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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 0 m m 0 0 0 N O a n 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 0 a m P 0 a N P a 0 0 1 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