HomeMy WebLinkAbout198399 06/21/2011 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1
ONE CIVIC SQUARE TRAVELERS
CHECK AMOUNT: $4,122.75
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE
CHICAGO IL 60693 CHECK NUMBER: 198399
CHECK DATE: 6/21/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 381452 1,395.90 GENERAL INSURANCE
1205 4347500 381533 366.60 GENERAL INSURANCE
1205 4347500 382065 2,360.25 GENERAL INSURANCE
TR A ELERS J PAGE 1
DEDUCTIBLE INVOICE
GPO9315757 521GX7087 05/31/2011 000381553 06/15/2011 789.60
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 Jp PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
GPO9315757 521GX7087 05/31/2011 000381553 06/15/2011 789.60
CURRENT
CLAIM#: EPS2377 DATE OF LOSS: 02/19/2011
DESCRIPTION: C- PARK,GREG VS CITY OF CARMEL POLICE MERIT BOARD.
COMPLAINT FILED AGAI
CLAIMANT:- GREG PARK
EXPENSE 366.60
CLAIM TOTAL 366.60
CURRENT CHARGES $366.60
ACCOUNT SUMMARY
CURRENT CHARGES 366.60 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST" DUE CHARGES 423.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 789.60
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 789.60
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 Q
JUN 20 2011
By
TRAVELERS
NON- FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
39001
1
CITY OF CARMEL, CARMEL CLAY PARKS BUILD
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS J PAGE 1
DEDUCTIBLE INVOICE
GPO93i3908 5216X7087 05/31/2011 000381452 06/15/2011 3,517.80
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL; CARMEL CLAY PARKS
13607 COLLECTIONS CENTER DRIVE ATTN: JIM SPELBRING
CHICAGO, IL 60693 ONE CIVIC SQUARE
CARMEL IN 48032
RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE T AVE n--
PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YO [By HE 0 2011
TRAVELERS J� PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
m
GPO9313908 521GX7087 05/31/2011 000381452 06/15/2011 3,517.80
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 564.00
CLAIM TOTAL 564.00
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 831.90
CLAIM TOTAL 831.90
CURRENT CHARGES $1,395.90
ACCOUNT SUMMARY
CURRENT CHARGES 1,395.90 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 2,121,90 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 3,517.80
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 3,517.80
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
39002
CITY OF CARMEL; CARMEL CLAY PARKS
ATTN: JIM SPELBRING
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS J PAGE
DEDUCTIBLE INVOICE
3036P64A -810 521GX7087 05/31/2011 000382065 06/15/2011 3,654.45
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 PAYABL
PLEASE WRITE THE POLICY ACCOUNT NUMBER ON 1 0 R C
AOW JUN 2 0 2011
TRAVELERS J By PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
303GP64A -810 521GX7087 05/31/2011 000382065 06/15/2011 3,654.45
CURRENT
CLAIMf#: EPS7703 DATE OF LOSS: 05/02/2011
DESCRIPTION: IV WAS STOPPED AT A 126TH STREET HAD A GREEN ARROW
WENT AND STRUCK THE
CLAIMANT: ADAM HIATT
LOSS 2,360.25
CLAIM TOTAL 2,360.25
CURRENT CHARGES $2,360.25
ACCOUNT SUMMARY
CURRENT CHARGES 2,360.25 INSURED NAME: CITY OF CARMEL,CARMEL CLAY
PAST DUE CHARGES 1,294.20 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 3,654.45
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 3,654,45
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 061$3
39000
CITY OF CARMEL,CARMEL CLAY
ONE CIVIC SQUARE
CARMEL IN 46032
0
0
0
0
O
VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF
13607 Collections Center Drive
Chicage, IL 60693
$4,122.75
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1205 I 000382065 j 43- 475.00 I $2,360.25 I hereby certify that the attached invoice(s), or
1205 I 000381452 43- 475.00 I $1,395.90 bill(s) is (are) true and correct and that the
1205 000381533 43- 475.00 $366.60
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, June 20, 2011
Dire tor, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
05/31/11 000382065 $2,360.25
05/31/11 000381452 $1,395.90
05/31/11 4 000381533 I $366.60
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