HomeMy WebLinkAbout334361 01/10/19 i
CITY OF CARMEL, INDIANA VENDOR: 362876
�•® ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $*****2,745.60*
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK NUMBER: 334361
CHICAGO IL 60693 CHECK ATE: 01/10/19
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 R4347500 102417 000550343 2,745.60 GENERAL INSURANCE
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VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 362876
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
TRAVELERS IN SUM OF$ CITY OF CARMEL
13607 COLLECTIONS CENTER DRIVE An invoice or bill to be properly itemized must show:kind ofservice,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
$2,745.60
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
102417 000550343 43-475.00 $2,745.60 1 hereby certify that the attached invoice(s),or 12/31/18 000550343 12/31/18 Invoice $2,745.60
1205 Grrcrm tiered 101 Prior Year 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
Wednesday,January 9,2019
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
14TG2033-ZLP 521GX7087 12/31/2018 000550343 01/15/2019 2,745.60
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CURRENT CHARGES Submiftd To
CLAIM#:
EXPENSE 1,591 .20
CLAIM TOTAL 1,591.20
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TOTAL CLAIMS) DUE $2,745.60
PAGE 2
TRAVELERS J�
DEDUCTIBLE / SELF- INSURED INVOICE
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14TG2033-ZLP 5216X7087 12/31/2018 000550343 01/15/2019 2,745.60
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ACCOUNT SUMMARY
CURRENT CHARGES 2,745.60 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 2.745.60
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 2,745.60
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
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INDIANA RETAIL TAX EXEMPT Page 9 of 1
City ®f Carme� CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 102417
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,AIP
CARMEL,INDIANA 46032-2584 VOUCHER,DELIVERY MEMO,PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
12/14/2018 362876
TRAVELERS General Administration
VENDOR 13607 COLLECTIONS CENTER DRIVE SHIP 1 Civic Square
TO Carmel, IN 46032-
CHICAGO, IL 60693-
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
32238
QUANTITY, UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department., 1205 Fund., 101 General Fund
Account. 43-475.00
1 Each General Insurance $64,'050.00 $64,050.00
Sub Total $64,050.00
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Send Invoice To:
Dept of AdministrationA
1 Civic Square lP, T
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $64,050.00
SHIPPING INSTRUCTIONS •AIP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A
PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN
'SHIP PREPAID.. AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
'C.O.D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
'PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABE
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 194 C "
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
James Crider James Crider
TITLE Administration Administration
CONTROL NO. 102417 CLERK-TREASURER