HomeMy WebLinkAbout328803 08/14/18 �(' "� CITY OF CARMEL, INDIANA VENDOR: 362876
® ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $*****1,162.80*
:q J��; CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 328803
y,��aN�. CHICAGO IL 60693 CHECK DATE: 08/14/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000542374 1,162.80 GENERAL INSURANCE
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 362876 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
TRAVELERS IN SUM OF$ 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
$1,162.80
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
000542374 43-475.00 $1,162.80 1 hereby certify that the attached invoice(s),or 7/31/18 000542374 $1,162.80
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
Monday,August 13,2018
Ac-_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
20Cost 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
14T62033-ZLP 5216X7087 07/31/2018 000542374 08/15/2018 i-I ,9 2
b* 2 .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 1,310.40
CLAIM TOTAL 1,310.40
CLAIM#: FBU4031 DATE OF LOSS: 11/13/2017
DESCRIPTION: EMPLOYEE ALLEGES DISCRIMINATION IN THE WORK PLACE
CLAIMANT: LISA STEWART
EXPENSE 124.80
CLAIM TOTAL 124.80
CLAIM#: FBU4032 DATE OF LOSS: 11/03/2017
DESCRIPTION: EMPLOYEE ALLEGING DISCRIMINATION IN THE WORK PLACE
CLAIMANT: KYLE N SMITH
EXPENSE 327.60
CLAIM TOTAL 327.60
PAST DUE 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
( AUG 0 9 2018
TRAVELERS J, PAGE 2
DEDUCTIBLE / SELF-INSURED INVOICE
• i ipi, : I i
11111
14T62033-ZLP 521GX7087 07/31/2018 000542374 08/15/2018 2,932.80
PAST DUE CHARGES CONTINUED
CLAIM#: FBU4031 DATE OF LOSS: 11/13/2017
DESCRIPTION: EMPLOYEE ALLEGES DISCRIMINATION IN THE WORK PLACE
CLAIMANT: LISA STEWART
EXPENSE d795.1130
95.60
CLAIM TOTAL
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 15.50
TOTAL CLAIMS) DUE $2,932.80
ACCOUNT SUMMARY
CURRENT CHARGES 1,762.80 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 1, 170.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 2.932.80
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 2.932.80
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