HomeMy WebLinkAbout325668 05/23/18 CITY OF CARMEL, INDIANA VENDOR: 362876
i1 ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $*****5,124.80*
x• ,aa; CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 325668
9M�roN_�o. CHICAGO IL 60693 CHECK DATE: 05/23/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000538065 5,124.80 GENERAL INSURANCE
VOUCHER NO. WARRANT NO. _ Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 362876 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
TRAVELERS IN SUM OF$ 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
$5,124.80
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
000538065 43-475.00 $5,124.80 1 hereby certify that the attached invoice(s),or 4/30/18 000538065 $5,124.80
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, May 15,2018
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
TRAVELERS PAGE 1
14T62033-ZLP 5216X7087 04/30/2018 000538065 05/15/2018 5, 124.80
CURRENT CHARGES
CLAIM#: EZK3495 DATE OF LOSS: 11/03/2013
DESCRIPTION: SLIP AND FALL ON SIDEWALK PAVER
CLAIMANT: SUE POTASNIK -
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 78.00
CLAIM TOTAL 78.00
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 46.80
CLAIM TOTAL 46.80
TOTAL CLAIM(S) DUE $5,124.80
SuWrn-i-l-ted To
MAY 0 9 2018
05-07-18PO4: 13 RCVD
TRAVELERS) PAGE 2
DEDUCTIBLE / SELF-INSURED INVOICE
• i : i i
14TG2033-ZLP 5216X7087 04/30/2018 000538065 05/15/2018 5, 124.80
ACCOUNT SUMMARY
CURRENT CHARGES 5, 124.80 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. 124.80
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 5, 124.80
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