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HomeMy WebLinkAbout196634 04/13/2011 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1 ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $6,677.26 ,20 CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 CHECK NUMBER: 196634 CHECK DATE: 4/13/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 376333 6,408.40 GENERAL INSURANCE 1205 4347500 376905 268.86 GENERAL INSURANCE AMW TR AVEL SJ PAGE i DEDUCTIBLE INVOICE 303GP64A -810 521GX7087 03/31/2011 000376905 04/15/2011 268.86 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL,CARMEL CLAY 13607 COLLECTIONS CENTER DRIVE ONE CIVIC SQUARE CHICAGO, IL 60693 CARMEL IN 46032 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK. AMk TRAVELERS JJ PAGE 1 3036PG4A -810 5216X7087 03/31/2011 000376905 04/15/2011 268.86 CURRENT CLAIM ENZ7580 DATE OF LOSS: 02/05/2011 DESCRIPTION: C WILIFORD, STEVEN TORT NOTICE ALLEGING A CITY SNOW PLOWTRUCK THREW CLAIMANT: STEVEN WILIFURD LOSS 268.86 CLAIM TOTAL 268.86 CURRENT CHARGES $268.86 ACCOUNT SUMMARY CURRENT CHARGES 268.86 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000 TOTAL DUE 268.86 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 268.86 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 D Zj `J r APR 11 2611 i By TRAVELERS NON FUNDED DEPARTMENT ONE TOWER SQUARE -9CR HARTFORD, CT 06183 39038 CITY OF CARMEL,CARMEL CLAY ONE CIVIC SQUARE CARMEL IN 46032 M 0 0 0 0 0 0 a 0 TRAVELERS J PAGE 1 DEDUCTIBLE INVOICE 1 I I I I I GP09313908 521GX7087 03/31/2011 000376333 04/15/2011 6,408.40 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL; CARMEL CLAY 13607 COLLECTIONS CENTER DRIVE ATTN: JIM SPELBRING Q CHICAGO, IL 60693 ONE CIVIC SQUARE CARMEL IN 46032 APR 11 2011 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK. e TRAVELERS J PAGE 1 12 I I ill mi GPO9313908 521GX7087 03/31/2011 000376333 04/15/2011 6,408.40 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 310.20 CLAIM TOTAL 310.20 CLAIM CESS844 DATE OF LOSS: 06/13/2010 DESCRIPTION: C ROBERTS, MARY TORT NOTICE ALLEDGING BATTERY, TRESPASS, FALSE ARR CLAIMANT: MARY ROBERTS EXPENSE 5,259.30 CLAIM TOTAL 5,259.30 CLAIM EMS6617 DATE OF LOSS: 04/16/2010 DESCRIPTION: TORT NOTICE ARISING OUT OF THE ARREST MADE BY CPD OF THE CLAIMANT FOR CLAIMANT: SHARRON ATKINS EXPENSE 838.90 CLAIM TOTAL 838.90 CURRENT CHARGES $6,408.40 ACCOUNT SUMMARY CURRENT CHARGES 6,408.40 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 6,408.40 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 6,408.40 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 TRAVELERS NON- FUNDED DEPARTMENT ONE TOWER SQUARE -9CR HARTFORD, CT 06183 39039 CITY OF CARMEL; CARMEL CLAY PARKS ATTN: JIM SPELBRING ONE CIVIC SQUARE CARMEL IN 46032 m ro 0 O `I n f7 O 0 0 N 0 Q 0 0 VOUCHER NO. WARRANT NO. ALLOWED 20 Travelers IN SUM OF 13607 Collections Center Drive Chicage, IL 60693 $6,677.26 ON ACCOUNT OF APPROPRIATION FOR Carmel Administration PO# Dept. INVOICE NO. I ACCT /TITLE AMOUNT Board Members 1205 000376333 I 43- 475.00 j $6,408.40 1 hereby certify that the attached invoice(s), or 1205 000376905 43- 475.00 $268.86 i 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, April 11, 2011 Director, Administration I Title Cost distribution ledger classification if claim paid motor vehicle highway fund I 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)) 04/15/11 000376333 $6,408.40 04/15/11 000376905 $268.86 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