HomeMy WebLinkAbout333755 12/19/18 0CITY OF CARMEL, INDIANA VENDOR: 362876
I; ® I ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $*****4,476.80*
?� CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 333755
.y�TON�°, CHICAGO IL 60693 CHECK DATE: 12/19/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 5216X7087 4,476.80 GENERAL INSURANCE
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 362876 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
TRAVELERS IN SUM OF$ 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
$4,476.80
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
000548739 43-475.00 $4,476.80 1 hereby certify that the attached invoice(s),or 11/30/18 000548739 Policy 14T62033-ZLP $4,476.80
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, December 17,2018
CA-4 dc.�
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
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE
14TG2033-ZLP 5216X7087 11/30/2018 000548739 12/15/2018 4,476.80
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 109.20
CLAIM TOTAL 109.20
CLAIM#: FBU4031 DATE OF LOSS: 11/13/2017
DESCRIPTION: EMPLOYEE ALLEGES DISCRIMINATION IN THE WORK PLACE
CLAIMANT: LISA STEWART
EXPENSE 62.40
CLAIM TOTAL 62.40
CLAIM#: FDT8868 DATE OF LOSS: 10/06/2016
DESCRIPTION: ALLEGATIONS OF FALSE ARREST/DETAINMENT WHICH RESULTED
IN THE CLAIMANT
CLAIMANT: PATRICK MCCALLEY
EXPENSE 2,542.40
CLAIM TOTAL 2,542.40
CLAIM#: FDTS614 DATE OF LOSS: 10/26/2018
DESCRIPTION: EEOC CHARGE, ALLEGED AGE DISCRIMINATION
CLAIMANT: CHAD HUGHES
EXPENSE 1,762.80
CLAIM TOTAL 1,762.80
TOTAL CLAIM(S) DUE $4,476.80 .
4
DEC 14 2018
PAGE 2
TRAVELERS/
DEDUCTIBLE / SELF-INSURED INVOICE
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL
14TG2033-ZLP 5216X7087 11/30/2018 000548739 12/15/2018 4,476.80
ACCOUNT SUMMARY
CURRENT CHARGES 4,476.80 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 4.476.80
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 4,476.80
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