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182624 02/18/2010 CITY OF CARMEL, INDIANA VENDOR: 00352999 Page 1 of 1 ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $156,893.00 ,moo CARMEL, INDIANA 46032 P 0 BOX 40925 INDIANAPOLIS IN 45082 -4910 CHECK NUMBER: 182624 CHECK DATE: 211812010 DEPARTMENT ACC PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 716168 62,575.00 INSURANCE 651 5023990 716168 67,983.00 INSURANCE 601 5023990 716189 12,555.00 OTHER EXPENSES 651 5023990 716189 13,780.00 OTHER EXPENSES HYLANT pa. Box 40925 Indianapolis, IN 46280 -0925 T R O U P Local: 317 817 -5000 I N V O 1 C E 716189 �T CARME80 79 01/27/10 z Umbrella" k cA> v a. POLICluN. is.:,.: "b�.S�`;..za.�`2.�Maiok 013136324 W. Michael Wells SEEFECrIVe.w i s .F,APIR1T -ION x HCLANCE DUE 01 /01 /10 01 /01/11 01 /01 /10 City of Carmel 5 r� pn10UNT eAiD x# s ;1MOUNTEDUE s r xy Steve Engelking 26,335.00 One Civic Square Carmel, IN 46032 n s a, "y f '�^S�"": a s k •5 �Otv;3' h �3 R s'#"';�'�, r 1' a;e ae 1 3�3�'�e, k5a �j r Eff•;Date��,Trn �Type� Pollcy ��4; Descrlptlon t�,� 1 a� Amount; iA ..r,:;, fl•,z. +�rz „°S V +'��',at"'��.Y P��,. 'w t .�.s �Pt •y: �e �.�'3 dip t {.e... h�.' �S.` �I'»�.�'.t.L- ^�;r,n;.�3::�...it va?, t:: �l` x^ z ti� .e�$?�ss.�x.w_- .znlCaa;:�.`�1. e:.'�:':;i�. �e1. t,✓.. ...:.`ze�.�.ra...4.::.:�,;; t�..�� *.a::�.t..._�.s».�. +'��+`::V:�`E�.”. `��..L`.e�.�?:n m -_3 �i:s ..,c. INVOICE 716189 01/01/10 MEM UM -S 013136324 UMBRELLA POLICY Lexington Insurance Conipanv S 26,335.00 UTILITIES, WATER SEWER DEPTS. $26,335.00 Invoice Balance: 26,335.00 HYLANT GROUP www.hylant.com 301 Pennsylvania Parkway Suite 201 P.O. Box 40925 Indianapolis, IN 46280 -0925 Local: 317 -817 -5000 Fax: 317 817 -5151 1 �YLANT P.O. Box 40925 Indianapolis, IN 46280 -0925 0'�GRoup Local: 317- 817 -s000 I N V O I C E# 716168 page l CARME80 79 01/27/10 A i�, I?RODUCER =�+s.�s�xx'r�Wx,�s,.,,:; _..r d -s =,e. v r. _.o aw....... �t.'°.,. N W. Michael Wells zr 1tL. 5,\ CL-; DUL .ONa_.r..aeu.+rs..,.......i>:.` ya..wi_,�`°'.a,WWt.�z: =:t 01/01/10 L;�NNIOU, AID,?_ 4a`�„� .i?� s�.,MA1ti1OUNJ' K'.,,i.�'..... 130,558.00 City of Carmel Steve Engelking One Civic Square Carmel, IN 46032 mount �,..L.....:.. .'�'v.,..f�- ...x -.raF w ,�f '."�i �`Ti -F__. j� '3 'Y 1c INVOICE 4 715168 01 /01 /10 MEM PCKG OP09313908 PACKAGE POLICY Travelers Insurance Companies S t30,558.00 UTILITIES (INCL SEWER WATER) DEPT- $130,558 Invoice Balance: 130,558.00 HYLANT GROUP www.bylant.com 301 Pennsylvania Parkway Suite 201 P.O. Box 40925 Indianapolis, IN 46280 -0925 Local: 317 -817 -5000 Fax: 317 -817 -51.51 City of Carmel Water Utility 2010 Insurance Costs Auto 19,388.00 General Liability 22,199.00 Other: Property 20,104.00 IV 884.00 Umbrella 12,555.00 75,130.00 Vehicle Orig Budget orig Bud Payment 01.6560.03 8,250 36.67% 7,110 01.6560.05 11,000 48.89% 9,479 01.6560.07 2,600 11.55% 2,239 01.6560.08 650 2.89% 560 Total 22,500 100.00% 19,388 19,388.00 22500 19388 Gen. Liab. Orig Budget orig Bud Payment 01.6570.03 15,000 35.71% 7,927 01.6570.04 2,000 4.76% 1,057 01.6570.06 15,000 35.71% 7,927 01.6570.07 6,000 1429% 3,172 01.6570.08 4,000 9.53% 2,116 Total 42,000 100.00% 22,199 22,199.00 42000 22199 Workman's Comp Budget of Bud Payment Workman's comp was paid according to the original budget 01.6580.03 30,375 30,375 01.6580.06 29,000 29,000 01 -658M7 4,700 4,700 01.6580.08 800 800 Total 64,875 64,875 64,875 64,875 Other Orig Budget orig Bud Payment 01.6590.03 25,000 50.61% 16,976 01 .6590.04 2,000 4.05% 1,359 01 .6590.05 1,500 3.04% 1,020 01.6590.06 2,600 5.26% 1,764 01.6590.07 1,300 2.63% 882 01.6590.08 17,000 34.41% 11,542 Total 49,400 100.00% 33,543 33,543.00 49400 33543 113,900 75,130.00 75,130 Prescribed by State Board of Accounts Fgrm No. 301(Rev.1995) ACCOUNTS PAYABLE VOUCHER TO ADDRESS Invoice Date Invoice Number Item Amount 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 M0. Day Yr. Signature Title 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. /Z"/, Mo, Day Yr. bfrp6f Title Voucher No, Warrant No. ACCOUNTS PAYABLE DETAILED ACCOUNTS MUNICIPAL WATER DEPT. ACCT. CARMEL, INDIANA No. Of Total Amount of Voucher Deductions SAS oQ !6g 62575 d •D Amount of Warrant Month of Yr VOUCHER RECORD No No. Source of Sup Water Treatment Transmission and Dist. Customer Accounts Administrative and General O eration- Maintenance 1 Utility Plant in Service Constr. Work in Pro Tess Materials and Supplies Customers Deposits Total Allowed Board of Control Filed Official Title BOYCE FORMS SYSTEMS 1 -800 -382 -8702 325 1' LANT PO. Box 40925 Indianapolis, IN 46280 -0925 GROUP °°a�: 31'- s17 -SO °o INVOICE 716189 2 I fflF,"O 'k gel a 5e- �a rya s a K x �AC.C.OUNxi 0.::.sCs1t" 12�yD•ATE_, RAM CARME80 79 01/27/10 Umbrellas Comm 1 Slmp� 01.3136324 W. Michael Wells W ��Eh P.C21T10Na�" 01/01/10 01101/11 01/01/10 City of Carmel S -W �.DI: nvAauNTenlnx.r xniau�vravuEM 1� Steve Engelking 26,335.00 One Civic Square Carmel, IN 46032 `.s r x.=�, t �;i� x1/^`- 'y,�i �'.;'s'� ae+ ai:'t af ,s,. �i- ��s'$`� ..e 1�.' INVOICE 716189 01/01/10 MEM UM -S 013136324 UMBRELLA POLICY Lexington Insurance Company 26,335.00 UTILITIES, WATER SEWER DEPTS. $26,335.00 Invoice Balance: 26,335.00 H YLANT GROUP wNvw.hy1antcom 301 Pennsylvania Parkway Suite 201 P.O. Box 40925 Indianapolis, IN 46280 -0925 Local: 317-817-5000 Fax: 317 -81.7 -5151 Uy H LANT P.O. Box 40925 Indianapolis, IN 46280 -0925 GROUP Local: 317- 817 5000 716168 Pa e INVOICE# 5 1 CCOUNf NO :ram i a �GSli o 100" 41MMy CARME8 79 01/27/10 W. Michael Wells 1. :eBALAl�'C EeDUC 01/01 /10 �1NfOUNTZMMEIM ,u.. :sue „ARIOUNT,DUE S 130,558.00 City of Carmel Steve Engelking One Civic Square Carmel, IN 46032 aEffsDate Policy$ $1 h Descreptiort a t s Amount INVOICE 4 716168 01 /01 /10 MEM PCKG GP09313908 PACKAGE POLICY Travelers Insurance Companies 130,558.00 UTILITIES (INCL SEWER WATER) DEPT $130,558 Invoice Balance: 130,558.00 HYLANT GROUP www.hylant. corn 301 Pennsylvania Parkway Suite 201 P.O. Box 40925 Indianapolis, IN 46280 -0925 Local: 317 -817 -5000 Fax: 317 817 51.51 Eity of Carmel Sewer Utility 2010 Insurance Costs Auto 14,808.00 General Liability 23,298.00 Other: Property 28,125.00 IM 1,752.00 Umbrella 13,780.00 81,763.00 Vehicle Orig Budget orig Bud Payment 01.7560.02 6,200 33.15% 4,909 01.7560.04 1,800 9.63% 1,426 01.7562.05 5,000 26.74% 3,960 01.7562.06 1,700 9.09% 1,346 01.7560.07 3,000 16.04% 2,375 01.7560.08 1,000 5.35% 792 `dotal 18,700 100.00% 14,808 14,808.00 18700 14808 Gen. Liab. Orig Budget orig Bud Payment 01.7570.01 12,000 21.90% 5,102 01.7570.02 7,000 12.78% 2,978 01.7570.03 1,400 2.55% 594 01.7570.04 1,400 2.55% 594 01.7572.05 15,000 27.37% 6,377 01.7572.06 12,000 21.90'% 5,102 01.7570.07 4,000 7.30% 1,701 01.7570.08 2,000 3.65% 850 Total 54,800 100.00% 23,298 23,298.00 54800 23298 Workman's Comp Budget of Bud Payment Workman's camp was paid according to the original budget 01.7580.01 3,400 3,400 01.7580.02 5,400 5,400 01.7580.04 1,600 1,600 01.7582.05 7,500 7,500 01.7582.06 9,200 9,200 01.7580.07 2,500 2,500 01.7580.08 1,500 1,500 31,100 31,100 31,100 31,100 Other Orig Budget orig Bud Payment 01.7590.01 4,200 7.15% 3,121 01.7590.02 5,000 8.52% 3,720 01.7590.03 9,000 15.33% 6,693 01.7590.04 1,000 1.70% 742 01.7592.05 19,000 32.37% 14,132 01.7592.06 8,000 13.63% 5,950 01.7590.07 2,500 4.26% 1,860 01.7590.08 10,000 17.04% 7,439 Total 58,700 100.00% 43,657 43,657.00 58700 43657 132,200 81,763.00 81763 Prescribed by State Board Accounts ACCOUNTS PAYABLE VOUCHER Farm No. 301 -5 (Rev. 7995) TO ADDRE Invoice Date Invoice Number Item Amount 1 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 1 19 Signature Title 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. 19 i er Title Voucher No. Warrant No. ACCOUNTS PAYABLE DETAILED ACCOUNTS SANITATION DEPARTMENT ACCT, NO- CARMEL, INDIANA Favor Of Total Amount of Voucher Deduct 7$d �$a y-- 6 67q'93 as ,0 Amount of Warrant a 17 63 0 Month of 19 VOUCHER RECORD No' Collection System Operation Plant Commercial General Undistributed Construction Depreciation Reserve r Stock Accounts Merchandise Totel Allowed Board Members Filed BOYCE FORMS SYSTEMS 1- 800 382 -8702 325