HomeMy WebLinkAbout331113 10/12/18 d,C�q
�/ tF� CITY OF CARMEL, INDIANA VENDOR: 362876
® ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $*****1,638.00*
:9� �,, CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 331113
MUTON�. CHICAGO IL 60693 CHECK DATE: 10/12/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000545508 1,638.00 GENERAL INSURANCE
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 362876 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
TRAVELERS IN SUM OF$ 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
$1,638.00
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
000545508 43-475.00 $1,638.00 1 hereby certify that the attached invoice(s),or 9/28/18 000545508 claims $1,638.00
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,October 16,2018
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
TRAVELERS PAGE 1
DEDUCTIBLE / SELF-INSURED INVOICE
POLICY iTOTAL
14T62033—ZLP 5216X7087. 09/28/2018 000545508 10/15/2018 2,466.90
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, PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
POLICYAUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE
14TG2033—ZLP 5216X7087 09/28/2018 000545508 10/15/2018 13 , � 2 .90
CURRENT CHARGES colD
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 577.20
CLAIM TOTAL 577.20
CLAIM#: FBU4031 DATE OF LOSS: 11/13/2017
DESCRIPTION: EMPLOYEE ALLEGES DISCRIMINATION IN THE WORK PLACE
CLAIMANT: LISA STEWART
EXPENSE 1,060.80
CLAIM TOTAL 1,060.80
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 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
r-t Av�;.,, _,,�,n.n,�.��� r7 EXPENSE 234.00
�� y`��^,W��� '"i ` CLAIM TOTAL 234.00
OCT 09 2018 ri
TRAVELERS PAGE 2
DEDUCTIBLE / SELF- INSURED INVOICE
NUMBERPOLICY iTOTAL
14TG2033-ZLP 521GX7087 09/28/2018 000545508 10/15/2018 2,466.90
PAST DUE CHARGES CONTINUED
CLAIM#: FDT3482 DATE OF LOSS: 08/08/2018
DESCRIPTION: GLIA C - GARRIDO, MARIA TORT NOTICE ALLEGING THAT
INSURED WAS MOWING A
CLAIMANT: MARIA GALAN
LOSS 142.50
CLAIM TOTAL 142.50
TOTAL CLAIM(S) DUE $2,466.90
ACCOUNT SUMMARY
CURRENT CHARGES 1,638.00 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 8.90 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 2,466.90
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 2,466.90
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