HomeMy WebLinkAbout195475 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
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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
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3 f a Eff pateTrn Type, Policy #,3 Description 3 4�Amount
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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
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G ROUP \C COU V'IiYO `�..x.,snx r. >.ra.CSR......rA
CA11ME80 79 03101 11
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WCX002730
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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�
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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