HomeMy WebLinkAbout185453 05/11/2010 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1
ONE CIVIC SQUARE TRAVELERS
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $1,763.62
CHICAGO IL 60693
CHECK NUMBER: 185453
CHECK DATE: 5/11/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 348423 1,763.62 GENERAL INSURANCE
A VELERS J PAGE 1
DEDUCTIBLE INVOICE
AGENT COPY
GPO9313908 5216X7087 04/30/2010 000348423 .05/15/2010 3,701.41
MAIL PAYMENT TO: AGENT:
TRAVELERS HYLANT GROUP INC
13607 COLLECTIONS CENTER DRIVE PO BOX 40925
CHICAGO, IL 60693 INDIANAPOLIS IN 46280 -0925
RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS.
PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK.
TRAVELEI\SJ PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
GPO9313908 5216X7087 04/30/2010 000348423 05/15/2010 3,701.41
CURRENT
CLAIM#: CAW7554 DATE OF LOSS: 01/04/2007
DESCRIPTION: C JACKSON. CHAD TORT NOTICE ARISNG OUT OF ALLEGED
Rance INJURIES THE CLA
CLAIMANT: CHAD JACKSON
EXPENSE 147.40
CLAIM TOTAL 147.40
CLAIM EFW0425 DATE OF LOSS: 02/06/2010
DESCRIPTION: IV PLOW TRUCK RAN INTO A PARKED UNOCCUPIED VEH
CLAIMANT: /JONES BROTHERS ELECTRIC
LOSS 1 616 .22
CLAIM TOTAL 1,616.22
CURRENT CHARGES $1,76$.82
ACCOUNT SUMMARY
CURRENT CHARGES 1,763.62 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 1.937.79 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: OM 617 -5000
TOTAL DUE 3,701.41
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 3,701.41
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE- HELPOESK@TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1 -800- 356 -4098 EXT. 08900: ANTONIO CONTRERAS
p RECF
MAY 1 U 2010 MAY Q 6 Z018
By HYLANT' GRCIJs
VOUCHER NO. WARRANT NO.
ALLOWED 20
Trawlers
IN SUM OF
13607 Collections Center Drive
Chicage, IL 60693
$1,763.62
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1205 000348423 43- 475.00 I $1,763.62 1 hereby certify that the attached invoice(s), or
l 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
Monday, May 10, 2010
Director, Administratiol
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))
04/30/10 000348423 $1,763.62
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
1 20
Clerk- Treasurer