HomeMy WebLinkAbout326988 06/29/18 �Aq� CITY OF CARMEL, INDIANA VENDOR: 362876
` ,• ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $*****2,464.80*
9� _� CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 326988
MUTON�. CHICAGO IL 60693 CHECK DATE: 06/29/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000539624 2,464.80 GENERAL INSURANCE
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 362876 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
TRAVELERS IN SUM OF$ CITY OF CARMEL
13607 COLLECTIONS CENTER DRIVE An invoice or bill to be properly itemized must show:kind of service,when;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
$2,464.80
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
000539624 43-475.00 $2,464.80 1 hereby certify that the attached invoice(s),or 5/31/18 000539624 $2,464.80
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,June 19,2018
A4__Vcl�
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
TRAVELERSPAGE ,
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
14TG2033-ZLP 5216X7087 05/31/2018 • 000539624 06/15/2018 7 89.60
CURRENT CHARGES �( 1
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 2,059.20
CLAIM TOTAL 2,059.20
CLAIM#: FBU4031 DATE OF LOSS: 11/13/2017
DESCRIPTION: EPLI C = STEWART, LISA EEOC COMPLAINT ALLEGING
VIOLATION OF THE ADAAA
CLAIMANT:- LISA STEWART
EXPENSE 312.00
CLAIM TOTAL 312.00
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 93.60
CLAIM TOTAL 93.60
PAST DUE CHARGES
CLAIM#: EZK3495 DATE OF LOSS: 11/03/2013
DESCRIPTION: SLIP AND FALL ON SIDEWALK PA .��,,__ --
CLAIMANT: SUE POTASNIK S,ub ifted �o LOSS 5,000.00
CLAIM TOTAL 5,000.00
JUN 19 2018
TRAVELERS PAGE 2
DEDUCTIBLE / SELF-INSURED INVOICE
POLICY NUMBER ACCOUNT NUMBERTOTAL
14TG2033-ZLP 52.16X7087 05/31/2018 000539624 06/15/2018 7,589.60
PAST DUE CHARGES CONTINUED.'
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
-------- -- - --- ----- .. ..... .. . ........ CLAIMTOTAL78.00
-
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 $7,589.60
ACCOUNT SUMMARY
CURRENT. CHARGES2,464.80 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 5, 2 ..-P� AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 7,589.60
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 7,589.60
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
TRAVELERSJ
In an effort.to "go green" - a company wide initiative - we are asking our
customers to begin receiving deductible invoices via email. The email will be sent
from a Travelers' mailbox with the deductible invoice attached as a PDF file.
Please contact the Accounting Specialist that is listed at the bottom of the
enclosed invoice or send an email to deductible-helpdesk@travelers.com
referencing your policy #to make the change to email today.
Thank you for your consideration of this paperless, go green option.