HomeMy WebLinkAbout183174 03/16/2010 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1
i4,� ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $7,819.70
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE
a CHICAGO IL 60693 CHECK NUMBER: 183174
CHECK DATE: 3/1612010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 343530 7,819.70 GENERAL INSURANCE
TR,AVELERSJ PAGE 1
i 2
DEDUCTIBLE INVOICE �Z
i i
GP093i3908 521GX7087 02/26/2010 000343530 03/15/2010 7,819.70
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL; CARMEL CLAY PARKS
13607 COLLECTIONS CENTER DRIVE ATTN: JIM SPELBRING
CHICAGO, IL 60693 ONE CIVIC SQUARE
CARMEL IN 46032
RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS.
PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK.
AM
TRAVELERS JJ PAGE 1
GP09313908 5216X7087 02/26/2010 000343530 03/15/2010 7,819.70
CURRENT
CLAIM EFW0425 DATE OF LOSS: 02/06/2010
DESCRIPTION: IV PLOW TRUCK RAN INTO A PARKED UNOCCUPIED VEH
CLAIMANT: /JONES BROTHERS ELECTRIC
LOSS 2,500.00
CLAIM TOTAL 2,500.00
CLAIM EHS6965 DATE OF LOSS: 02/02/2010
DESCRIPTION: OV AND IV GOING SB ON PENNA AVE, IV MAKING A LEFT HAND
TURN AND DID NO
CLAIMANT: TODD CORNELIUS
LOSS 5,556.17
CLAIM TOTAL 5,556.17
CURRENT CHARGES $�1�
ACCOUNT SUMMARY
CURRENT CHARGES 8,056.17 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 236.47 AGENT PHONE: (317) 817 -5000
TOTAL DUE 7,819.70
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 7
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE- HELPDESK @TRAVELERS.CDM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1 -800 356 -4098 EXT. 08900: ANTONIO CONTRERAS
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By
TRAVELERS
NON- FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
39066
CITY OF CARMEL; CARMEL CLAY PARKS
ATTN: JIM SPELBRING
ONE CIVIC SQUARE
CARMEL IN 46032
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VOUCHER NO. WARRANT NO.
ALLOWED 20
'Travelers
IN SUM OF
13607 Collections Center Drive
Chicage, IL 60693
$7,819.70
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
PO# Dept. INVOICE NO. ACCT #rr1TLE AMOUNT Board Members
1205 I 000343530 43- 475.00 $7,819.70 1 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
Friday, March 12, 2010
Director, Administration
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 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 (o note at tac h e d i nvoic e( s) or bi]I(s))
02/26/10 I 000343530 I $7,819.70
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