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Home My WebLink About181413 01/13/2010 o CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1 ri. s., ONE CIVIC SQUARE TRAVELERS CO LER COLLECTIONS CENTER DRIVE CHECK AMOUNT: $2,945.88 o CARMEL, INDIANA 46032 �4�b io CHICAGO IL 60693 CHECK NUMBER: 181413 r CHECK DATE: 1/13/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4347500 338585 854.37 GENERAL INSURANCE 1205 4347500 338585 2,091.51 GENERAL INSURANCE C) TRAVELERS PAGE 1 DEDUCTIBLE INVOICE AGENT COPY POLICY: NUMBER. ACCOUNT NUMBER4 BILL hDATE IBILL,NUMBER ,',At.PAYMENT, DUE TOTAL DUE 6P09313908 5216X7087 12/31/2009 000338585 01/15/2010 2,709.41 MAIL PAYMENT TO AGENT: TRAVELERS HYLANT GROUP INC 13607 COLLECTIONS CENTER DRIVE PO BOX 40925 CHICAGO, IL 60693 INDIANAPOLIS IN 46280 -0925 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. P.,OLICY;; NUMBER ACCOUNTr NUMBER BILL: DATE;,, BILL NUMBER:::x, ::PAYMENT DUE TOTAL DUE GP09313908 5216X7087 12/31/2009 000338585 01/15/2010 2,709.41 CURRENT CLAIM#: A4P0980 DATE OF LOSS: 09/28/2007 DESCRIPTION: C FLYNN, MICHAEL POLICE OFFICER FILING CHARGES PO1Ge AGAINSTCITY HIS EMPLO CLAIMANT: MICHAEL FLYNN EXPENSE 826.00 CLAIM TOTAL 826.00 CLAIM A6N6445 DATE OF LOSS: 07/30/2009 DESCRIPTION: PER FAX: C ZULOAGA, ALEJANDRO STREET DEPT MOWING AND DEBRIS FLEW ONT S f ee 1 CLAIMANT: ALEJANDRO ZULOAGA LOSS 1,265.51 CLAIM TOTAL 1,265.51 CLAIM#: EGV8335 DATE OF LOSS: 11/02/2009 DESCRIPTION: C MATHIS, DAVID PER CLAIMANT HE WAS STOPPED IN r;r'e, TRAFFIC EBON I465 AND CLAIMANT: MARK NEWTON LOSS 854.37 CLAIM TOTAL 854.37 CURRENT CHARGES $2,945.88 RECEIVED JAN 05 2010 HYLANT GROUP TRAVELER PAGE 2 DEDUCTIBLE INVOICE AGENT COPY POLICY- NUMBER ACCOUNT:: NUMBER BILt OA BILL; NUMBS i PAYMENT -DUE. 4 TOTAL DUE GP09313908 5216X7087 12/31/2009 000338585 01/15/2010 2,709.41 ACCOUNT SUMMARY CURRENT CHARGES 2,945.88 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 860.23 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 1,096.70- AGENT PHONE: (317) 817 -5000 TOTAL DUE 2,709.41 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 2,709.41 CONTACT YOUR AGENT LISTED ABOVE IF. YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE COVERAGE. FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE- HELPDESK @TRAVELERS.COM OR CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1 -800- 356 -4098 EXT. 08900: ANTONIO CONTRERAS VOUCHER NO. WARRANT NO. ALLOWED 20 Travelers IN SUM OF$ 13607 Collections Center Drive Chicago, IL 60693 $854.37 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1120 43- 475.00 $854.37 I hereby certify that the attached invoice(s), or 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 JAN 11 2010 d/ Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund Ii Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL 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. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 465 Accident $854.37 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 Clerk- Treasurer impknok TRAVELERS PAGE 1 DEDUCTIBLE INVOICE AGENT COPY POLICY. NUMBER ACCOUNT NUMBER ,BILL DATE i BILL NU,MBER_ PAYMENT DUE' TOTAL DUE GP09313908 5216X7087 12/31/2009 000338585 01/15/2010 2,709.41 MAIL PAYMENT T0: AGENT: TRAVELERS HYLANT GROUP INC 13607 COLLECTIONS CENTER DRIVE PO BOX 40925 CHICAGO, IL 60693 INDIANAPOLIS IN 46280 -0925 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. PDLICY;NUMBER :ACCOUNT NUMBER BILL DATE BILL NUMBER -PAYMENT DUE r TOTAL DUE GP09313908 5216X7087 12/31/2009 000338585 01/15/2010 2,709.4i CURRENT CLAIM#: A4P0980 DATE OF LOSS: 09/28/2007 DESCRIPTION: C FLYNN, MICHAEL POLICE OFFICER FILING CHARGES poli AGAINSTCITY HIS EMPLO CLAIMANT: MICHAEL FLYNN EXPENSE 826.00 CLAIM TOTAL 826.00 CLAIM#: A6N6445 DATE OF LOSS: 07/30/2009 DESCRIPTION: PER FAX: C ZULOAGA, ALEJANDRO STREET DEPT MOWING AND s cc e 1 DEBRIS FLEW ONT CLAIMANT: ALEJANDRO ZULOAGA LOSS 1,265.51 CLAIM TOTAL 1,265.51 CLAIM: EGV8335 DATE OF LOSS: 11/02/2009 DESCRIPTION: C MATHIS, DAVID PER CLAIMANT HE WAS STOPPED IN TRAFFIC EBON I465 AND CLAIMANT: MARK NEWTON LOSS 854.37 CLAIM TOTAL 854.37 CURRENT CHARGES $2,945.88 RECEIVED JAN 05 2010 HYLANT GROUP TRAVELERS J PAGE 2 DEDUCTIBLE INVOICE AGENT COPY POLICY NUMBER ACCOUNT NUMBER' •:a •BILL_ DATE;:, BILL'.NUMBE_ R PA_ YMENT DUE TOTAL.DUE GP09313908 5216X7087 12/31/2009 000338585 01/15/2010 2,709.44 ACCOUNT SUMMARY CURRENT CHARGES 2,945.88 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 860.23 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 1,096.70 AGENT PHONE; (317) 817 -5000 TOTAL DUE 2,709.41 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 2,709.41 CONTACT YOUR AGENT LISTED ABOVE IF. YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE COVERAGE. FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE HELPDESK@TRAVELERS.COM OR CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1- B00 -35B -4098 EXT. 08900: ANTONIO CONTRERAS VOUCHER NO. WARRANT NO. ALLOWED 20 Travelers IN SUM OF 13607 Corections Center Drive Chicage, IL 60693 $2,091.51 ON ACCOUNT OF APPROPRIATION FOR Carmel Administration PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1205 000338585 43- 475.00 $1,265.51 I hereby certify that the attached invoice(s), or 1205 000338585 43-475.00 $826.00 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 Friday, January 08, 2010 Director, Administratidn Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service renderer, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 12/31/09 000338585 A6N6445 Street $1,265.51 12/31/09 000338585 A4P0980 Police $826.00 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance ith IC 5- 11- 10 -1.6 20 Clerk- Treasurer