecticut 06183 CHANGE ENDORSEMENT Named Insured: CITY OF CARMEL Policy Number: H-630-581M4076-TIL-18 Policy Effective Date: 01/01/18 Issue Date: 03/14/18 Additional Premium $ 58 INSURING COMPANY: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA Effective from 01/01/18 at the time of day the policy becomes effective. THIS INSURANCE IS AMENDED AS FOLLOWS: THE COMMERCIAL INLAND MARINE COVERAGE PART IS AMENDED AS FOLLOWS: AMENDING SCHEDULED PROPERTY AS FOLLOWS: "SCHEDULED PROPERTY" LIMITS OF INSURANCE COVERED ITEMS (SEE SCHEDULE) "SCHEDULED ITEMS": $ 4,792,797 "FLOOD LIMIT OF INSURANCE": $ 4,792,797 "FLOOD ANNUAL AGGREGATE LIMIT OF INSURANCE": $ 4,792,797 "EARTH MOVEMENT LIMIT OF INSURANCE": $ 4,792,797 "EARTH MOVEMENT ANNUAL AGGREGATE LIMIT OF INSURANCE": $ 4,792,797 AMENDING CM TO 29 08 96 IM PAK COVERAGE "SCHEDULED PROPERTY" SCHEDULE AS PER ATTACHED. **** RESPECTS TO: ADDING: ROTARY LIFT MOBILE VEHICLE LIFT $10,841 HCO17F0008 ROTARY LIFT MOBILE VEHICLE LIFT $10,841 HCO17F0009 REMOVING: HARLO FORKLIFT, MODEL- HF456, SERIAL- C764225, FIRE DEPT ID F008580 NAME AND ADDRESS OF AGENT OR BROKER: COUNTERSIGNED BY: HYLANT GROUP INC (G8433) 10401 N MERIDIAN ST STE 200 INDIANAPOLIS, IN 46280 Authorized Representative DATE: IL TO 07 09 87 PAGE 1 OF 1 OFFICE: SAN ANTONIO-EAST CHANGE EFFECTIVE DATE:01-01-18 CHANGE ENDORSEMENT NUMBER:0003 TRAVELERSJ� POLICY NUMBER: H-630-581M4076-TIL-18 EFFECTIVE DATE: 01-01-18 ISSUE DATE: 03-14-18 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS. IL TO 07 09 87 CHANGE ENDORSEMENT IL T8 01 10 93 FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS INLAND MARINE CM TO 29 08 96 IM PAR COV SCHEDULED PROPERTY SCHEDULE INTERLINE ENDORSEMENTS IL T3 82 05 13 EXCL OF LOSS DUE TO VIRUS OR BACTERIA IL T8 01 10 93 PAGE: 1 OF 1 COMMERCIAL INLAND MARINE r` : ::: .................. COMMERCIAL INLAND MARINE y, A�► TRAVELERS J One Tower Square, Hartford, Connecticut 06183 IM PAKa COVERAGE POLICY NUMBER: H-630-581M4076-TIL-18 "SCHEDULED PROPERTY" ISSUE DATE: 03-14-18 SCHEDULE "Scheduled Items" ITEM DESCRIPTION OF ITEM LIMIT OF INSURANCE 001 SCHEDULED PROPERTY ITEMS & LIMITS OF 4,792,797 INSURANCE SHOWN IN THE SCHEDULE ON FILE WITH US, RECEIVED 09-28-2016 TOTAL "SCHEDULED ITEMS" LIMIT OF INSURANCE FOR ALL COVERED ITEMS$ 4,792,797 "Fine Arts" ITEM DESCRIPTION OF ITEM LIMIT OF INSURANCE 001 FINE ARTS $1,649,975 TOTAL "FINE ARTS" LIMIT OF INSURANCE FOR ALL COVERED ITEMS $ 1,649,975 CM TO 29 08 96 Page 1 (END) INTERLINE ENDORSEMENTS ................. INTERLINE ENDORSEMENTS ..... THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION OF LOSS DUE TO VIRUS OR BACTERIA This endorsement modifies insurance provided under the following: COMMERCIAL PROPERTY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART FARM COVERAGE PART A. The exclusion set forth in Paragraph B. applies to croorganism that induces or is capable of induc- all coverage under all forms and endorsements ing physical distress, illness or disease. that comprise this Coverage Part or Policy, in- C. With respect to any loss or damage subject to the cluding but not limited to forms or endorsements exclusion in Paragraph B., such exclusion super- that cover property damage to buildings or per- sedes any exclusion relating to"pollutants". sonal property and forms or endorsements that D. The terms of the exclusion in Paragraph B., or the cover business income, extra expense, rental inapplicability of this exclusion to a particular loss, value or action of civil authority. do not serve to create coverage for any loss that B. We will not pay for loss or damage caused by or would otherwise be excluded under this Coverage resulting from any virus, bacterium or other mi- Part or Policy. IL T3 82 05 13 ©2013 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc.with its permission. PRODUCER CHANGE EFFECTIVE DATE:02.06-16 CHANGE ENDORSEMENT NUMBER:0006 TRAVELERS One Tower Square, Hartford,Connecticut 06183 CHANGE ENDORSEMENT Named Insured: CITY OF CARMEL Policy Number: H-630-581M4076-TIL-18 Policy Effective Date: 01/01/18 Issue Date: 03/21/18 Additional Premium $ 56 INSURING COMPANY: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA Effective from 02/06/18 at the time of day the policy becomes effective. THIS INSURANCE .IS AMENDED AS FOLLOWS: THIS INSURANCE IS AMENDED AS FOLLOWS: THE COMMERCIAL INLAND MARINE COVERAGE PART IS AMENDED AS FOLLOWS: AMENDING CONTRACTORS EQUIPMENT AS FOLLOWS: AMENDING COVERED ITEMS, LISTED ITEMS LIMIT OF INSURANCE T0: $2,796,623 AMENDING "MAXIMUM AMOUNT OF PAYMENT" LIMIT OF INSURANCE .TO: $3,046,623 AMENDING "FLOOD LIMIT OF INSURANCE" TO: $3.046,623 AMENDING "FLOOD ANNUAL AGGREGATE LIMIT OF INSURANCE" TO: $3.046,623 AMENDING "EARTH MOVEMENT LIMIT OF INSURANCE" TO: $3.046,623 AMENDING "EARTH MOVEMENT ANNUAL AGGREGATE LIMIT OF INSURANCE" TO: $3,046,623 AMENDING CM TO 28 08 96 - IM PAK COV CONTRACTORS EQUIP SCHEDULE AS PER o= ATTACHED AS RESPECTS TO ADDING: 2006 OLYMPIA MILLENNIUM ZAMBONI #RMO60425206 $25.000 a;= NAME AND ADDRESS OF AGENT OR BROKER: COUNTERSIGNED BY: HYLANT GROUP INC (G8433) „c 10401 N MERIDIAN ST STE 200 o.. INDIANAPOLIS, IN 46280 Authorized Representative DATE: IL TO 07 09 87 PAGE 1 OF 1 OFFICE : SAN ANTONIO-EAST 000802 CHANGE EFFECTIVE DATE:02-06.18 ' CHANGE ENDORSEMENT NUMBER:0006 /l TRAVELERS) POLICY NUMBER: H-630-581 M4076-TIL-18 EFFECTIVE DATE: 01-01-18 ISSUE DATE: 03-21-18 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS. IL TO 07 09 87 CHANGE ENDORSEMENT IL T8 01 10 93 FORMS,. ENDORSEMENTS AND SCHEDULE NUMBERS INLAND MARINE CM TO 28 0896 IM PAK COV CONTRACTORS EQUIP SCHEDULE o i= m� o� a oC o o o� IL T8 01 10 93 PAGE : 1 OF 1 000903 CHANGE EFFECTIVE DATE:02-06.18 CHANGE ENDORSEMENT NUMBER:0006 b OVERPRINT/CHANGE SLIP PAGE 1 OF 1 POLICY NUMBER: H-630-581M4076—TIL-18 RATER: GW3F ISSUE DATE : 03/21/18 MUNICIPALITIES GUAR COST EFFECTIVE DATE : 01/01/18 EXPIRATION DATE : 01/01/19 CHANGE EFFECTIVE DATE : 02/06/18 INSUREDS NAME : CITY OF CARMEL PRORATA FACTOR: 0.901 SHORT RATE FACTOR: 0.901 NEW/RENEWAL: R PAYMODE : P SOLICITOR CODE : AUDIT FREQUENCY: N SAI : 5216X7087 RESPONSIBILITY: H MSI : WATCH FILE : 0 RATING MODE : G SURVEY CODE : 2 SPECIAL CODE : REINSURANCE : N PROGRAM CODE : S4M AUTO FILINGS: FEDERAL TAX ID: PREMIUM SUMMARY ACCOUNT EFF . NON S.B. MONTH DATE PREMIUM PREMIUM TOTAL 0318 02/06/18 56.00 0.00 56.00 p= TOTAL: 56.00 0.00 56.00 o� OFFICE : SAN ANTONIO—EAST 24T PRODUCER NAME : HYLANT GROUP INC G8433 000804 CHANGE EFFECTIVE DATE:02.06.18 CHANGE ENDORSEMENT NUMBER:0006 TRAVELERS � PREMIUM SPLIT FORM PAGE 1 OF 1 POLICY NUMBER: H-630-581M4076-TIL-18 RATER: GW3F ISSUE DATE : 03/21/18 COMM ITEM COMM ITEM COMM ITEM COMM ITEM .1000 PREM ACCOUNT EFFECTIVE MONTH DATE PREMIUM PREMIUM PREMIUM PREMIUM 0318. 02/06/18 56 o� a� o o o o OFFICE : SAN ANTONIO-EAST 24T PRODUCER NAME : HYLANT GROUP INC G8433 000805 COMMERCIAL INLAND MARINE - 000608 7 'r. l # f" COMMERCIAL INLAND MARINE . Y r AM TRAVELERS One Tower Square, Hartford,Connecticut 06183 IM PAK COVERAGE POLICY NUMBER:H-630-581 M4076-TIL-18 "CONTRACTORS EQUIPMENT' ISSUE DATE: 03-21-18 SCHEDULE ITEM DESCRIPTION OF ITEMS LIMIT OF INSURANCE 001 LISTED ITEMS & LIMITS OF INSURANCE $ 2,796,623 SHOWN IN THE SCHEDULE ON FILE WITH US, RECEIVED 09/28/2016 002 LEASED OR RENTED ITEMS $250,000 PER ITEM 0 o m� o o o o e d� o o o TOTAL LIMIT OF INSURANCE FOR ALL LISTED ITEMS $ 2,796,623 CM TO 28 08 96 Page 1 (END) 000807 pill Fr I Fall*V-11-Mata Nutt L/alC 1 Fall* NC*GFIFJl1U11 PVIWuIII Package-Commercial Policy# 630581 M4076 Effective: 1/1/17 - 111/18 Issuing Company Travelers Prop Cas Co of Amer 1337001 10/1/2017 3/7/2018 ENDT Add Christkindlmarkt Exposures 969.00 Total Invoice Balance: $969.00 Submitted To MAY 16 2018 Clerk Treasurer HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290 2/20/2018 City of Carmel Loan# Invoice#173151 FARWE1 Page 1 of 1 ZSB'3-OINOWN xvs :3oIaao T 30 T zova LS 60 LO OS 'II :31da ani}e;uesaideN pezljoyjny 08Z9V NI 'SIZodmiaNI OOZ zss is wialdam N TOPOT (££689) oNI dOoun SN1UH :AS a3NJISIMINno0 :uaxoxs do zm!)v 3o sSzHaav amy smtx X 60003LTOOH Tb810TI laIz 3'IOIHHA TIISOW S3I'I AUTIOU 80003LTOOH Tb8'OT MaIz 3'IOIH3A TIIHON laI'I MIOU aaw Os 3'ma3HOS ZNEW1003 SHOID INOo 9NIaNSWrd *** amoessy xzd sy s'mazHos mmdin0a suosovEmKoo - 96 80 8z os No 9NIamw 088'66Z'£$ ox 3oN ansm ao ZIWI'I ZNmI7 va 30 amoKy Nmix iW 9NIamam '080'9b0'£$ OS HOXMSNI 30 SIWI'I SWHZI a3SSI'I 9NIMrdW SMOTIO3 ST SNZKdIOaH SHOIDWINOo 9NICLUMM SMOTIo3 SK azammm SI IVTd Z!)VHZAoo HHIM aRV7NI 7VIDE'ZKKOo 3HS SM0TIo3 sy aHaNmm SI 3oN MSNI SIBS •9e.4oa;;a samooaq doiTod aqg Asp ;o amtg aqg gE LT/TT/ZT mos; aeigoa;;g VDIUMM 30 &MdWOo XIMSVO ][IMO'dd SHWIBA1ES XWdWOo 9NIUMMI 'IIN $ mnimasd 8T/£T/Zo :egva anssi LT/TO/i0 :agsa aetgoa;;B doiTod LT-7IS-9L06WT84-0£9-H :saqunm A6-r rlZK o 30 AIIo :paznsul pamEN SNHKZsuoaNa 39Nf[Ho E8 X90 >nO1138uu03'PJOJUBH 'ajenbS jenmol euo , UNTMAYN1 ££00:N39WnN 1NMUSNOaN3 3JNVHO LVWZ�Mda 3MI03d33 3JMdHO CHANGE EFFECTIVE DATE:12-11-17 CHANGE ENDORSEMENT NUMBER:0033 TRAVELERSJ� POLICY NUMBER: H-630-581144076-TIL-17 EFFECTIVE DATE: 01-01-17 ISSUE DATE: 02-13-18 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS. IL TO 07 09 87 CHANGE ENDORSEMENT IL T8 01 10 93 FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS INLAND MARINE CM TO 28 08 96 IM PAK COV CONTRACTORS EQUIP SCHEDULE IL T8 0110 93 PAGE: 1 OF 1 COMMERCIAL INLAND MARINE .................. .................. '`'`} COMMERCIAL INLAND MARINE A01k TRAVELERS J One Tower Square, Hartford,Connecticut 06183 IM PAK COVERAGE POLICY NUMBER:H-630-581M4076-TIL-17 "CONTRACTORS EQUIPMENT" ISSUE DATE: 02-13-18 SCHEDULE ITEM DESCRIPTION OF ITEMS LIMIT OF INSURANCE 001 LISTED ITEMS 6 LIMITS OF INSURANCE $ 3,046,080 SHOWN IN THE SCHEDULE ON FILE WITH IIS, RECEIVED 09/28/2016 002 LEASED OR RENTED ITEMS $250,000 PER ITEM TOTAL LIMIT OF INSURANCE FOR ALL LISTED ITEMS $ 3,046,080 CM TO 28 08 96 Page 1 (END) CHANGE EFFECTIVE DATE:12-11-17 CHANGE ENDORSEMENT NUMBER:0033 OVERPRINT/CHANGE SLIP PAGE 1 OF 1 POLICY NUMBER: H-630-581M4076-TIL-17 RATER: PK3F ISSUE DATE: 02/13/18 MUNICIPALITIES GUAR COST EFFECTIVE DATE: 01/01/17 EXPIRATION DATE: 01/01/18 CHANGE EFFECTIVE DATE: 12/11/17 INSUREDS NAME: CITY OF CARMEL PRORATA FACTOR: 0.058 SHORT RATE FACTOR: 0.058 NEW/RENEWAL: R PAYMODE: P SOLICITOR CODE: AUDIT FREQUENCY: N SAI: 5216X7087 RESPONSIBILITY: H MSI: WATCH FILE: 0 RATING MODE: G SURVEY CODE: 2 SPECIAL CODE: REINSURANCE: N PROGRAM CODE: S4M AUTO FILINGS: FEDERAL TAX ID: PREMIUM SUMMARY ACCOUNT EFF. NON S.B. MONTH DATE PREMIUM PREMIUM TOTAL 0218 12/11/17 0.00 0.00 0.00 TOTAL: 0.00 0.00 0.00 OFFICE: SAN ANTONIO-EAST 24T PRODUCER NAME: HYLANT GROUP INC G8433 CHANGE EFFECTIVE DATE:12-11-17 CHANGE ENDORSEMENT NUMBER:0033 TRAVELERSJ� PREMIUM SPLIT FORM PAGE 1 OF 1 POLICY NUMBER: H-630-581M4076-TIL-17 RATER: PK3F ISSUE DATE: 02/13/18 COMM ITEM COMM ITEM COMM ITEM COMM ITEM .1000 PREM ACCOUNT EFFECTIVE MONTH DATE PREMIUM PREMIUM PREMIUM PREMIUM 0218 12/11/17 0 OFFICE: SAN ANTONIO-EAST 24T PRODUCER NAME: HYLANT GROUP INC G8433 1Svr3-olmolmv Kvs :HOIA.90 T do T HOW L8 60 LO Oz 'II :31VO anlJeJuasaidazl pezljoy;ny 08296 NI 'SI'IOdYNYIaNI OOZ His is NvilaiEzK N Tom (EE680) OHI dn0U0 2rt7AH :AS a3NOISIMINno3 ndmIoua uo iNHOvT 3o sszuaciv cm mm 'm :azuzm nN (S)oNIa'IIAS oNIMO'I'Io3 HHi acm OZ 000'Os$ uo3 sIWIZ HoNH2moo0 HNo Am Ni aoou AS H'ISlsonaHa ONIaNHw •on :aauam nN (s)oNla'Ilns ONIMo'I'Ioa HHi aav of 000'os* soa sIWIrI HoidH2l2in000 HNo my Ni m ab i2IviH As H'ISIsonaaa ONIaNHw�i 081 :aH2 mim (S)oNIa'IIns ONIMo'Izoa HHi iv 000'000'oT$ uo3 sIWI'I HmHuem 7vnmv mm mmiri HoNHmn000 aoou Wuo3 avto-as - ss0'I 3o sainvro ONlacri '08T aHuamim (S)oNIa'IIAs ONIMo'I'Io3 HHi ivr 000'000'OT$ voa sIW2'I HivTOHHWV 7vnNNvr aNvr MINH Homan mono m?TrdnaHi2TrdH - ssoz 3o sasnv o ONICICN "OST ONIOULIS 08T NOLIV307 aaT of (HsNHaxH v uxxz ami) WZIoa HOv uaAoo Hw0oN2 SSHNISAS Hxn'IHa ONIaNHwfl '9Z9'6ZO'666$ of mmm Aidzaoda TvNosuHa SSHNISAs unox aNhi ONlazlns iH?IIdv E ONIaRZKV sMo'Izo3 sed aaaNam SI iuva HOv azA0o ALazd02id HXn'IHa HHi 'zEo96 Ni ''IHw2lvio NHH2I0 ZImm E :xvi aHivioo'I NHH2iO 2IHiNHO 'IHw?IfiO SVT aHIdnOoO 08T ONICnIAS 'oeT NOIiv oori ONIaavi SMO'PI03 ST H'InaHHOS NOIlVOOz - 96 60 CO Oi 'II ONIaNHwFi sMo'I'Io3 svr aHaNHwvr sl sNoliv moHa aolzoa Nowwoo Hai sMoz'Io3 svr asman SI HommmsNi SIHi •eATgoa33a semooeq AOTTod aq4 dEp ;o OWT4 BIR 4e LT/TO/OT uios; aAT408;;H VOIEHM 30 ANYCIK00 Ai'IvTflsv o LluzaOud SEWIHAMU ANTdW00 ONIHnSNI 696 $ mnTm=d TQuoi,4Tp" 81/ET/ZO :84ea enss2 LT/TO/TO :alma aAi408;;H AOTTod LT-ZIi-9L06WT89-OE9-H :aaqumN xoiToa 'IZKM 30 ASID :peansu2 pa=N iNmmsuoaNH HONvHo £9 WO inOlIoauuoO'pJOPJBH 'ejenbg jemol aup r 21313AYSI 6200:a3avgnN 1N3W3SNOaN3 3JNVHO LVW-%:31da 3AI103=l33 3JNVHO CHANGE EFFECTIVE DATE: 10-01-17 CHANGE ENDORSEMENT NUMBER:0029 OVERPRINT/CHANGE SLIP PAGE 1 OF 1 POLICY NUMBER: H-630-581M4076-TIL-17 RATER: PK3F ISSUE DATE: 02/13/18 MUNICIPALITIES GUAR COST EFFECTIVE DATE: 01/01/17 EXPIRATION DATE: 01/01/18 CHANGE EFFECTIVE DATE: 10/01/17 INSUREDS NAME: CITY OF CARMEL PRORATA FACTOR: 0.252 SHORT RATE FACTOR: 0.252 NEW/RENEWAL: R PAYMODE: P SOLICITOR CODE: AUDIT FREQUENCY: N SAI: 5216X7087 RESPONSIBILITY: H MSI: WATCH FILE: 0 RATING MODE: G SURVEY CODE: 2 SPECIAL CODE: REINSURANCE: N PROGRAM CODE: S4M AUTO FILINGS: FEDERAL TAX ID: PREMIUM SUMMARY ACCOUNT EFF. NON S.B. MONTH DATE PREMIUM PREMIUM TOTAL 0218 10/01/17 969.00 0.00 969.00 TOTAL: 969.00 0.00 969.00 OFFICE: SAN ANTONIO-EAST 24T PRODUCER NAME: HYLANT GROUP INC G8433 CHANGE EFFECTIVE DATE:10-01-17 CHANGE ENDORSEMENT NUMBER:0029 TRAVELERSJM PREMIUM SPLIT FORM PAGE 1 OF 1 POLICY NUMBER: H-630-581M4076-TIL-17 RATER: PK3F ISSUE DATE: 02/13/18 COMM ITEM COMM ITEM COMM ITEM COMM ITEM .1000 PREM ACCOUNT EFFECTIVE MONTH DATE PREMIUM PREMIUM PREMIUM PREMIUM 0218 10/01/17 969 OFFICE: SAN ANTONIO-EAST 24T PRODUCER NAME: HYLANT GROUP INC G8433 item iF -i tans ttt Date Due Date Trans Description Amount Package-Commercial Policy# 630581M4076 Effective: 1/1/18 - 1/1/19 Issuing Company Travelers Prop Cas Co of Amer 1403485 2/28/2018 5/16/2018 ENDT Add(2)Water Dept Buildings 1,482.00 Total Invoice Balance: $1,482.00 SS ii TT MAS( 16 2018 (1erk, Treasurer HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290 5/1/2018 City of Carmel Loan# Invoice#180495 FARWEI Page 1�of CHANGE EFFECTIVE DATE:02-28-18 CHANGE ENDORSEMENT NUMBER:0007 TRAVELERS J One Tower Square, Hartford, Connecticut 06183 CHANGE ENDORSEMENT Named Insured: CITY OF CARMEL Policy Number: H-630-581M4076-TIL-18 Policy Effective Date: 01/01/18 Issue Date: 04/17/18 Additional Premium $ 1 ,482 INSURING COMPANY: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA Effective from 02/28/18 at the time of day the policy becomes effective. THIS INSURANCE IS AMENDED AS FOLLOWS: THE COMMON POLICY DECLARATIONS IS AMENDED AS FOLLOWS: AMENDING IL TO 03 04 96 - LOCATION SCHEDULE AS FOLLOWS: ADDING LOCATION 152, BUILDING 152 OCCUPIED AS .WEST SIDE BOOSTER (WATER DEPT) LOCATED AT: 301 W. 136TH STREET, CARMEL, IN 46032 ADDING LOCATION 153, BUILDING 153 OCCUPIED AS WATER PLANT LOCATED AT: 10675 N. GRAY ROAD, CARMEL, IN 46032 THE DELUXE PROPERTY COVERAGE PART IS AMENDED AS FOLLOWS: AMENDING BLANKET BUILDING AND YOUR BUSINESS PERSONAL PROPERTY LIMIT TO $ 471 ,789,475 AMENDING DELUXE BUSINESS INCOME ' (AND EXTRA EXPENSE) COVERAGE FORM TO ADD LOCATION 152,153, BUILDING 152,153 o� '= NAME AND ADDRESS OF AGENT OR BROKER: COUNTERSIGNED BY: '-� HYLANT GROUP INC (G8433) 10401 N MERIDIAN ST STE 200 INDIANAPOLIS, IN 46280 Authorized Representative DATE: p IL TO 07 09 87 PAGE 1 OF 1 OFFICE : SAN ANTONIO-EAST 000320