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329480 08/30/18 (��_,qMf. CITY OF CARMEL, INDIANA VENDOR: 00352999 (.;® CHECK AMOUNT: $********42.00* ONE CIVIC SQUARE HYLANT GROUP �. a CARMEL, INDIANA 46032 PO BOX 638720 CHECK NUMBER: 329480 °�,,�TON�.` CINCINNATI OH 45263-8720 CHECK DATE: 08/30/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 191604 42.00 GENERAL INSURANCE VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995) Vendor# 00352999 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER HYLANT GROUP IN SUM OF$ CITY OF CARMEL PO BOX 638720 An invoice or bill to be 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. CINCINNATI, OH 45263-8720 Payee $42.00 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 191604 43-475.00 $42.00 I hereby certify that the attached invoice(s),or 8/29/18 191604 Policy 630581m4076 $42.00 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 Thursday,August 30,2018 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 Package-Commercial Policy# 630581M4076 Effective: 1/1/18 - 1/1/19 Issuing Company Travelers Prop Cas Co of Amer 1507186 8/7/2018 9/13/2018 ENDT Add Library Booth&Benches 42.00 Total Invoice Balance: $42.00 S b,-a ate To AUG 3 0 2018 �R TC es } �^,��i 6 r HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290 8/29/2018 City of Carmel Loan# Invoice#191604 FARWE1 Page 1 of 1 ' PRODUCER CHANGE EFFECTIVE ENDORSEMENT NUMBER 0018 TRAVELERS AlmJ One Tower Square,Hartford,Connecticut 06193 CHANGE ENDORSEMENT Named Insured: CITY OF CARMEL Policy Number: H-630-581M4076-TIL-18 Pot i cy Effective Date: 01/01/18 Issue Date: 08/16/18 Additional Premium $ 42 INSURING COMPANY: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA Effective from 08/07/18 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 SCHEDULED PROPERTY AS FOLLOWS: AMENDING COVERED ITEMS LIMIT OF INSURANCE TO $4,827,535. AMENDING "FLOOD LIMIT OF INSURANCE" TO $4,827,535. AMENDING "FLOOD ANNUAL AGGREGATE LIMIT OF INSURANCE TO $4,827,535. AMENDING "EARTH MOVEMENT LIMIT OF INSURANCE TO $4,827,535. AMENDING "EARTH MOVEMENT ANNUAL AGGREGATE LIMIT OF INSURANCE TO $4,827,535. AMENDING CM TO 29 08 96 - IM PAK COV SCHEDULED PROPERTY SCHEDULE AS PER ATTACHED. e= o� o= o o� o; NAME AND ADDRESS OF AGENT OR BROKER: COUNTERSIGNED BY: HYLANT GROUP INC (G8433) „c 10401 N MERIDIAN ST STE 200 INDIANAPOLIS, IN 46280 Authorized Representative o DATE: IL TO 07 09 87 PAGE 1 OF 1 OFFICE : SAN ANTONIO-EAST 002021 CHANGE EFFECTNE DATE:08.07-18 All CHANGE ENDORSEMENT NUMBER:0015 TRAVELERSJ POLICY NUMBER: H-630-581 M4076-TIL-18 EFFECTIVE DATE: 01-01-18 ISSUE DATE: 08-16-18 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS. IL TO O7 09 87 CHANGE ENDORSEMENT IL T8 01 10 93 FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS INLAND MARINE CM TO 29 08 96 IM PAK COV SCHEDULED PROPERTY SCHEDULE 0 o� oC o� o� a� o o� IL T8 01 10 93 PAGE: 1 OF 1 002022 CHANGE EFFECTIVE DATE:08.07-18 CHANGE ENDORSEMENT NUMBER:0015 OVERPRINT/CHANGE SLIP PAGE 1 OF 1 POLICY NUMBER: H-630-581M4076—TIL-18 RATER: AK3E ISSUE DATE: 08/16/18 MUNICIPALITIES GUAR COST EFFECTIVE DATE: 01/01/18 EXPIRATION DATE : 01/01/19 CHANGE EFFECTIVE DATE : 08/07/18 INSUREDS NAME : CITY OF CARMEL PRORATA FACTOR: 0.403 SHORT RATE FACTOR: 0.403 NEW/RENEWAL: R PAYMODE : P SOLICITOR CODE : AUDIT FREQUENCY: N SAI : 521GX7087 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 0818 08/07/18 42.00 0.00 42.00 o� a� o� o; TOTAL: 42.00 0.00 42.00 o� o� OFFICE : SAN ANTONIO—EAST 24T PRODUCER NAIVE: : HYLANT GROUP INC G8433 002023 CHANGE EFFECTNE DATE:08.07-18 CHANGE ENDORSEMENT NUMBER:0015 TRAVELERSI PREMIUM SPLIT FORM PAGE 1 OF 1 POLICY NUMBER: H-630-581M4076—TIL-18 RATER: AK3E ISSUE DATE : 08/16/18 COMM ITEM COMM ITEM COMM ITEM COMM ITEM .1000 PREM ACCOUNT EFFECTIVE MONTH DATE PREMIUM PREMIUM PREMIUM PREMIUM 0818 08/07/18 42 o� oC o� m— e; o� oC OFFICE : SAN ANTONIO—EAST 24T PRODUCER NAME : HYLANT GROUP INC G8433 002024 COMMERCIAL INLAND MARINE m= 002025 COMMERCIAL INLAND MARINE i TRAVELERSI One Tower Square, Hartford, Connecticut 06183 IM PAK' COVERAGE POLICY NUMBER: H-630-581 M4076-TIL-18 "SCHEDULED PROPERTY" ISSUE DATE: 08-16-18 SCHEDULE "Scheduled Items" ITEM DESCRIPTION OF ITEM LIMIT OF INSURANCE 001 SCHEDULED PROPERTY ITEMS & LIMITS OF $4,827,535 INSURANCE SHOWN IN THE SCHEDULE ON FILE WITH US, RECEIVED 09-28-2016 TOTAL "SCHEDULED ITEMS" LIMIT OF INSURANCE FOR ALL COVERED ITEMS$ 4,827,535 "Fine Arts" ITEM DESCRIPTION OF ITEM LIMIT OF INSURANCE 001 FINE ARTS $1 ,903,075 TOTAL "FINE ARTS" LIMIT OF INSURANCE FOR ALL COVERED ITEMS $ 1 ,903,075 o= o. o� o o� o o CM TO 29 08 96 Page 1 (END) 002020 PRODUCER CHANGE ENDORSEMENT NUMBER 0016 TRAVELERS J One Tower Square, Hartford,Connecticut 06183 CHANGE ENDORSEMENT Named Insured: CITY OF CARMEL Policy Number: H-630-581M4076-TIL-18 Pol i cy E f fect 1 ve Date: 01/01/18 Issue Date: 08/16/18 Additional Premium $ 42 INSURING COMPANY: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA Effective from 08/07/18 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 SCHEDULED PROPERTY AS FOLLOWS: AMENDING COVERED ITEMS LIMIT OF INSURANCE TO $4,827,535. AMENDING "FLOOD LIMIT OF INSURANCE" TO $4,827,535. AMENDING "FLOOD ANNUAL AGGREGATE LIMIT OF INSURANCE TO $4,827,535. AMENDING "EARTH MOVEMENT LIMIT OF INSURANCE TO $4,827,535. AMENDING "EARTH MOVEMENT ANNUAL AGGREGATE LIMIT OF INSURANCE TO $4,827,535. AMENDING CM TO 29 08 96 - IM PAK COV SCHEDULED PROPERTY SCHEDULE AS PER ATTACHED. C n� nr- o� o� m� S_ of - NAME AND ADDRESS OF AGENT OR BROKER: COUNTERSIGNED BY: HYLANT GROUP INC (G8433) 10401 N MERIDIAN ST STE 200 o� INDIANAPOLIS, IN 46280 Authorized Representative o� DATE: IL TO 07 09 87, PAGE 1 OF 1 OFFICE : SAN ANTONIO-EAST 002021 CHANGE EFFECTIVE DATE:08.07-18 i� CHANGE ENDORSEMENT NUMBER:0015 TRAVELERSJ POLICY NUMBER: H-630-581 M4076-TIL-18 EFFECTIVE DATE: 01-01-18 ISSUE DATE: 08-16-18 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS. IL TO 07 09 87 CHANGE ENDORSEMENT IL T8 01 10 93 FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS INLAND MARINE CM TO 29 08 96 IM PAK COV SCHEDULED PROPERTY SCHEDULE C� O� O� O� O� w� w� O� O� IL T8 01 10 93 PAGE : 1 OF 1 002022 CHANGE EFFECTIVE DATE:08.07-18 CHANGE ENDORSEMENT NUMBER:0015 OVERPRINT/CHANGE SLIP PAGE 1 OF 1 POLICY NUMBER: H-630-581M4076—TIL-18 RATER: AK3E ISSUE DATE: 08/16/18 MUNICIPALITIES GUAR COST EFFECTIVE DATE: 01/01/18 EXPIRATION DATE : 01/01/19 CHANGE EFFECTIVE DATE : 08/07/18 INSUREDS NAME : CITY OF CARMEL PRORATA FACTOR: 0.403 SHORT RATE FACTOR: 0.403 NEW/RENEWAL: R PAYMODE : P SOLICITOR CODE : AUDIT FREQUENCY: N SAI : 521GX7087 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 0818 08/07/18 42.00 0.00 42.00 o o. o� o; TOTAL: 42.00 0.00 42.00 00 IMo. OFFICE : SAN ANTONIO—EAST 24T PRODUCER NAME : HYLANT GROUP INC G8433 002023 CHANGE EFFECTIVE DATE:08.07-18 CHANGE ENDORSEMENT NUMBER:0015 TRAVELERS PREMIUM SPLIT FORM PAGE 1 OF 1 POLICY NUMBER: H-630-581M4076—TIL-18 RATER: AK3E ISSUE DATE : 08/16/18 COMM ITEM COMM ITEM COMM ITEM COMM ITEM .1000 PREM ACCOUNT EFFECTIVE MONTH DATE PREMIUM PREMIUM PREMIUM PREMIUM 0818 08/07/18 42 o_ oC oC o� a; o� oC OFFICE : SAN ANTONIO—EAST 24T PRODUCER NAME : HYLANT GROUP INC G8433 002024 COMMERCIAL INLAND MARINE _ 002025 r COMMERCIAL INLAND MARINE TRAVELERSr One Tower Square, Hartford,Connecticut 06183 IM PAK! COVERAGE POLICY NUMBER: H-630-581 M4076-TIL-18 "SCHEDULED PROPERTY" ISSUE DATE: 08-16-18 SCHEDULE "Scheduled Items" ITEM DESCRIPTION OF ITEM LIMIT OF INSURANCE 001 SCHEDULED PROPERTY ITEMS & LIMITS OF $4.827,535 INSURANCE SHOWN IN THE SCHEDULE ON FILE WITH US, RECEIVED 09-28-2016 TOTAL "SCHEDULED ITEMS" LIMIT OF INSURANCE FOR ALL COVERED ITEMS$ 4.827,535 "Fine Arts" ITEM DESCRIPTION OF ITEM LIMIT OF INSURANCE 001 FINE ARTS $1 ,903,075 TOTAL "FINE ARTS" LIMIT OF INSURANCE FOR ALL COVERED ITEMS $ 1 ,903,075 m� nP� O� Os of o� o� CM TO 29 06 96 Page 1 (END) 002026