HomeMy WebLinkAbout194474 02/15/2011 9 a-�„ CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1
ONE CIVIC SQUARE TRAVELERS
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $3,205.25
:,(rl�r'. CHICAGO IL 60693
CHECK NUMBER: 194474
CHECK DATE: 2/15/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 371195 3,205.25 GENERAL INSURANCE
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TRAVELERS J PAGE 1
DEDUCTIBLE INVOICE
1;1 1 llM C V] Jill 4M3.1 1 q MlYl i 1M.11 I 1 I
GPO9313908 5216X7087 01/31/2011 000371195 02/15/2011 3,205.25
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.
T r, D C I
Y R r ELERS J PAGE 1
1 1 I
GPO9313908 521GX7087 01/31/2011 000371195 02/15/2011 3,205.25
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 1,276.00
CLAIM TOTAL 1,276.00
CLAIM CBV7605 DATE OF LOSS: 03!04/2007 L.✓
DESCRIPTION: ENGINE 41 BACKING UP WITH A SPOTTER BUT STRUCK D
PARKED UNOCCUPIED VEH 1 FEB 1 G
4 2011
CLAIMANT: BRIAN L RITTER
LOSS 417.35
By CLAIM TOTAL 417.35
CLAIM ENJ5682 DATE OF LOSS: 12/08/2010
DESCRIPTION: C GRABERT, BETTY FIRE DEPARTMENT ON FIRE RUN, BACKED
UP IN TO CLAIMA
CLAIMANT: BETTY GRABERT
LOSS 2,164.56
CLAIM TOTAL 2,164.56
CURRENT CHARGES $3,857.91
ACCOUNT SUMMARY
CURRENT CHARGES 3,857.91 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 652.66 AGENT PHONE: (317) 817 -5000
TOTAL DUE 3,205.25
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 3,205.25
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
TRAVELERS
NON- FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
38977
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
$3,205.25
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
PO# Dept. INVOICE NO, I ACCT #!TITLE AMOUNT
Board Members
1205 I 371195 I 43- 475.00 I $3,205.25 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, February 14, 2011
Director, L Administrati n
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))
02115/11 371195 $3,205.25
1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with [C 5- 11- 10 -1.6
20
Clerk Treasurer