Loading...
HomeMy WebLinkAbout197843 05/26/2011 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1 ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $3,839.10 CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 CHECK NUMBER: 197843 CHECK DATE: 5/26/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 000378912 2,121.90 GENERAL INSURANCE 1205 4347500 000379017 423.00 GENERAL INSURANCE 1205 4347500 000379517 1,294.20 GENERAL INSURANCE TRAVELERS PAGE 1 DEDUCTIBLE INVOICE GP09315757 521GX7087 04/29/2011 000379017 05/15/2011 423.00 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL, CARMEL CLAY PARKS BUILD 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. TRAVELERS PAGE 1 GPO9315757 5216X7087 04/29/2011 000379017 05/15/2011 423.00 CURRENT CLAIM EPS2377 DATE OF LOSS: 02/19/2011 DESCRIPTION: C- PARK,GREG VS CITY OF CARMEL POLICE MERIT BOARD. COMPLAINT FILED AGAI Io, l CLAIMANT: GREG PARK EXPENSE 423.00 CLAIM TOTAL 423.00 CURRENT CHARGES $423.00 ACCOUNT SUMMARY CURRENT CHARGES 423.00 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 423.00 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 423.00 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 MAY 3 2011 By TRAVELERS NON- FUNDED DEPARTMENT ONE TOWER SQUARE -9CR HARTFORD, CT 06183 39037 CITY OF CARMEL, CARMEL CLAY PARKS BUILD ONE CIVIC SQUARE CARMEL IN 46032 m O m m O r O r m O O O O Q O N TRAVELERS PAGE 1 DEDUCTIBLE INVOICE GPO9313908 521GX7087 04/29/2011 000378912 05/15/2011 2,121.90 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL; CARMEL CLAY PARKS 13607 COLLECTIONS CENTER DRIVE ATTN: JIM SPELBRING CHICAGO, IL 60693 ONE CIVIC SQUARE a CARMEL IN 46032 D Z /'AA RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. MAY 9, J 2"1 PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK. BY TRAVELERS PAGE 1 GPO9313908 521GX7087 04/29/2011 000378912 05/15/2011 2,121.90 CURRENT CLAIM CAW7554 DATE OF LOSS: 01/04/2007 DESCRIPTION: C JACKSON, CHAD TORT NOTICE ARISNG OUT OF ALLEGED INJURIES THE CLA Jll CLAIMANT: CHAD JACKSON EXPENSE 796.50 CLAIM TOTAL 796.50 CLAIM CESS844 DATE OF LOSS: 06/13/2010 DESCRIPTION: C ROBERTS, MARY TORT NOTICE ALLEDGING BATTERY, q-'., TRESPASS, FALSE ARR CLAIMANT: MARY ROBERTS EXPENSE 874.20 CLAIM TOTAL 874.20 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 451.20 CLAIM TOTAL 451.20 CURRENT CHARGES $2,121.90 ACCOUNT SUMMARY CURRENT CHARGES 2,121.90 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 2,121.90 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 2,121.90 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 39038 CITY OF CARMEL; CARMEL CLAY PARKS ATTN: JIM SPELBRING ONE CIVIC SQUARE CARMEL IN 46032 m 0 m 0 N m m n m O O O N O Q O O TRAVELERS J PAGE 1 DEDUCTIBLE INVOICE 1 1 1 I 1 1 3036P64A 810 521GX7087 04/29/2011 000379517 05/15/2011 1,294.20 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. TRAVELEC l S J PAGE 1 1 All 0 kmollliTiklil 1 1 1 1 303GP64A -810 5216X7087 04/29/2011 000379517 05/15/2011 1,294.20 CURRENT CLAIM EPS3174 DATE OF LOSS: 03/30/2011 DESCRIPTION: C- DALEY, SCOTT EMPLOYEE DONALD SIMPSON WAS BACKING UP INSURED VEHICLE CLAIMANT: SCOTT DALEY LOSS 1,294.20 CLAIM TOTAL 1,294.20 CURRENT CHARGES $1,294.20 ACCOUNT SUMMARY CURRENT CHARGES 1,294.20 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 1,294.20 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 1,294.20 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 MAY 232011 BY TRAVELERS NON- FUNDED DEPARTMENT ONE TOWER SQUARE -9CR HARTFORD, CT 06183 39036 CITY OF CARMEL,CARMEL CLAY ONE CIVIC SQUARE CARMEL IN 46032 m 0 0 0 0 0 N 0 Q 0 0 VOUCHER NO. WARRANT NO. ALLOWED 20 Travelers IN SUM OF 13607 Collections Center Drive Chicage, IL 60693 $3,839.10 ON ACCOUNT OF APPROPRIATION FOR Carmel Administration PO# I Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members r 1205 000379517 43- 475.00 $1,294.20 I hereby certify that the attached invoice(s), or 1205 000378912 43- 475.00 $2,121.90 bill(s) is (are) true and correct and that the 1205 I 000379017 1 43- 475.001 $423.00 i materials or services itemized thereon for which charge is made were ordered and received except Monday, May 23, 2011 r Director, Xdministratin Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No 261 (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)) 05/15/11 000379517 $1,294.20 05/15/11 000378912 $2,121.90 05/15111 I 000379017 I $423.00 I 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