HomeMy WebLinkAbout189640 09/13/2010 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1
r 0 ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $1,988.80
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE
CHICAGO IL 60693 CHECK NUMBER: 189640
CHECK DATE: 9/13/2010
DEPARTMENT AC PO N UMBER IN VOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000358056 1,988.80 GENERAL INSURANCE
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TRAVELERS J PAGE 1
GPO9313908 521GX7087 08/31/2010 000358056 09/15/2010 1,988.80
q li CURRENT
CLAIM A4P0980 1 DATE OF LOSS: 09/28/2007
DESCRIPTION: C FLYNN, MICHAEL POLICE OFFICER FILING CHARGES
AGAINSTCITY HIS EMPLO
CLAIMANT: MICHAEL FLYNN
EXPENSE 1,694.00
�1• CLAIM TOTAL 1,694.00
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 294.80
CLAIM TOTAL 294.80
CURRENT CHARGES $1,988.80
ACCOUNT SUMMARY
CURRENT CHARGES 1,988.80 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 1,988.80
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 1,988.80
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE- HELPDESK @TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1- 800 -356 -4098 EXT. 08900: ANTONIO CONTRERAS
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13 2010
By
TRAVELERS
NON- FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
38921
CITY OF CARMEL; CARMEL CLAY PARKS
ATTN: JIM SPELBRING
ONE CIVIC SQUARE
CARMEL IN 46032
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J':,H7 7. f�; ^.RRANIT NO.
Travelers
Chicage, IL 60693
$1,988.80
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1205 I 000358056 I 43- 475 -00 j $1,988.80 1 hereby certify that the attached involce(s), or
bi11(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, September 13, 2010
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
by State Board of Accounts Cray Form No 201 (Rev. 1 °95)
OF CARNIEL
whom, r 'Ics per day, number of hours, rate per hour, number of units, price per unit, ctc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
08/31/10 000358056 $1,988.80
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