HomeMy WebLinkAbout200656 08/17/2011 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1
ONE CIVIC SQUARE TRAVELERS
1 CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $1,480.40
CHICAGO IL 60693 CHECK NUMBER: 200656
CHECK DATE: 8117/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000386518 423.00 GENERAL INSURANCE
1205 4347500 000386623 1,057.40 GENERAL INSURANCE
TR MVELERJJ PAGE 1
DEDUCTIBLE INVOICE
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GPO9313908 521GX7087 07/29/2011 000386518 08/15/2011 423.00
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 n
RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO z I_1
PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHEC rr nn
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TRAVELERS J By EA- 1
GPO9313908 521GX7087 07/29/2011 000386518 08/15/2011 423.00
CURRENT
CLAIM CAW7554 DATE OF LOSS: 01/04/2007
DESCRIPTION: C JACKSON, CHAD TORT NOTICE ARISNG OUT OF ALLEGED
INJURIES THE CLA
•a`lcCL-
CLAIMANT: CHAD JACKSON
EXPENSE 183.30
CLAIM TOTAL 183.30
CLAIM CESS844 DATE OF LOSS: 06/13/2010
DESCRIPTION: C ROBERTS, MARY TORT NOTICE ALLEDGING BATTERY,
TRESPASS, FALSE ARR
1 'Al'-'z-
CLAIMANT: BILLYJOE ROBERTS
EXPENSE 28.20
CLAIM TOTAL 28.20
CLAIM EMS6617 DATE OF LOSS: 04/16/2010
DESCRIPTION: TORT NOTICE ARISING OUT OF THE ARREST MADE BY CPO OF
THE CLAIMANT FOR
0� LC
CLAIMANT: SHARRON ATKINS
EXPENSE 211.50
CLAIM TOTAL 211.50
CURRENT CHARGES $423.00
ACCOUNT SUMMARY
CURRENT CHARGES 423.00 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 423.00
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 423.00
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE- HELPDESK@TRAVELERS.CDM 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
38971
CITY OF CARMEL; CARMEL CLAY PARKS
ATTN: JIM SPELBRiNG
ONE CIVIC SQUARE
CARMEL IN 46032
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0
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TRAVELERS J PAGE 1
DEDUCTIBLE INVOICE
19 1 1 1 I 1111
1
GPO9315757 521GX7087 07/29/2011 000386623 08/15/2011 1,057.40
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.
AMk
TR A 'Y ELCRC PAGE 1
2 1 1 R IWMi III Jj Ij IMET01 I I 1 I
GPD9315757 521GX7087 07/29/2011 000386623 08/15/2011 1,057.40
CURRENT
CLAIM EPS2377 DATE OF LOSS: 02/19/2011
DESCRIPTION: C- PARK,GREG VS CITY OF CARMEL POLICE MERIT BOARD.
0 COMPLAINT FILED AGAI
CLAIMANT: GREG PARK
EXPENSE 465.20
CLAIM TOTAL 465.20
CLAIM EQG5061 DATE OF LOSS: 05/12/2011
DESCRIPTION: KNONSARI, RANA; CLAIMANT ALLEGES DISCRIMINATION DUE TO
11 MERDISABILITY C
�tICQ�
CLAIMANT: RANA KHONSARI
EXPENSE 592.20
CLAIM TOTAL 592.20
CURRENT CHARGES $1,057.40
ACCOUNT SUMMARY
CURRENT CHARGES 1,057.40 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 1,057.40
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 1,057.40
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
L_1
AUG 152011
By_
TRAVELERS
NON- FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT o6183
38970
CITY OF CARMEL, CARMEL CLAY PARKS BUILD
ONE CIVIC SQUARE
CARMEL IN 46032
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Prescribed by State 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.
Pay ee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
9 a-q -fl 0003M51Y 7,,e,3, o d
.2y_ 00038 �a 3 05 y6
Total 6Q
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.
T S ALLOWED 20
V �'Z
1 IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
6 Qe9A L T -n1
Board Members
PO# or INVOICE NO. ACCT# /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
ADS OOD $�Si y7S UO ;23• bill(s) is (are) true and correct and that the
o S 1 1d y7S 06 165'��/a materials or services itemized thereon for
which charge is made were ordered and
received except
20
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Cost distribution ledger classification if Title
claim paid motor vehicle highway fund