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
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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.
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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
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r APR 11 2611
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By
TRAVELERS
NON FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
39038
CITY OF CARMEL,CARMEL CLAY
ONE CIVIC SQUARE
CARMEL IN 46032
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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
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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
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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