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