182691 03/02/2010 CITY OF CARMEL, INDIANA VENDOR: 00352999 Page 1 of 1
ONE CIVIC SQUARE HYLANT GROUP
CARMEL, INDIANA 46032 P 0 BOX 40925 CHECK AMOUNT: $108,411.75
INDIANAPOLIS IN 46082 -4910 CHECK NUMBER: 182691
CHECK DATE: 3/2/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4347500 716167 732.00 GENERAL INSURANCE
1091 4347500 716167 56,800.00 GENERAL INSURANCE
1125 4347500 716167 12,209.00 GENERAL INSURANCE
1081 4347500 716188 269.00 GENERAL INSURANCE
1091 4347500 716188 10,510.00 GENERAL INSURANCE
1125 4347500 716188 2,695.00 GENERAL INSURANCE
302 5023990 718540 25,196.75 WORKERS COMP
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I_,�.�N:.sl7 51e1 INVOI 7 1.6157
U"YLAN
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W Michaol Wells
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69,74 1.00
City of Catind
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'Otte Civic Square
Carmel, `IN 46032
a Amount::
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Eff =Date Type Policy# a,
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PACKAGE POLICY i' ravelcis :insifitnicrG�niip;fnics 09,741100
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SCFI(?()1. PRO RAM1- 57:12; �t71vI1N "r1I.:1: (71 I1I l2" $'12;2017
Invoice Balsacc: S 69,741.00
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1° YLAN'r Gi3oUll avi wA1ylallr:Ct1lta
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HyLANT Pa -Box 40925
Indianapolis, IN 46280 -0925 11 lt
GROUP Local: 317 -817 -5000 INVOICE 716188
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013136324
W. Michael WcliS
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!i F FEGI t6 E
01/01/10 0.1,'01/11 61fU111U
City of Carmel
Steve Engell ing 13,474 -p
One Civic Square
Carmel, IN 46032
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INVOICE N 716188
01/01/10 MEM UM -S 013136324 t1MBkr-LI,A POLICY Lexington Insurance Company 13,414 -00
PREMIUM ALLOCATION: MONON CENTER $10,510; BEFORE/AFI'ER
SCHOOL PROGRAM $269; ADMiN "ALL OTHER" $2,695
Invoice Balance: 13,474,00
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HYLANT GROUP wwwhylant.com
301 Pennsylvania Parkway Suite 201 P.O. Box 40925 Indianapolis, IN 46280 -0925 Local: 31.7 -817 -5000 Fax: 317 -817 -5151
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
352999 Hylant Group Terms
P.O. Box 40925 Date Due
Indianapolis, IN 46280 -0925
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1127/10 716167 Insurance premium 56,800.00
1127110 716167 Insurance premium 732.00
1/27/10 716167 Insurance premium 12,209.00
1127/10 716188 Insurance umbrella premium 10,510.00
1127/10 716188 Insurance umbrella premium 269.00
1/27/10 716188 Insurance umbrella premium 2,695.00
Total 83,215.00
1 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
i
Voucher No. Warrant No.
352999 Hylant Group Allowed 20
P.O. Box 40925
Indianapolis, IN 46280 -0925
In Sum of
83,215.00
ON ACCOUNT OF APPROPRIATION FOR
101 General 108 ESE 109 Monon Center
PO# or INVOICE NO. kCCT #,rTITLl AMOUNT Board Members
Dept
1091 716167 4347500 56,800.00 1 hereby certify that the attached invoice(s), or
1081 -99 716167 4347500 732.00 bill(s) is (are) true and correct and that the
1125 716167 4347500 12,209.00 materials or services itemized thereon for
1091 716188 4347500 10,510.00 which charge is made were ordered and
1081 -99 716188 4347500 269.00 received except
1125 716188- 4347500 2,695.00
25 -Feb 2010
Signature
83,215.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
4"�� r ��k? ?V5^�. ,a;�r�.�, %.R. a' i �v.m G�:T 2a"'a�a�gg a�t�" ggs� 7 i 'r �s"da arc' re` `'m r' r a
,r�'S$ tvw k.�� ".Ni x s^4.„^ R ua t 4 sr. cia r�•.,..�..,._.....W::. i �6. S�sL.,.�* y s_. f�,..: k;�'_ r
INVOICE 718540
01/01/09 RIS WC-S WCX002730 WORK COMP 2 OF 4 Citizens Ins Co of America 14,058.25
01/01109 RIS WC -S WCX002730 TPA 2 OF 4 Citizens Ins Co of America 11,138-50
Invoice Balance 25,196.75
HYLANT G ROUP www.hylant.com
301 Pennsylvania Parkway Suite 201 P.O. Box 40925 Indianapolis, IN 46280 -0925 Local: 317 817 -5000 Fax: 317 -81,7 -5151
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
02/24110 718540 $25196.75
Total $25,196.75
1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
;TOUCHER NO�$?° WARRANT NO.
ALLOWED 20
Hylant Group IN SUM OF
PO Box 4 0925
In dianapolis, IN 46280 -0925
$25,196.75
ON ACCOUNT OF APPROPRIATION FOR
302 Workers Compensation
Board Members
PO# or D PT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
718540 302 $25 ,196.75 materials or services itemized thereon for
which charge is made were ordered and
received except
20
Sig u e
iJl�f Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund