181773 02/02/2010 ,a CITY OF CARMEL, INDIANA VENDOR: 00352999 Page 1 of 1
t`' ONE CIVIC SQUARE HYLANT GROUP
0 CARMEL, INDIANA 46032 P 0 Box 40925 CHECK AMOUNT: $531,069.50
JNDIANAPOUS IN 46082 -4910 CHECK NUMBER: 181773
CHECK DATE: 212!2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 716166 345,391.00 GENERAL INSURANCE
1205 R4347500 21688 716166 103,000.00 GENERAL INSURANCE
1115 4347500 716187 4,950.00 GENERAL INSURANCE
1120 4347500 716187 60,000.00 GENERAL INSURANCE
1192 4347500 716187 6,500.00 GENERAL INSURANCE
1205 4347500 716187 2,228.50 GENERAL INSURANCE
1207 4347500 716187 9,000.00 GENERAL INSURANCE
HYLANT P.O. Box 40925
Indianapolis, IN 46280 -0925
A AA GROUP Local: 317- 817 -5000 I N V O I C E# 716187 Paul
CARME80 79 01/27/10
Umbrella Comm'I SImP a,
:API'
013136324
PRODUCER!:._ c...,,, .....r_.._.._.'.E..,.._.s...:t. ",c� 'i
W. Michael Wells
City of Carmel 01/01/10 01/01/11 01 /01 /10
Steve Engelking 82,678.50
One Civic Square
Carmel, IN 46032
w.ra r�"'dss3° "v�: TA 5rv•&'" u a s .a.a� .o T T y ,mot f -p yt�F .a. :"t` P..B.,✓, m"$� p i s rr �.`u' x s g it; +�i-�nSarf.::.. iwa.r Ixx«r' AkVii::.. ....,�...:..',.T «.,...ss'rrt,..{ giit `..'X�,'.« ..d..
INVOICE 716187
01/01/10 MEM UM 013136324 UMBRELLA POLICY Lexington Insurance Company 82,678.50
CITY OF CARMEL $82,678.50
Invoice Balance: 82.678.50
HYLANT GROUP wwwhylant.com
301 Pennsylvania Parkway Suite 201 PO. Box 40925 Indianapolis, IN 46280 -0925 Local: 3:17 -817 -5000 Fax: 317 -817 -5151
pritIHYLANT PO. Box 40925
Indianapolis, IN 46280 -0925 ry T
A AA L 317 -817 -5000 I NVOICE 716166
GROUP
CARME80 79 01/27/10
q a� 4„^x',,"2 t .�E� i, 4 .z
r PRO DUC ER .va �.R..�.:_�...� a... :ate ..�._�z. x.,.
W. Michael Wells
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•s IIrALthCE DUE ON _.t .a.�.. >.5,....., .�..A�............ ,.b .a,�f #::�'d 'x as .ua.a.
01/01/10
rrAb10UN ['hl'AID.��...s�:�.�.c_�.,.x :�._.9v_a ?a- ,m�.A�IOUNTtDUE ...,._,��s+ „6. ��s:���.,.
448,391.00
City of Carmel
Steve Engelking
One Civic Square
Carmel, IN 46032
Z a Eff:Date Trn 1 ..Types Polrcy 3„ t::' ,M•Desenptr �r.: Amougt.
f ,:.:'h' tg S i i 'C sa x`.,a,�r ._.s 4K Y s
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INVOICE 716166
01/01/10 MEM PCKG GP09313908 PACKAGE POLICY Travelers Insurance Companies 448,391.00
CITY OF CARMEL PREMIUM $448,391
Invoice Balance: 448,391.00
HYLANT GROUP www.hylant.com
301 Pennsylvania Parkway Suite 201 P.O. Box 40925 Indianapolis, IN 46280 -0925 Local: 31,7 -81,7 -5000 Fax: 317 -817 -5151
Prescribed by State Board al 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
Hylant Group Purchase Order No.
4
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
02/01/10 716187 716163 Package Umbrella Policy $531,069.50
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and 1 have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER N9731110 WARRANT NO.
ALLOWED 20
Hylant Grnu e IN SUM OF
PC) Rnx 40925
$531,069.50
ON ACCOUNT OF APPROPRIATION FOR
General Fund
Board Members
PO# DEPT. INVOICE NO. ACCT #/TITLE AMOUNT hereby certify �Ep�. I hereb certif that the attached invoice(s), or
C2/0 `(■,(C 4 3 bill(s) is (are) true and correct and that the
1115 716187V401`86 4R -475 00 $4,950.00 materials or services itemized thereon for
11 92 716187 /'7 43- 475.00 $6,500.00 which charge is made were ordered and
1207 716187./ 4.6+66' 43- 475.00, $9,000.00 received except
1120 7161875 43- 475.00 $60,000.00
1205 7'6• -87 171 6166 43- 475.00 7, t
21688 J 716166 43- 475.00 1 03,000.00
Full
20
�g atur
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund