162613 08/20/2008 i
��A CITY OF CARMEL, INDIANA VENDOR: 354565 Page 1 of 1
ONE CIVIC SQUARE ST PAUL TRAVELERS
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CARMEL, INDIANA 46032 13607 COLLECTION CENTER CHECK AMOUNT: $5,425.45
CHICAGO IL 60693 CHECK NUMBER: 162613
CHECK DATE: 8120/2008
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 295873 5,425.45 GENERAL INSURANCE
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AOW
TRAVELERS J PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
GP09313908 521GX7087 07/31/2008 000295873 08/15/2008 10,494.66
CURRENT
CLAIM#: AGP4648 DATE OF LOSS: 03/04/2008
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DESCRIPTION: SALT TRUCK SLID OFF ROAD AND HIT A TELEPHONE POLE C/
CLAIMANT: /INDIANA PO
LOSS 5,425.45
CLAIM TOTAL 5,425.45
CLAIM#: A9Q9599 DATE OF LOSS: 03/14/2008
DESCRIPTION: C LYNEM, NICHOLAS CHILD AGE 8 WAS CLIMBING ON OR
UNDER A CAFETERIA T
CLAIMANT: NICHOLAS LYNEM
LOSS 2,008.78
CLAIM TOTAL 2,008.78
CURRENT CHARGES $7,434.23
ACCOUNT SUMMARY
CURRENT CHARGES 7,434.23 INSURED NAME: CITY OF CARMEL
PAST DUE CHARGES 3,060.43 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 10,494.66
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 10,494.66
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE- HELPDESK @STPAULTRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1- 800 356 -4098 EXT. 08900: JULIE HUPPERT
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F:escribed by5tate Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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
Travelers Purchase Order No.
Terms
Date Due
Invoice Invoice Description q Amount
Date Number (or note attached invoice(s) or bill(s))
Total $5,425.45
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.
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Clerk- Treasurer
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