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Home My WebLink About327910 07/20/18 CITY OF CARMEL, INDIANA VENDOR: 362876 ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $*****1,170.00* i. CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 327910 9M,IroN'c�. CHICAGO IL 60693 CHECK DATE: 07/20/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 000541260 1,170.00 GENERAL INSURANCE VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995) Vendor# 362876 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER TRAVELERS IN SUM OF$ 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 $1,170.00 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 000541260 43-475.00 $1,170.00 1 hereby certify that the attached invoice(s),or 6/29/18 000541260 $1,170.00 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 Tuesday,July 17,2018 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 distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer TRAVELERS PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE 14T62033-ZLP 521GX7087 06/29/2018 000541260 07/15/2018 3, 80 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 358.80 CLAIM TOTAL 358.80 CLAIM#: FBU4031 DATE OF LOSS: 11/13/2017 DESCRIPTION: EMPLOYEE ALLEGES DISCRIMINATION IN THE WORK PLACE CLAIMANT: LISA STEWART EXPENSE 795.60 CLAIM TOTAL 795.60 CLAIM#: FBU4032 DATE OF LOSS: 11/03/2017 DESCRIPTION: EMPLOYEE ALLEGING DISCRIMINATION IN THE WORK PLACE CLAIMANT: KYLE N SMITH EXPENSE 15.60 CLAIM TOTAL 15.60 PAST DUE CHARGES CLAIM#: E4E8597 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 Subrm t:,ed To JUL 17 2018 WRk TRAVELERS/ J PAGE 2 DEDUCTIBLE / SELF- INSURED INVOICE POLICY NUMBER ACCOUNT : DUE TOTAL 14T62033-ZLP 521GX7087 06/29/2018 000541260 07/15/2018 3,634.80 PAST DUE CHARGES CONTINUED CLAIM#: FBU4031 DATE OF LOSS: 11/13/2017 DESCRIPTION: EMPLOYEE ALLEGES DISCRIMINATION IN THE WORK PLACE CLAIMANT: LISA STEWART EXPENSE 312.00 CLAIM TOTAL 312.00 CLAIM#: FBU4032 DATE OF LOSS: 11/03/2017 DESCRIPTION: EMPLOYEE ALLEGING DISCRIMINATION IN THE WORK PLACE CLAIMANT: KYLE N SMITH EXPENSE 93.60 CLAIM TOTAL 93.60 TOTAL CLAIM(S) DUE $3,634.80 ACCOUNT SUMMARY CURRENT CHARGES 1, 170.00 Jfi INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 2,464.80 LT AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 3,634.80 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 3,634.80 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 TRAVELERS J 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'.