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327769 07/20/18 i us.C^�Ab CITY OF CARMEL, INDIANA VENDOR: 00352999 �� ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $*****3,459.00* �. ,_�; CARMEL, INDIANA 46032 PO 80X 638720 CHECK NUMBER: 327769 p��rmi'�O CINCINNATI OH 45263-8720 CHECK DATE: 07/20/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 166867 -1,669.00 GENERAL INSURANCE 1205 4347500 176995 4,995.00 GENERAL INSURANCE 1205 4347500 187044 133.00 GENERAL INSURANCE VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 00352999 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER HYLANT GROUP IN SUM OF$ CITY OF CARMEL PO BOX 638720 An invoice or bill to be property 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 $3,459.00 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 176995 43-475.00 $4,995.00 1 hereby certify that the attached invoice(s),or 3/30/18 176995 $4,995.00 1205 101 1205 101 166867 43-475.00 ($1,669.00) bill(s)is(are)true and correct and that the 7/10/18 166867 Amended Premium Basis ($1,669.00) 1205 101 materials or services itemized thereon for 1205 1 101 187044 43-475.00 $133.00 7/10/18 I 187044 I I $133.00 1205 101 which charge is made were ordered and 1205 101 received except Wednesday,July 11,2018 CA-4 - c� 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 Please Return Top with Remittance To: PO Box 638720,Cincinnati,OH 45263-8720 _ .____ Item# Trans Eff Date Due Date Trans 4 Description E Amount _ Executive Risk Package Policy# 105770103 Effective: 4/12/18 - 4/12/19 Issuing Company Travelers Cas&Surety of Amer 1374250 4/12/2018 4/12/2018 RENB 18/19 Executive Risk Package 1,195.00 General Liability Policy# 6605046C259 Effective: 4/12/18 - 4/12/19 Issuing Company Travelers Prop Cas Co of Amer 1374248 4/12/2018 4/12/2018 RENB 18/19 General Liability 3,800.00 Total Invoice Balance: $4,995.00 �—1 ibm-11-tted To JUL 11 2018 Clerk Treasurer HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290 3/30/2018 Carmel Farmers Market,Inc. Loan# Invoice#176995 FARWEI Page 1 of 1 Please Return Top with Remittance To: PO Box 638720,Cincinnati,OH 45263-8720 Item# Trans�Eff Date��Due Date Trans _ f 'Description�y J gAmount General Liability Policy# 6605046C259 Effective: 4/12/17 - 4/12/18 Issuing Company Travelers Prop Cas Co of Amer 1278436 4/12/2017 12/21/2017 ENDT Amend Premium Basis (1,669.00) Total Invoice Balance: ($1,669.00) ateT&, iaZ n, JUL 11 2018 HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290 7/10/2018 Carmel Farmers Market,Inc. Loan# Invoice#166867 FARWE1 Page 1 of 1 Please Return Top with Remittance To: PO Box 638720,Cincinnati,OH 45263-8720 __ —_. - - -------D- -'-Due- - ------- - ____.i.__-- ------ Item# Trans Eff 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 1460919 3/22/2018 7/25/2018 ENDT Add 2711 E.96th Street 92.00 1460924 5/24/2018 7/25/2018 ENDT Add ATV to Sewer Dept 41.00 Total Invoice Balance: $133.00 Sub, ; PRODUCER CHANGE EFFECTIVE DATE:05-24.18 CHANGE ENDORSEMENT NUMBER:0010 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: 06/15/18 Additional Premium $ 41 INSURING COMPANY: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA Effective from 05/24/18 ,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 CONTRACTORS EQUIPMENT AS FOLLOWS: AMENDING LISTED ITEMS LIMIT OF INSURANCE TO $2,789,924. AMENDING "MAXIMUM AMOUNT OF PAYMENT" LIMIT OF INSURANCE TO $3,039,924. AMENDING "FLOOD LIMIT OF INSURANCE" TO $3,039,924. AMENDING "FLOOD ANNUAL AGGREGATE LIMIT OF INSURANCE TO $3,039,924. AMENDING "EARTH MOVEMENT LIMIT OF INSURANCE TO $3,039,924. AMENDING "EARTH MOVEMENT ANNUAL AGGREGATE LIMIT OF INSURANCE TO $ 3,039,924. AMENDING CM TO 28 08 96 - CONTRACTORS EQUIPMENT SCHEDULE AS PER ATTACHED. AMENDING SCHEDULED PROPERTY AS FOLLOWS: AMENDING COVERED ITEMS LIMIT OF INSURANCE TO $4,803,785. AMENDING "FLOOD LIMIT OF INSURANCE" TO $4,803,785. AMENDING "FLOOD ANNUAL AGGREGATE LIMIT OF INSURANCE TO $4,803,785. AMENDING "EARTH MOVEMENT LIMIT OF INSURANCE TO $4,803,785. AMENDING "EARTH MOVEMENT ANNUAL AGGREGATE LIMIT OF INSURANCE TO $ NAME AND ADDRESS OF AGENT OR BROKER: COUNTERSIGNED BY: HYLANT GROUP INC (G8433) /��l'Q Q 10401 N MERIDIAN ST STE 200 (�'�1 o' INDIANAPOLIS, IN 46280 Authorized Representative o� DATE: IL TO 07 09 87 PAGE 1 OF 2 �— OFFICE: SAN ANTONIO-EAST 0o23M CHANGE EFFECTIVE DATE:05-2418 CHANGE ENDORSEMENT NUMBER:0010 AM TRAVELERS J One Tower Square, Hartford, Connecticut 06183 CHANGE ENDORSEMENT Policy Number: H-630-581M4076-TIL-18 Pol i cy. Effecti ve Date: 01/01/18 Issue Date: 06/15/18 4,803,785. AMENDING CM TO 29 08 96 - IM PAK COV SCHEDULED PROPERTY SCHEDULE AS PER ATTACHED. o. o o d IL TO 07 09 87 PAGE 2 OF 2 OFFICE : SAN ANTONIO-EAST 24T PRODUCER NAME: HYLANT GROUP INC G8433 • 0=21 CHANGE EFFECTIVE DATE:05-24.18 CHANGE ENDORSEMENT NUMBER:0010 r >t OVERPRINT/CHANGE SLIP PAGE 1 OF 1 POLICY NUMBER: H-630-581M4076-TIL-18 RATER: PK27 ISSUE DATE : 06/15/18 MUNICIPALITIES GUAR COST EFFECTIVE DATE: 011/01/118 EXPIRATION DATE: 01/01/19 CHANGE EFFECTIVE DATE : 05/24/18 INSUREDS NAME : CITY OF CARMEL PRORATA FACTOR: 0.608 SHORT RATE FACTOR: 0.608 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 0618 05/24/18 41 .00 0.00 41 .00 o o o TOTAL: 41 .00 0.00 411 .00 o o OFFICE: SAN ANTONIO-EAST 24T PRODUCER NAME : HYLANT GROUP INC G8433 002322 r CHANGE EFFECTIVE DATE:05.2418 CHANGE ENDORSEMENT NUMBER:0010 A TRAVELERSJ PREMIUM SPLIT FORM PAGE 1 OF 1 POLICY NUMBER: H-630-581M4076-TIL-18 RATER: PK27 ISSUE DATE: 06/15/18 COMM ITEM COMM ITEM COMM ITEM COMM ITEM .1000 PREM ACCOUNT EFFECTIVE MONTH DATE PREMIUM PREMIUM PREMIUM PREMIUM 0618 05/24/18 41 �r— o o� i o.s o. OFFICE : SAN ANTONIO-EAST 24T PRODUCER NAME : HYLANT GROUP INC G8433 002323