187871 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 00352999 Page 1 of 1
ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $50.00
is .a CARMEL, INDIANA 46032 P O BOX 40925
4,. NOIANAPOLIS IN 46082 -4910 CHECK NUMBER: 187871
CHECK DATE: 7/21/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 732723 50.00 KIBBEE NOTARY
HYLANT P.O. Box 40925
Indianapolis, IN 46280 -0925
V
Local: 3 17- 817 -5000 I N V O I C E 732723'
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CARM08B 79 07/13/10 -Vy
6722152
W. Michael Wells
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City Of Carmel 07/13/10 07/13/18 07/13110
One Civic Square 50.00
Carmel, IN 46032
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INVOICE 732723
07/13/10 NEW BOND 6722152 NOTARY BOND American States Insurance Co 50.00
NOTARY BOND FOR SHARON M KIBBE
Invoice Balance: 50.00
4 30 L4 G �nsuranc.e-1
JULY 9 2010
By
HYLANT 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
Liberty Mutual Surety
1001 4th Avenue, Suite 1700
t a Seattle. WA 98154
NOTARIAL BOND Bond No. 6722152
KNOW ALL MEN BY THESE PRESENTS, That we SHARON M KIBBE
(Name of Applicant)
as principal (Applicant) and AMERICAN STATES INSURANCE COMPANY, as corporate surety, are held and firmly
bound unto the State of Indiana, in the penal sum of FIVE THOUSAND DOLLARS ($5,000), the payment of which, well
and truly to be made, we bind ourselves, our heirs, executors and administrators, firmly by these presents.
WHEREAS, the above bound principal has applied for appointment by the Governor of the State of Indiana as a
Notary Public, in and for the State of Indiana, for an eight year term.
Now, if the said principal shall truly and faithfully perform and discharge the duties of said office of Notary Public,
In all things according to law, then the above obligation to be null and void, otherwise to remain in full force and virtue in
law. The term of this bond is from the effective date of the principal commission to the expiration date of the same:
CD
y�P�� INSU
Timothy A. Mikolajewski, Vice President
/NDlA�1A�
Congratulations, you have successfully obtained a notary bond for the State of Indiana.
Bond 6722152
Surety Company: Amerlcan States Insurance Company, a member of Liberty Mutual Group
To obtain the notary commission:
Each notary applicant must now access the Indiana Notary Public Appllcation online at www,in.gov to complete the pre
qualification, training and oath agreement. After successfully completing, the applicant must pay the application fees to
the State of Indiana via MasterCard or Visa. Once the flees are paid, your client can download a file that contains the
Notary Commission Certificate.
S -6080/DA 4110
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AMERICAN STATES INSURANCE COMPANY
NOTARY PUBLIC ERRORS AND OMISSIONS POLICY
POLICY NO. E O 6722152
AMERICAN STATES INSURANCE COMPANY will pay on behalf of SHARON M KIBBE
of 827 Winter Court Carmel, IN 46032
(Address)
(hereinafter called the insured), all sums which the insured shall become obligated to pay by reason of liability for breach of duty
while acting as a duly commissioned and swom Notary Public, claim for which is made against the insured by reason of any
negligent act, error or omission, committed or alleged to have been committed by the Insured, arising out of the performance of
notarial service for others in the insured's capacity as a duly commissioned and sworn Notary Public.
POLICY PERIOD: This policy applies only to negligent acts, errors or omissions which occur during the policy period and then
only if clalm, suit or other action arising therefrom is commenced during the policy period, and is not barred by the applicable
Statute of Limitations pertaining to the insured. The Policy Period commences on the effective date of the insured's commission
as a Notary Public and terminates upon the expiration of the Insureds commisslon as a Notary Public unless cancelled eariler as
provided in this policy. This policy Is not valid for more than one commission term.
LIMITS OF LIABILITY: The liability of this company shall not exceed in the aggregate for all claims under this insurance the
amount of Five Thousand Dollars And Zero Cents 5,000.00
In addition to the limit of liability and In accordance with the other provisions of this policy, this company will pay costs and
expenses paid and incurred in investigating, contesting or settling liability in an amount not to exceed, In the aggregate, one -half
of the limit of this policy.
tNSURED'S DUTIES IN THE EVENT OF OCCURRENCE, CLAIM, OR SUIT:
(a) Upon knowledge of any occurrence which may reasonably be expected to result in a claim or suit, written notice
containing particulars sufficient to identify the Insured and also reasonably obtainable information with respect to the time,
place and circumstances thereof, and the names and addresses of the potential claimant and of available witnesses, shall
be given by orfor the Insured to the Company or any of its authorized agents as soon as practicable, but in no event
longer than forty- five(45) days after discovery.
(b) If claim is made or suit Is brought against the Insured, the Insured shall immediately forward to the Company every
demand, notice, summons or other process received by him or his representative.
(c) The Insured shall cooperate with the Company and, upon the Company's request, assist In making settlements, in the
conduct of suits and the Insured shall attend hearings and trials and assist in securing and giving evidence and obtaining
the attendance of witnesses. The Insured shall not, except at his own cost, voluntarily make any payment, assume any
obligation or incur any expense except with the prior written consent of the Company.
EXCLUSIONS: Coverage under this policy does not apply to any dishonest, fraudulent, criminal or malicious act or omisslon of
the insured.
CO- INSURANCE: If the insured has other Insurance against a loss covered by this policy, the company shall not be liable
under this policy for a greater proportion of such loss, cost and expenses than the limit of liability stated in this policy bears to the
total limit of liability of all valid and collectible insurance against such loss.
CANCELLATION: This policy may be cancelled by the Company by mailing thirty (30) days written notice to the Insured and
may be cancelled by the Insured by surrender thereof to the Company or any of its agents or by mailing to the Company thirty
(30) days written notice and this policy shalt be deemed cancelled and the Policy Period terminated upon such return or at the
expiration of said thirty (30) days. A pro rata return premium shall be allowed on cancellation.
Dated, signed and sealed this 13th day of July 2010
AMERICAN STATES INSURANCE COMPANY
Address Claims to: S INSU
Liberty Mutual Surety
1001 4th Avenue, Suite 1700 By t r
Seattle, WA 98154 Tim Mikolajewski senlor vice- PresWeK Surety
/NDIANP`
5- 6835/DA 06103
x0P
VOUCHER NO. WARRANT NO.
Hylan# Group ALLOWED 20
IN SUM OF
301 Pennsylvania Parkway, Suite 201
Indianapolis, IN 46280 -0925
$50.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
PO# Dept. INVOICE NO. I ACCT #(TITLE AMOUNT
Board Members
1205 I 732723 I 43- 475.00 I $50.00 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
Friday, July 16, 2010
Director, dministration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1195)
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))
07113!10 732723 $50.00
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