HomeMy WebLinkAbout194437 02/09/2011 CITY OF CARMEL, INDIANA VENDOR: 365068 Page 1 of 1
y` f ONE CIVIC SQUARE INDIANA INSURANCE COMPANY
CHECK AMOUNT: $975.00
CARMEL, INDIANA 46032 PO BOX 5001
4 HAMILTON OH 45012 -5001 CHECK NUMBER: 194437
CHECK DATE: 2/9/2011
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4347500 750005067093 975.00 CORDRAY BOND
ACCOUNT NUMBEH ACCOUNT BALANCE
7500115067093 $975.00
I nd iana 9450 Seward Road, Fairfield, Ohio 45014 BILLING DATE DUE DATE
nsurance.
www.indiana- ins.com /services 12/02/2010 01/03/2011
t
Bond MINIMUM DUE
$975.00
Premium Due
FAVOR AGENT AGENT'S PHONE N0.
DIANA L CORDRAY RMD /PATT1 INS FINANCIAL SVCS (317) 845 -1547
11843 STONEY BAY CIRCLE 7116 E 71ST ST
CARMEL IN 46033 -9501 INDIANAPOLIS IN 46256 -1997
I1II6, Il1011,ll„1 oil III oil 10111111l „1„ 111 ,,1111
DesrCustottrer,
It you need assistance, contact your agent at
Thank you for continuing your Bond with your the above number, or for billing Inquires phone
fn dependent Agent. 1.800. 543 -1953.
Please pay the current
payment due by the due date.
Account Detail for DIANA L CORDRAY
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SURETY 01/01011 01101/2012 $300,000.00 RENEWAL $975.00
SNO 05067093
Princlpa 0SUrea. MAIM L CORDRAY 014ee. CITYOFCARMEL
Underw fiten by. Ohio Casuanylnsurance Company Description: TREASURERS
Total $975.00 $975.00
Foryoor Raeords: Amount Paid Date Paid Check Na
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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
u l VV Purchase Order Flo.
O I L U Terms
AM Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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
VOUCHER NO. WARRANT NO.
�MADU �A�,&CW(k ALLOWED 20
IN SUM OF
TO&� 60o
fia dj�A 0 4�Zl
q7
ON ACCOUNT OF APPROPRIATION FOR
1 6&0- (/�t S �t r
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bills) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund