HomeMy WebLinkAbout184513 04/14/2010 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1
ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $9,113.30
e CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE
CHICAGO IL 60693
CHECK NUMBER: 184513
CHECK DATE: 4/14/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 345963 9,113.30 GENERAL INSURANCE
AVOW
TRAVELERS J PAGE 1
DEDUCTIBLE INVOICE
ulwa i 1
GPO9313908 5216X7087 03/31/2010 000345963 04/15/2010 11,051.09
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.
TRAVELERS JW S PAGE 1
GPO9313908 521GX7087 03/31/2010 000345963 04/15/2010 11,051.09
CURRENT
CLAIM A4PO980 DATE OF LOSS: 09/28/2007
DESCRIPTION: C FLYNN, MICHAEL POLICE OFFICER FILING CHARGES
AGAINSTCITY HIS EMPLO
CLAIMANT: MICHAEL FLYNN
EXPENSE 1,708.00
CLAIM TOTAL 1,708.00
CLAIM#/: ASN6445 DATE OF LOSS: 07/30/2009
DESCRIPTION: PER FAX: C ZULOAGA, ALEJANDRO STREET DEPT MOWING AND
DEBRIS FLEW ONT
CLAIMANT: ALEJANDRO ZULOAGA
LOSS 977.17
CLAIM TOTAL 977.17
CLAIM#!: CAW7554 DATE OF LOSS: 01/04/2007
DESCRIPTION: C JACKSON, CHAD TORT NOTICE ARISNG OUT OF ALLEGED
INJURIES THE CLA
CLAIMANT: CHAD JACKSON
EXPENSE 381.00
CLAIM TOTAL 381.00
CLAIM##: EFW1188 DATE OF LOSS: 02/25/2010
DESCRIPTION: FARRIS, JOHN AMBULANCE RESPONDING TO A CALL AND BACKED
INTO A DRIVEWAY
CLAIMANT: JOHN N FARRIS
LOSS 1,937.79
CLAIM TOTAL 1,937.79
CLAIM EHS6965 DATE OF LOSS: 02/02/2010
DESCRIPTION: OV AND IV GOING SE ON PENNA AVE, IV MAKING A LEFT HAND
TURN AND DID NO
CLAIMANT: TODD CORNELIUS
n LOSS 3,243.31
D IJ CLAIM TOTAL 3,243.31
APR Y 2 2616 1
By �J I 30
TRAVELERS
NON- FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT o6183
38995
CITY OF CARMEL; CARMEL CLAY PARKS
ATTN: JIM SPELBRING
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS J PAGE 2
DEDUCTIBLE INVOICE
GPO9313908 521GX7087 03/31/2010 000345963 04/15/2010 11,051.09
CURRENT
CLAIM#: EHS9844 DATE OF LOSS: 02/22/2010
DESCRIPTION: OV STOPPED SUDDENLY TO AVOID AN ACCIDENT WHEN IV REAR
ENDED OV
CLAIMANT: KARIN ROMANI
LOSS 4,508.16
CLAIMANT: KARIN ROMANI
LOSS 250.00
CLAIM TOTAL 4,758.16
CURRENT CHARGES $11,051.09
ACCOUNT SUMMARY
CURRENT CHARGES 11,051.09 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 5000
TOTAL DUE 11,051.09
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 11,051.09
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
TRAVELERS
NON- FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
38994
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
$9,113.30
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
PO# Dept. INVOICE NO. ACCT #fTITLE AMOUNT Board Members
1205 I 000345963 I 43- 475.00 I $9,113.30 1 hereby certify that the attached invoice(s), or
I 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, April 09, 2010
Directo 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 (or note attached invoice(s) or bill(s))
03131/10 000345963 $9,113.30
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