185787 05/26/2010 CITY OF CARMEL, INDIANA VENDOR: 00352999 Page 1 of 1
ONE CIVIC SQUARE HYLANT GROUP
CARMEL, INDIANA 46032 P o Box 40925 CHECK AMOUNT: $5,162.00
INDIANAPOLIS IN 46082 -4910 CHECK NUMBER: 185787
CHECK DATE: 5/26/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4347500 724991 2,913.00 ENERGY CNT INSURANCE
302 5023990 727822 2,249.00 OTHER EXPENSES
HYLANT PO. Box 40925
Indianapolis, IN 46280 -0925
d GROUP
Local: 317 -817 -5040 INVOICE 724991
.1CCOUN'I'!NO It tCSR i.:'g y- D'?.FE.
CARME13 79 04/23/10
W. Michael Wells
BAUANCE °DIJEON "'a'..�...a,.
04/22/10
T: DUE._.. i+.: .,.�._..,..s:....
S 2,913.00
Carmel Redevelopment Comm
Sherry Mielke
111 W. Main, Ste 140
Carmel, IN 46032
Eff Date Trnl Type Policy Description y ,Amount l
INVOICE 724991
04/22/10 +EN BRA 06637524 ENERGY CENTER Federal Insurance Company 2,913.00
EXTEND POLICY EXPIRATION FROM 4/22/10 TO 10/22/10
Invoice Balance: 2,913 -00
H YLANT 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
Inland Uadne Insurance
Premium Bill
Policy Period OCTOBER22,2007 TO OCTOBER 22, 2010
Effective Date APRIL 22, 2010
Policy Number 0063-75-24 IND
Insured CARREL RED FV ELOIIINI ENT COMMISSION AND
CONTRACTORS INTERESTS
Name of Company 1-1 INSURANCE COMPANY
Date Issued APRIL 6, 2010
Portion of total premium attributable for terrorism and statutory standard fire where applicable
is 0.00
POLICY PERIOD EXTENDED
Date Payment Due Premium
APRIL 22, 20111 2,913.00
TOTAL $2,913.00
Producer:
HYLANTGROUP INC
811 MADISON AVENUE
TOLEDO, OH 43624-0000
last page
Form 04-02-0841 {Ed. 9-95) Premium Bill Page 1
Inland Marine Insurance
Endorsement
Policy Period OCTOBER 22, 2007 TO OCTOBER 22, 2010
Effective Date APRIL 22, 20
Policy Number 0663-75-24 [ND
Insured CARMEL RI DEVELOPMENT' AND
CONTRACTORS INTERESTS
Name of Company FEDERAL INSURANCE COMPANY
Date Issued A 6, 20
XX.
This Endorsement applies to the following forms;
PROJEC'I'BIJII-,I)]-'
Common
Policy
Conditions
SCHEDULE
This policy is issued for the period 12:01 AM Standard Time
at the Named Insured's Maitino C Address.
Policy Period: From 10/22/2( 10/22/20
CONDITIONS: Under Conditions, the following condition is added:
AMENDMENT OF POLICY PERIOD
The policy period of this policy, as described in the Insuring
Agreement, Premium Summary, Declarations and other documents
that comprise this policy is deleted and replaced with the
Policy Period shown in the Schedule above.
This endorsement does not modify, limit or enlarge any
other policy provisions, nor does it reinstate any of
the Limits of Insurance.
All other terms and conditions remain unchanged.
Authorized Representative 0�i
Inland Marine Insurance AMENDMENT OF POLICY PERIOD last page
Form 04-02-0859 (Ed. 6-99) Endorsement Page I
cHUe�
Inland Marine Insurance
Declarations
Chubb Group of Insurance Companies
15 Mountain View Road
Warren, NJ 07059
Named Insured and Mailing Address
Policy Number 0663 -75 -24 IND
CARMEL REDEVIsLOPMFJNT COMMISSION AND
CONTRACTORS INTERESTS Effective Date APRIL 22, 2010
ONE CIVIC SQUARE,
CARMEL, IN 46032 Issued by the stock insurance company
indicated below, herein called the company.
FEDERAL INSURANCE
COMPANY
Producer No. 0035144 Incorporated under the laws of
INDIANA
Producer HYLANT GROUP INC
911 MADISON AVENUE
TOLEDO, 01-1 43024-0000
Policy Period
From: OCTOBER 22, 2007 To: OCTOBER 22, 2010
12:01 A.M. standard time at the Named Insured's mailing address shown above.
The following displays the premises covered under this insurance.
Premises Summary
PREMISES 1 126TH CITY CENTER DR
CARMEL, IN 46032
Building Number: I
126TH RANGELINE RD., CITY CENTER DR.
CARMEL, IN 46032
Building Number: I
126TH RANGEI_.IN13 RD., CITY CENTER DR.
CARMI L, IN 46032
Building Number: I
126TH RANGE'LIN1 RD., CITY CENTER DR.
CARMEL., IN 46032
Building Number: 1
inland Marine Insurance Issue Date- APRIL 6, 2010 continued
Form 04 -02 -0638 (Ed. 9 -95) Declarations Page i
Premises Summary
(continued)
THIS PAGE INTENTIONALL Y LEFT BLANK
Inland Marine Insurance Issue Date. APRIL 6, 2010 continued
Form 04 -02 -0638 (Ed. 9 -95) Declarations Page 2
cHUBB
Inland Marine Insurance
Declarations
Chubb Group of Insurance Companies
15 Mountain View Road
Warren, NJ 07059
Named Insured and Mailing Address
Policy Number 0663 -75 -24 IND
CARMEL RFI)I -,.VELOPMEN'f COMMISSION AND
CONTRACTORS INTERI STS Effective Date APRII-, 22, 2010
ONE CIVIC SQUARE
CARMEI_,, IN 46032 Issued by the stock insurance company
indicated below, herein called the company.
FEDERAL INSURANCE
COMPANY
Producer No. 0035144 Incorporated under the laws of
INDIANA
Producer I 6ROTJP INC
811 MADISON AVENIJE
'I'OLI3DO, OI 43624 -00[10
Policy Period
From: OCTOBl 22, 20(17 To: OCTOBER 22, 2010
12:01 A.M. standard time at the Named Insured's mailing address shown above.
Deductible: 10,000
The deductible shown above applies to all coverages, except Business Income and Extra Expense, contained within this policy unless a
specific coverage deductible is shown below.
The following displays the coverages provided by this policy.
Coverages
PREMISES 1 126TH CITY CENTER DR
CARMI EL,1N 46()32
Building Number: 1
CONTRACT WORKS
DESCRIPTION ENERGY CIENTER
LIMIT OE INSURANCE 6,()()(),000
DEDUCTIBLE i0,UQ0
SOFT COSTS
LIMIT OF INSURANCI S50,000
WAITING PERIOD 108 HOURS
Inland Marine Insurance Issue Date: APRIL 6, 2010 continued
Page 3
Form 04 -02 -0638 (Ed. 9 -95) Declarations
'��tiS
Premises Coverages
(continued)
EFFECTS OF LAW
LIMIT OF INSURANCE 1,000,000
LOSS PREVENTION EXPENSE
LIMIT OF INSURANCE S 25,0011
ELECTRONIC DATA AND VALUABLE PAPERS
LIMIT OF INSURANCE- S50,000
FUNGUS CLEAN -UP OR REMOVAL
LIMIT OF INSURANCE S 25,000
RENTAL INCOME
LB1IT OF INSURANCE 50,000
WAITING PERIOD 12 HOURS
PREMISES 1 126TH CITY CEN'T'ER DR
(continued) CARMEL, IN 46032
13uiiding Number: I
CONTRACT WORKS
DESCRIPTION ENERGY CENTER
LIMIT OF INSURANCE 6,500,01111
DEDUCTIBLE 10,000
SOFT COSTS
LIMIT OF INSURANCE 50,000
WAITING PERIOD 168 HOURS
EFFECTS OF LAW
LIMTT OF INSURANCE S 1,0011,000
LOSS PREVENTION EXPENSE
LIMIT OF INSURANCE 25,000
ELECTRONIC DATA AND VALUABLE PAPERS
LIMIT OF INSURANCE S 50,000
FUNGUS CLEAN -UP OR REMOVAL
L IM.I:T OF INSURANCE S 25,000
RENTAL INCOME
LIMIT OF INSURANCE 50,000
WAITING PERIOD 12 HOURS
PREMISES 1 126TI -I CITY CENTER DR
(continued) CARMIL, IN 46032
Building Number: I
CONTRACT WORKS
Inland Marine Insurance Issue Date: APPIL 6, 2010 continued
Form 04 -02 -0638 (Ed. 9 -95) Declarations Page 4
Inland Marine Insurance
CHUBB
Declarations
Effective Date APRIL 22, 2010
Policy Number 066; -75 -24 IND
Premises Coverages
(continued)
DESCRIPTION ENERGY CENTER
LIMIT OF INSURANCE S 6,500,000
DEDUCTIBLI. S 10,000
SOFT COSTS
LIMIT OF INSURANCE S 50,000
WAITING PERIOD 168 HOURS
EFFECTS OF LAW
LIMITOFINSURANCE I,OOO,Opil
LOSS PREVENTION EXPENSE
LIMIT OF INSURANCE S 25,000
ELECTRONIC DATA AND VALUABLE PAPERS
LIMIT OF INSURANCE S 50,000
FUNGUS CLEAN -UP OR REMOVAL
LIMIT OF INSURANCE 25,11()0
RENTAL INCOME
LIMIT OF INSURANCI", 50,000
WAITING PERIOD 12 HOURS
PREMISES 1 1.26TI1 CITY CENTER DR
(continued) CAfJMEJ,, IN 46()32
Building Number: 1
CONTRACT WORKS
DESCRIPTION ENERGY CENTER
LIMIT OF INSURANCE 7,000,000
DEDUCTIBLE S 10,000
SOFT COSTS
LIMIT OF INSURANCI S 51.1,001.1
WAITING PERIOD 168 HOURS
EFFECTS OF LAW
LIMII'OFINSURANCE 1,000,000
LOSS PREVENTION EXPENSE
IMIT OE INSURANCE S 25,000
Inland Marine Insurance lssue Date: APRIL 6, 2010 continued
w Form 04 -02 -0638 (Ed, 9 -95) Declarations Page 5
Premises Coverages
(continued)
ELECTRONIC DATA AND VALUABLE PAPERS
LIMIT OF INSURANCE 50,000
FUNGUS CLEAN -UP OR REMOVAL
LIMIT OF INSURANCE 25,000
RENTAL INCOME
LIMA' OF INSURANCE 50,11011
WAITING PERIOD 12 HOURS
Coverage at Unnamed Premises
The following displays the coverages provided at other premises.
PREMISES ANY OTHER PREMISES WITHIN THE COVERAGE TERRITORY
CONTRACT WORKS AWAITING DELIVERY
LIMIT OF INSURANCE S 600,001"1
Coverages Away From Premises
The following displays the coverages provided away from premises.
CONTRACT WORKS IN TRANSIT
LIMIT OF INSURANCE 200,000
Coverages at Named Premises, Unnamed Premises and Away From Premises
The following displays the coverages provided at premises which are specifically covered under this insurance, other premises and away
from premises.
DEBRIS REMOVAL
LIMIT OF INSURANCE 150,000
POLLUTANT CLEAN UP OR REMOVAL
LIMIT OF INSURANCE 50,000
EXPEDITING EXPENSES
LIMIT OF INSURANCE 50,000
Inland Marine Insurance Issue Date: APRIL 6, 2010 continued
Form 04 -02 -0638 (Ed. 9 -95) Declarations Page 6
Inland Marine Insurance
criuBB
Declarations
Effective Date APRIL 22, 2010
Policy Number 0663- 75 -24IND
Premises Coverages
(continued)
PREPARATION OF LOSS FEES
LIMB' OF INSURANCE 25,000
PUBLIC SAFETY SERVICE CHARGES
LIMIT OF INSURANCE 25,000
Inland Marine Insurance Issue Date: APRIL 6, 2010 last page
Form 04 -02 -0638 {Ed 9 -95) Declarations Page 7
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.
I 1 1 Payee
Purchase Order No.
Terms
t��4ilnA 2 !25 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
4-13-110 O Irr ehs %on 2 q f3 �o
Total 9 0
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
VOUCHER NO. WARRANT NO.
j r ALLOWED 20
IN SUM OF
�0 6ox It
I A+ykwli S, �Al l+ 9 D 015
ON ACCOUNT OF APPROPRIATION FOR
T/F)//O
Board Members
DEPT. o r INVOICE NO. ACCTWTITLE AMOUNT I hereby certify that the attached invoice(s), or
q02 724 3`75'0 2 1 13. OD bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
r received except
f
s- 12 2010
S ggnature
Director ofRedeveiopment
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
HYLANT P.O. sox 40925
Indianapolis, IN 46280 -0925
Local: 317 -817 -5000 I N V O I C E# 727822
GR OUP
CARMEN 79 05/24/10
W. Michael Wells
r ,BALANCE-DUErON�. Y. r_c.• .:aa -.r
01/01/09
2,249.00
City of Carmel
Steve Engelking
One Civic Square
Carmel, EST 46032
Rafe 7 my l_#acar. Descrfptior Y .it»ottnt
INVOICE 727822
01/01/09 AUD WC -S WCX002730 WC FINAL AUDIT Citizens Ins Co of America 2,249.00
FINAL AUDIT PERIOD: 1/1109 10
Invoice Balance: 2,249.00
HYLANT GROUP wwwhylant.com
301 Pennsylvania Parkway Suite 201 P.O. Box 40925 Indianapolis, IN 46280 -0925 Local: 317- 817 -5000 Fax: 317 -817 -51.51
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
Hylant Group Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
05/24/10 727822 WC Final Audit $2,249.00
Total $2,249.00
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
VOUCHER NO /2-4110 WARRANT NO.
ALLOWED 20
Hylant Group IN SUM OF
PO Box 40925
Indianapolis, IN 46280 -0925
$2249.00
ON ACCOUNT OF APPROPRIATION FOR
302 Workers Compensation
Board Members
PO# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
727822 302 $2,249.01 materials or services itemized thereon for
which charge is made were ordered and
received except
20
A
Sin ure
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund