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Home My WebLink About195475 03/16/2011 CITY OF CARMEL, INDIANA VENDOR: 00352999 Page 1 of 1 ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $26,268.75 CARMEL, INDIANA 46032 P 0 BOX 40925 a� d6, INDIANAPOLIS IN 46082 -4910 CHECK NUMBER: 195475 CHECK DATE: 3/16/2011 DE PARTMENT ACCOUNT PO NUMBER INVOICE NU MBER AMOUNT DESCRIPTION 1125 4347500 753381 1,072.00 GENERAL INSURANCE 302 5023990 753382 14,058.25 OTHER EXPENSES 302 5023990 753383 11,138.50 OTHER EXPENSES I TG YLANT P.O. Box 40925 W Indianapolis, IN 46280 -0925 I't�c ,GI Local: 317 -8 a -5000 INVOICE 73382 I R OUP e1CCOUN,I�YO CARME80 79 03101111 I J k .y WCX002730 W. Micha Wells ECI' I\, F .�Ss... E \P1R�TIOR',?..^�a�.,,; City of Carmel 01/01/09 01/01/12 04110111 Steve Engelking 14,058.25 One Civic Square Carmel, IN 46032 4 did tx u' 'a.,. E s.�r r^;;�. w 3 f a Eff pateTrn Type, Policy #,3 Description 3 4�Amount "a,- "f' r +e fib n� '&F` 1 M. M1�r- r. s,�...�_� -a. a 3 z� ..�,..c,.�t'+�,.`'.�.',.,r�'... INVOICE 753382 01 /01 /11 RiS WC -S WCX002730 WC PREM 2 OF 4 Citizens Ins Co of America 14,058.25 Invoice Balance: 14,058.25 MAR 4 1011 ;i 301 Pennsylvania Parkway Suite 201 P.O. Box 40925 Indianapolis, IN 46280 -0925 Toll Free: 800 -678 -0361 Local: 317- 817 -5000 Fax: 317 -817 -5151 Risk AAanagerne'nt:-; Insurance 40 1(k) Investments Benefits U HYLANT P.O. Indianapolis, IN 46280 -0925 Local: 317- 817 -5000 INVOICE 753383 a G ROUP \C COU V'IiYO `�..x.,snx r. >.ra.CSR......rA CA11ME80 79 03101 11 �WQr�Ice COn]pCUSatton sirs mss' T w i ��..e. WCX002730 t PR zC 4M, sr C a p. §h .;'•k "z M g Fa.fi 3 �T u rt:.Yf20DUC. EIt..x..g�':..s*s,aP�a; W. Michael Wells City of Carmel 01/01/09 01 /01 /12 04 /10 /t)1 y DUE Steve Engelking 11,138.50 One Civic Square Carmel, IN 46032 .ey 1x EffiDate Trn Type- Policy #a?,: sw,, Descrl tlon s g 'c• S' ?.e�� r a=..,. ss ,x;�Y i'�4, x rr ��a� "k;::.. r �m?w g fir"" t..� c� .Amount INVOICE 753383 01/01/11 1215 WC -S WCX002730 TPA 2 OF 4 Citizens Ins Co of America 11,138.50 Invoice Balance: 11,138.50 �f f MAR 14 2011 By- 301 Pennsylvania Parkway Suite 201 P.O. Box 40925 Indianapolis, IN 46280 -0925 Toll Free: 800 -678 -0361 Local: 317 -817 -5000 Fax: 317 -817 -5151 Risk Management Insurahce +1 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 Hylant Group Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 03/14/31 753382 WC Prem 2 of 4 $14,058.25 03/14/11 753383 TPA 2 of 4 11,138.50 Total $25,196.75 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 VOUCHER NOO114!1 WARRANT NO. ALLOWED 20 Hylant Group IN SUM OF PO Box 40925 Indianapolis, IN 46280 -0925 $25,196.75 ON ACCOUNT OF APPROPRIATION FOR 302 Fund Board Members Po# or INVOICE NO. ACCT /TITLE AMOUNT oEPT. I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 753382 302 $14,058.25 materials or services itemized thereon for which charge is made were ordered and received except 20 `f./ l i atur Cost distribution ledger classification if Title claim paid motor vehicle highway fund HYLANT P. O. Box 4 rN 46280-0925 INVOICE# 73381 e 1 Local: 317- 817 -5000 71, GROUP \CCOUNl;N9 CSR, .DA I I CARME -3 03141111 1PR06UC Ex.::..v i_... �z :__�.u...tt....a.:.�.....�.._.. _.Y.�� W. Michael Wells Y B�1 Lr1NCEI)UE.ON��._. Y_...+...a: .a. ......_.,__n �?��.s...s�a"}� i. 04/01/11 r ..��MOUNT�I'i\ID _._�...d _.:r. \M1IOUNT_DUE „s? a..: .;�71a% S 1,072.00 w r M_ Carmel Clay Bd.Parks Rec. g' 4S A UV ig 1411:E. 116th St KAR 0 3 1011 Carmel, IN 46032 b� ...�o —s T T- tz s� s ro f tt €j s' c., ti f •L a 1:,• 1. r"v AfT10Unty4: J Eff Date Trn Type Pollc Desch t on �.a.r �.�...n s.�..l ,..wc �.�.t +�r .ti��` ,..xi �``'i �...r..:.s•.•= :z�at•.., INVOICE-# 753381 04/01/09 REN CR -S 104720946 CRIME POLICY -3RD AN Travelers Insurance Companies 1.072.00 Invoice Balance: 1,072.00 Purchase Description DISHONGST>/ Pcu Cy P.O.# PorF SPi_lr? G.L.# 1 1X5 4N 75DD Budget Line Descr 1 P.nE' cd I {'1 L I on n CL° Purchaser Date Approval Date 301 Pennsylvania Parkway Suite 201 P.O. Box 40925 Indianapolis, IN 46280 -0925 Toll Free: 800 678 -0361 Local: 317 -817 -5000 Fax: 317 -817 -5151 Risk Management Insurance 41 B enefits ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. 00352999 Hylant Group Terms P.O. Box 40925 Date Due Indianapolis, IN 46280 -0925 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 3/1/11 753381 Insurance Employee Dishonest policy 1,072.00 f Total 1,072.00 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 i Voucher No. Warrant No. 00352999 Hylant Group Allowed 20 P.O. Box 40925 Indianapolis, IN 46280 -0925 In Sum of 1,072.00 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. kCCT #FFITLI AMOUNT Board Members Dept 1125 753381 4347500 1,072.00 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 10 -Mar 2011 Signature 1,072.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund