HomeMy WebLinkAbout188689 08/17/2010 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1
ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $1,369.58
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE
CHICAGO IL 60693 CHECK NUMBER: 188689
CHECK DATE: 811712010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 355618 1,369.58 GENERAL INSURANCE
TRAVELERS PAGE 1
DEDUCTIBLE INVOICE
GPO9313908 521GX7087 07/30/2010 000355618 08/15/2010 1,369.58
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL; CARMEL CLAY PARKS
13607 COLLECTIONS CENTER DRIVE ATTN: JIM SPELBRING
CHICAGO, IL 60693 ONE CIVIC SQUARE
CARMEL IN 46032
RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS.
PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK.
AW
TRAVELERS J PAGE 1
i i on d i
GP09313908 521GX7087 07/30/2010 000355618 08/15/2010 1,369.58
CURRENT
CLAIM CAW7554 DATE OF LOSS: 01/04/2007
DESCRIPTION: C JACKSON, CHAD TORT NOTICE ARISNG OUT OF ALLEGED
INJURIES THE CLA
CLAIMANT: CHAD JACKSON
EXPENSE 107.20
CLAIM TOTAL 107.20
CLAIM EKZ1066 DATE OF LOSS: 05/06/2010
DESCRIPTION: C- CHURCH OF JESUS CHRIST LATTER DAY SAINTS. IV WAS
STOPPED IN TRAFFI
CLAIMANT: /JESUS CHRIST OF LATTER D
LOSS 1,262.38
CLAIM TOTAL 1,262.38
CURRENT CHARGES $1,369.58
ACCOUNT SUMMARY
CURRENT CHARGES 1,369.58 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 1
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 1.369.58
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE HELPOESK@TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1- 800 356 -4098 EXT. 08900: ANTONIO CONTRERAS
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By
TRAVELERS
NON- FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
39020
CITY OF CARMEL;.CARMEL CLAY PARKS
ATTN: JIM SPELBRING
ONE CIVIC SQUARE
CARMEL IN 46032
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF
13607 Collections Center Drive
Chicage, IL 60693
$1,369.58
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1205 I 000355618 I 43- 475.00 I $1,369.58 I hereby certify that the attached invoice(s), or
1
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, August 16, 2010
Director, f Administr tion
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
Dat Nu mber (or note attached invoice(s) or bill(s))
08115/10 I 000355618 I $1,369.58
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