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Home My WebLink About330227 09/19/18 +°r c�A3 ,� CITY OF CARMEL, INDIANA VENDOR: 362876 ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $*****4,585.73* s. ,'r CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 330227 9M�<3oef��°'9 9 CHICAGO IL 60693 CHECK DATE: 09/19/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 000543917 828.80 GENERAL INSURANCE 1205 4347500 000544196 3,756.93 GENERAL INSURANCE VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) ALLOWED 20 ACCOUNTS PAYABLE VOUCHER Vendor# 362876 TRAVELERS IN SUM OF$ 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 $4,585.73 Purchase Order# ON ACCOUNT OF APPROPRIATION FOR 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 000543917 43-475.00 $828.80 1 hereby certify that the attached invoice(s),or 8/31/18 000543917 Current charges $828.80 1205 101 1205 101 000544196 43-475.00 $3,756.93 bill(s)is(are)true and correct and that the 8/31/18 000544196 E9M0498 $3,756.93 1205 101 1 materials or services itemized thereon for 1205 1 101 which charge is made were ordered and received except Tuesday,September 11,2018 A-C-0 CL� 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 TRAVE�LERSJ� PAGE 1 DEDUCTIBLE / SELF-INSURED INVOICE POLICY NUMBERDUE TOTAL 14TG2033-ZLP 5216X7087 08/31/2018 000543917 09/15/2018 1,428.90 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL 13607 COLLECTIONS CENTER DRIVE ONE CIVIC SQUARE CHICAGO, IL 60693 CARMEL IN 46032 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE WRITE THE POLICY & ACCOUNT NUMBER ON YOUR CHECK. TRAVELERS J� 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 DUF 14TG2033-ZLP 5216X7087 08/31/2018 000543917 09/15/2018 1 8.90 CURRENT 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 452.40 CLAIM TOTAL 452.40 CLAIM#: FBU4031 DATE OF LOSS: 11/13/2017 DESCRIPTION: EMPLOYEE ALLEGES DISCRIMINATION IN THE WORK PLACE CLAIMANT: LISA STEWART EXPENSE 234.00 CLAIM TOTAL 234.00 CLAIM#: FDT3482 DATE OF LOSS: 08/08/2018 DESCRIPTION: GLIA C - GARRIDO, MARIA TORT NOTICE ALLEGING THAT INSURED WAS MOWING A CLAIMANT: MARIA GALAN /CLAIM LOSS 142.50 TOTAL 142.50 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 1,310.40 CLAIM TOTAL 1,310.40 SEP 11 2018 TRAVELERS PAGE 2 DEDUCTIBLE / SELF-INSURED INVOICE POLICY NUMBER ACCOUNTBILL NUMBER PAYMENT DUE TOTAL DUE' 1.4TG2033-ZLP 5216X7087 08/31/2018 000543917 09/15/2018 1,428.90 PAST DUE CHARGES CONTINUED 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 PEXPENSE 327.60 CLAIM TOTAL 327.60 TOTAL CLAIM(S) DUE $2,591.70 ACCOUNT SUMMARY CURRENT CHARGES 828.90INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 1, .80 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 1, 162.80- AGENT PHONE: (317) 817-5000 TOTAL DUE 1,428.90 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 1 ,428.90 loco oo 5L b_, 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 Lj �g�G� TRAVELERS PAGE i DEDUCTIBLE / SELF- INSURED INVOICE POLICY NUMBER ACCOUNTBILL DATE BILL NUMBER PAYMENT DUE TOTAL 3036P64A-810 5216X7087 08/31/2018 000544196 09/15/2018 3,756.93 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL,CARMEL CLAY 13607 COLLECTIONS CENTER DRIVE ONE CIVIC SQUARE CHICAGO, IL 60693 CARMEL IN 46032 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE .WRITE THE POLICY & ACCOUNT NUMBER ON YOUR CHECK. TRAVELERS PAGE i POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE 3036P64A-810 521GX7087 08/31/2018 000544196 09/15/2018 3,756.93 CURRENT CHARGES ' CLAIM#: E9M0498 DATE OF LOSS: 07/26/2017 DESCRIPTION: BAUT C - SCHNEIDER,_KIMBERLEY CV WAS SB ON RANGELINE RD STOPPED AT THE CLAIMANT: KIMBERLY SCHNEIDER LOSS 3,756.93 CLAIM TOTAL 3,756.93 TOTAL CLAIMS) DUE $3,756.93. ACCOUNT SUMMARY CURRENT CHARGES 3,756.93 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 3,755.93 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 3,756.93 .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 SEP 11 2018