HomeMy WebLinkAbout186705 06/21/2010 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1
ONE CIVIC SQUARE TRAVELERS
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $21,440.40
CHICAGO IL 60693 CHECK NUMBER: 186705
CHECK DATE: 6/2112010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 350915 21,440.40 GENERAL INSURANCE
T'RAVELERS 6" PAGE 1
DEDUCTIBLE INVOICE
AGENT COPY
1 1441111 ilk I L 131 Mil IN m luld 1 1 1
GPOS313908 521GX7087 05/28/2010 000350915 06/15/2010 21,440.40
MAIL PAYMENT TO: AGENT:
TRAVELERS HYLANT GROUP INC
13607 COLLECTIONS CENTER DRIVE PO BOX 40925 a
CHICAGO, IL 60593 INDIANAPOLIS IN 46280 -092 D
RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS JUN 21 2010
PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK.
By
T RAVELERS i PAGE 1
millmom
GPOS313908 521GX7087 05/28/2010 000350915 06/15/2010 21,440.40
CURRENT
CLAIM#: A4P0980 DATE OF LOSS: 09/28/2007
DESCRIPTION: C FLYNN, MICHAEL POLICE OFFICER FILING CHARGES
Poltc e, AGAINSTCITY HIS EMPLO
CLAIMANT: MICHAEL FLYNN
LOSS 17,500.00
CLAIM TOTAL 17,500.00
CLAIM#: CAW7554 DATE OF LOSS: 01/04/2007
DESCRIPTION: C JACKSON, CHAD TORT NOTICE ARTSNG OUT OF ALLEGED
polLGB INJURIES THE CLA
CLAIMANT: CHAD JACKSON
EXPENSE 482.40
CLAIM TOTAL 482,40
CLAIM#: CES0262 DATE OF LOSS: 01/08/2008
DESCRIPTION: REED, SANDRA KENNETH AND DOWNNET, MICHAEL TORT CLAIM
P4l4Ge+ NOTICE, ALLEGES
CLAIMANT: KENNETH REED
EXPENSE 3,458.00
CLAIM TOTAL 3,458.00
CURRENT CHARGES $21,440.40
ACCOUNT SUMMARY
CURRENT CHARGES 21,440.40 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 21.440.40
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 21,440.40
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE- HELPDESK @TRAVELERS.CDM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1- 800 356 -4098 EXT. 08900: ANTONIO CONTRERAS
VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF
13607 Collections Center Drive
Chicage, IL 60693
$21,440.40
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1205 I 000350915 43- 475.00 I $21,440.40 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
Monday, June 21, 2010
Direct r, Administr Ion
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))
06/15/10 000350915 $21,440.40
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