161128 06/25/2008 CITY OF CARMEL, INDIANA VENDOR 00350540 Page 1 of 1
ONE CIVIC SQUARE WALKER ASSOCIATES
CARMEL, INDIANA 46032 7364 E WASHINGTON ST CHECK AMOUNT: E913.00
PO BOX 19445 CHECK NUMBER: 161128
INDIANAPOLIS IN 46219 -0445
CHECK DATE: 6/25/2008
DEPARTMENT ACCOUNT P N UMBER INVOICE NUMBER AMOUNT DESCRIPTION
905 4347500 893- 876 -356 913.00 GENERAL INSURANCE
f'
I
WALKER d ASSOCIATES INSURANCE May 2, 2008
PO BOX 19445 Page I
INDIANAPOLIS, IN 46219 -11415 J SELECTIV O
E
Laurance
Phone No. 317 -353 -3000
BLOCKOMS GOLF MANAGh-IENT CO LLC DBA 1311
12120 BROOKSHIRE PARKWAY
CAR-NIEL IN 46033 -3314
ACCOUNT 893 876 -356 SUM MARY See back for details your bill, please call your agent
at:
317- 353 -8000
Previous Amount Due S 913.00 Save Time &Avoid Late Fees
Payment Received 04/ Thank You S 913.00
Use SelectPayO
Go to www.selective.com
Minimum Amount Due By 05/23/08 S 913.00 OR
Call our automated payment system:
1 -888- 974 -7400
Detach and return this portion with your payment. Please write your account number on your check.
Page 2
BILL DETAILS FOR ACCOUNT 893 876 -356 RECENT ACCOUNT ACTIVITY
S IS34633 Effective (18/27/07 SICSC S 907.00 Prior Balance i
Commercial Package S 1834633 Eff. IN/27/07 S 2, 720. -00
BLOCKOMS GOLF INIANAGL'YIENI' CO LLC DBA BR Total S 2,720.00
Installment Pee S 6 .00 Payments and Adjustments
S 1834633 Ell'. 09/27107 S 907.00
MIN. AMOUNT DUE BY 05/23/08 913.00 Installment Fee S -6.0 Q
Total S 913.00
Current Balance
S 1834633 Eff. 08127/07 S 1,813.00
Total S 1,813.00
When you provide a check as payment, you authorize us either to use information from your check to make a one -time
electronic fund transfer from your account or to process the payment as a check transaction. When we use information
from your check to make an electronic fund transfer, funds may be withdrawn from your account as soon as the same day
we receive your payment, and you will not receive your check back from your financial institution.
ONE OR MORE OF SELECTIVE INSURANCE GROUP, INC.'S MEMBER INSURERS WHICH INCLUDE
SELECTIVE INSURANCE COMPANY OF AMERICA (SICA). SELECTIVE WAY INSURANCE COMPANY (SNVIQ,
SELEC'T'IVE INSURANCE COMPANY OF SOUTH CAROLINA (SICSC), SELECTIVE INSURANCE COMPANY
OF THE SOUTHEAST (SICSE), SELECTVVE iNSURANCE COMPANY OF NE`vV YORK ("STCNYI, SELECTIVE
INSURANCE COMPANY OF NEW ENGLAND (SICNE), AND SELECTIVE AUTO INSURANCE COMPANY OF
NEW JERSEY (SAICNJ) HAVE ISSUED YOUR POLICY TO WHICH THIS PREMIUM BILL PERTAINS.
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Farm No 201 (Rev 1995)
CITY OF CARMEL
f 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.
r
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoices) or bill(s)) Total /3
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
VOUCHER NO. WARRANT NO._
e ALLOWED 20
IN SUM OF
9r3 6t
ON ACCOUNT OF APPROPRIATION FOR
�OL
Board Members
PO #or INVOICE NO ACCT #!TITLE AMOUNT
DEPT I hereby certify that the attached invoice(s), or
p�13 9 76 5 913 0o bill(s) is (are) true and correct and that the
39 materials or services itemized thereon for
which charge is made were ordered and
received except
9 20 OF
igna ur�J
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund