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
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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
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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
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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