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HomeMy WebLinkAbout186768 06/23/2010 CITY OF CARMEL, INDIANA VENDOR: 364284 Page 1 of 1 `i. ONE CIVIC SQUARE STEPHEN CHANG o CARMEL, INDIANA 46032 5128 KINGSWOOD DRIVE CHECK AMOUNT: $115.00 CARMEL IN 46033 CHECK NUMBER: 186768 CHECK DATE: 6/23/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4237000 115.00 REPAIR PARTS -t Page 1 of 4 Callahan, Bonnie From: Zechman,Katie R [KZECH MAN @travelers, cum] Sent: Tuesday, June 15, 2010 5:02 PM To: Callahan, Bonnie Subject: RE: Travelers Claim EKZ5512 •P Pa90 aat6 Ws &I YSOIa 0.157 PM Pa9o.4 Ole __06 _10 /2FJ20 12;42 31757124Es CNRWL LAW t}EPARTMET PAG_ 02 /0e Y TORT C NalT E Namr. of Claimant 2. Ad& La ro.t.c 1A 4 3 3. Phone Nnmbcr of Claimant lJ-q 9 1 4. bate,Time of Cass W I M P -C t 17J e ms_" S. Location of Less k_. N� t s lro a l+ hb 0.r a5� oC► C DeqcdPfioU of Ci.NTmstartccs Rtin About Lass c� l a-w �C A, 7. Extent of Loa:. Being Claimed q C V 8. Nantes of All PetWns Ltvolved Including Alitntrses 9. Amount of Damages Bcjng Claimed 10. Residence of Petsaa flaking Claim at Time of Los t 1 I- WIS14cam of Peron Nlaiog Claim Camcotly� Stgramm: I]ate: rY� M�iO1 TORT Nora MUST BE FILED WITH CFrY OF CARMEL, INDIANA, WITH 18C DAYS AFTER THE LOSS OCCURS. THIS NICE MUST BE DELWERED IN.PERSON OR BY CERTIFIED MAIL TO: City of Garmo{ Indiana Department of Law Ono Chic Square Carmel, Indiana 46032 Phone: (317) 571.2412 r n,�•xs {euo.rrrnraroevna+ 311Prcatt:N�x..1.70f t11s9 Id k",fctr:01 BLOC f.0 ­r 'ON Yk;� 6/16/ N—OCd RhC,o F-JO. Pale 5 bf a MW.V 102010 D3 S7 PIA Pago 5 of 6 C 120 1 C 42 317571«4:4 C FTn LAkj XPARTW7 PAGE OWN Office: (w) $4. 74X (597) 842 C yl— Care, ree 1"atim kw lj4550 Olin Road#i000 Fishers, ln&lan-a 46037 MIMV A.116 Steyfwn cfbzno 5228 xiveswoodOrfve Car me C hl&lana, 46033 r7 NO 13207 mvmoy MTL*,L$&RVKZDA-Mi ADMMALDA13 jwVOICE DK,&TF I 7CURPMN) ��DATI M �13 20;�j 17, 27 IYCtffI May 65.005 65-00 50.0o L4&k to �thdg- F OW 30 aao� —d w V% bt d 10 AD iT� C-Aft ftnan4 b"Mt bn=dUttlY 4-C oni P"wbl& t*" 5 115.00 Make a9W Payable U). roc hTiption Im. Stephen Chane S12s xt Vswoo d Drive Carme4.Tnd?4" 4 )ftA 6/16/2010 F1a11,L11.ea W— F-10.. Page 0 W 0 Oa1e.OnOrO1003 57 PM Pagc.7 at 0 ecilciaeze 32:4: ?375'1:4:4 C.,PI.11i 11+ i l.RTTCT FAGS 0419: ruN'MM Jotm-CHANG 1 4m e 126 CNGS OOn CC CaM Msnngt ttt ACCMIt7!' C'MALF4 X0=31 a0 wTr� i ,1p 10 tS•aa•11g o a S .ro 2 9� r Cd 'We:fi a ;w fig ur.; 'D: *-4 1rD; 1 t ic Zechman o Physical Damage /Public Sector /IM P.O. Boa 3095, Naperville, N -60563 Phone: 800 842 -6172 x 8864 1 Fax: 877- 795 -9975 Email: kzechmanQ@uavelers.com From: Callahan, Bonnie mailto:BCallahan @carmel.in.gov] Sent: Tuesday, June 15, 2010 1:38 PM To: Zechman,Katie R Subject: RE: Travelers Claim EKZ5512 Katie I don't know if I'm missing something but like the last one, this one just has 6 pages of Hylant Stationary that are blank, From: Zechman,Kabe R [mailto:KZECHMAN @travelers.com] Sent: Tuesday, June 15, 2010 1:17 PM To: Callahan, Bonnie Subject: RE: Travelers Claim EKZ5512 Bonnie, I attached the form to this email, please review and call me to discuss further. Thank You, Katie Zeehman 6/16/2010 VOUCHER NO. WARRANT NO. ALLOWED 20 Stephen Chang IN SUM OF 5128 Kingswood Drive Carmel, IN 46033 $115.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO# I Dept. INVOICE NO. ACCT #ITITLE AMOUNT Board Member; 2201 42- 370.00 $115.00 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 Thulsday, lye 17, 2010 Y Street CommissionerV 77t1i rrri5�i�h� 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)) 06/15/10 $115.00 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