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Home My WebLink About199330 07/19/2011 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1 ONE CIVIC SQUARE TRAVELERS CARMEL, INDIANA 46032 CHECK AMOUNT: $13,973.94 13607 COLLECTIONS CENTER DRIVE ti oN CHICAGO IL 60693 CHECK NUMBER: 199330 CHECK DATE: 7/19/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 383906 5,000.00 GENERAL INSURANCE 1205 4347500 384014 8,296.90 GENERAL INSURANCE 1205 4347500 384135 437.10 GENERAL INSURANCE 1205 4347500 384640 239.94 GENERAL INSURANCE T RAVELER J PAGE 1 DEDUCTIBLE INVOICE 19 1 141wgiol I I I 1 I GP09311918 0018277244 06/30/2011 000383906 07/15/2011 5,000.00 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL 13607 COLLECTIONS CENTER DRIVE ATTENTION: B COOK CHICAGO, IL 60693 1 CIVIC SQUARE CARMEL IN 46032 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK. AdW TRAVELERS J PAGE 1 I I I I 1 1 GPO9311918 0018277244 06/30/2011 000383906 07/15/2011 5,000.00 CURRENT CLAIM#: ABF2247 DATE OF LOSS: 11/09/2006 DESCRIPTION: C— VECTREN ENERGY 4'' PLASTIC MAIN DAMAGE BY BACKHOE INSD SAID LOCATES CLAIMANT: /VECTREN ENERGY DELIVERY LOSS 5,000.00 CLAIM TOTAL 5,000.00 CURRENT CHARGES $5,000.00 ACCOUNT SUMMARY CURRENT CHARGES 5,000.00 ENSURED 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 5,000.00 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 5,000.00 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 TRAVELERS J PAGE 1 DEDUCTIBLE INVOICE 1 1 1' E 1 I GPO9315757 521GX7087 06/30/2011 000384135 07/15/2011 437.10 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 JJ PAGE 1 I 1 1 I 1 I GP09315757 521GX7087 06/30/2011 000384135 07/15/2011 437.10 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 437.10 CLAIM TOTAL 437.10 CURRENT CHARGES $437.10 ACCOUNT SUMMARY CURRENT CHARGES 437.10 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 437.10 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 437.10 CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE COVERAGE. FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE- HELPDESKCaTRAVELERS.COM OR CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1 -800- 356 -4098 EXT. 08900: ANTONIO CONTRERAS TRAVELERS T PAGE 1 DEDUCTIBLE INVOICE 303GP64A -810 521GX7087 06/30/2011 000384640 07/15/2011 239.94 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. TRAVELERS PAGE 1 303GPG4A -810 521GX7087 06/30/2011 000384640 07/15/2011 239.94 CURRENT CLAIM 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 239.94 y CLAIM TOTAL 239.94 �cw�eS rG CURRENT CHARGES $239.94 ACCOUNT SUMMARY CURRENT CHARGES 239.94 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 239.94 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 239.94 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) PAGE 1 DEDUCTIBLE INVOICE 91 1 1 I 1 I GPO9313908 5216X7087 06/30/2011 000384014 07/15/2011 8,296.90 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL; CARMEL CLAY PARKS 13607 COLLECTIONS CENTER DRIVE ATTN: JIM SPELBRING CHICAGO, IL 60693 ONE CIVIC SQUARE CARMEL IN 46032 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK. T f1 VELERS J PAGE 1 '1 1 I I 1 1 GP09313908 521GX7087 06/30/2011 000384014 07/15/2011 8,296.90 CURRENT CLAIM CAW7554 DATE OF LOSS: 01/04/2007 DESCRIPTION: C JACKSON, CHAD TORT NOTICE ARISNG OUT OF ALLEGED INJURIES THE CLA R o l l'-' CLAIMANT: CHAD JACKSON 1 EXPENSE 1,156.20 CLAIM TOTAL 1,156.20 CLAIM CES1243 DATE OF LOSS: 06/15/2008 DESCRIPTION: PER FAX: C YOUNG, JAMES CLMT WAS RIDING HIS CIR C- BICYCLE ON THE SIDEWAL CLAIMANT: JAMES YOUNG LOSS 5,000.00 CLAIM TOTAL 5,000.00 CLAIM CES6844 DATE OF LOSS: 06/13/2010 DESCRIPTION: C ROBERTS, MARY TORT NOTICE ALLEDGING BATTERY, J�IC-sL TRESPASS, FALSE ARR CLAIMANT: MARY ROBERTS EXPENSE 70.50 CLAIM TOTAL 70.50 CLAIM EMS6617 DATE OF LOSS: 04/16/2010 DESCRIPTION: TORT NOTICE ARISING OUT OF THE ARREST MADE BY CPD OF 1 '11C�L THE CLAIMANT FOR CLAIMANT: SHARRON ATKINS EXPENSE 2,070.20 CLAIM TOTAL 2,070.20 CURRENT CHARGES $8,296.90 TRAVELERS J PAGE 2 DEDUCTIBLE INVOICE GPO9313908 521GX7087 06/30/2011 000384014 07/15/2011 8,296.90 ACCOUNT SUMMARY CURRENT CHARGES 8,296.90 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 8,296.90 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 8,296.90 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Travelers IN SUM OF 13607 Collections Center Drive Chicage, IL 60693 $13,973.94 ON ACCOUNT OF APPROPRIATION FOR Carmel Administration PO# Dept. INVOICE NO. ACCT #!TITLE I AMOUNT Board Members 1205 000384014 43- 475.00 j $8,296.90 1 hereby certify that the attached invoice(s), or 1205 000384640 43- 475.00 $239.94 bill(s) is (are) true and correct and that the 1205 I 000384135 I 43- 475.00 I $437.10 materials or services itemized thereon for 1205 I 000383906 I 43- 475.00 $5,000.00 which charge is made were ordered and received except Friday, July 15, 2011 Director, Admr istration 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)) 06/30/11 000384014 $8,296.90 06/30/11 000384640 $239.94 06/30/11 000384135 $437.10 06/30/11 000383906 $5,000.00 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