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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 jl I i 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 �U6..1 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 m o 0 0 0 0 4 0 AUNk 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 0 0 0 0 0 a 0 0 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 n Cost distribution ledger classification if Title claim paid motor vehicle highway fund