201253 09/13/2011 CITY OF CARMEL, INDIANA VENDOR: 00352999 Page 1 of 1
ONE CIVIC SQUARE HYLANT GROUP
CARMEL, INDIANA 46032 P 0 BOX 40925 CHECK AMOUNT: $25,451.00
INDIANAPOLIS IN 46082 -4910
CHECK NUMBER: 201253
CHECK DATE: 9/13/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 769558 258.00 GENERAL INSURANCE
302 5023990 770369 14,056.00 OTHER EXPENSES
302 5023990 770370 11,137.00 OTHER EXPENSES
;f
Eff Date Trn Type Policy Desc[�pt on Amount ..4
INVOICE 776370
01/01/11 RIS WC -S WCX002730 TPA 4 OF 4 Citizens Ins Co of America 11,137.00
Invoice Balance: 1 1,137.00
D SEP4�1 2011 I
By- 301 Pennsylvania Parkway Suite 201 P.O. Box 40925 Indianapolis, IN 46280 -0925
Toll Free: 800 678 -0361 Local: 317- 817 -5000 Fax: 317- 817 -5151
Risk Management Insurance 40 (k)-,- Investments Benefits
.Amount. °I
INVOICE 770369
01 /01 /11 RIS WC -S WCX002730 WC PREM 4 OF 4 Citizens Ins Co of America 14,056.00
Invoice Balance: 14,056.00
SEP Y� Z011 1
BY
301 Pennsylvania Parkway Suite 201 P.O. Box 40925 Indianapolis, IN 46280 -0925
Toll Free: 800 678 -0361 Local: 317 817 -5000 Fax: 317 817 -5151
Risk Management ,Insurance 401 W Investments Benefits
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.
Payee
H
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
09/01/11 770369 Worker Comp Prem $14,056.00
09/01/11 770370 TPA 11,137.00
Total 25,193.00
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.
20
Clerk- Treasurer
VOUCHER Nq,. ._WARRANT NO.
ALLOWED 20
—NY1 ANT IN SUM OF
PC) Rox 40925
Ind ian an�l c�ll I dR280-0925
25,193.9n
ON ACCOUNT OF APPROPRIATION FOR
�302 Worker (.nmp Fund
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
770369 302 $14,056.00 materials or services itemized thereon for
which charge is made were ordered and
received except
20
Signature/
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
l Eff Date Trn ype T Policy Descnpt�on-,� ,t��a r n 1 a Amount
Y.�: �;ak,G._' ?.,xr ".w, :a .n A ,.,'"�,5...�.:.''. _s a _.ftF xsBh
..h+as._._.w.✓ac u..w...._x..we.0.k._._.. -_s +i- _..a_. ...._uv.�s'i.:.: Ni
INVOICE 769558
01/01/11 +EN PCKG 63058IM4076 ADD SCHEDULED EQUI Travelers Insurance Companies 333.00
ADD 120 -AED CARDIAC DEVICES ACCESSORIES cr $1,095 FOR A
TOTAL OF $131.400. ALLOCATE TO POLICE DEPT.
Invoice 13alance: 333.00
D �a a
SI' 12 2011
By
301 Pennsylvania Parkway Suite 201 P.O. Box 40925 Indianapolis, IN 46280 -0925
Toll Free: 800 678 -0361 Local: 317 -817 -5000 Fax: 317 817 -5151
Risk, Management Insurance- 40 1(k) Investments— Benefits
71
Eff Date Trn Type Policy f Description Amount
INVOICE 769559
01/01/11 -EN PCKG 63058IM4076 AMEND BLKT LIMIT Travelers Insurance Companies -75.00
CORRECT TRAFFIC SIGNALS /LIGH'T'S SCHEDULE ALLOCATE TO STREET
DEPT,
Invoice Balance: -75.00
301 Pennsylvania Parkway Suite 201 P.O. Box 40925 Indianapolis, IN 46280 -0925
Toll Free: 800 678 -0361 Local: 317 817 -5000 Fax: 317- 817 -5151
Risk Management Insurance:- 40 1(k) Investments
Be nefits
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))
08/26/11 769558 $258.00
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
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Hylant Group
IN SUM OF
301 Pennsylvania Parkway, Suite 201
Indianapolis, IN 46280 -0925
$258.00
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1205 769558 43- 475.00 $258.00 I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Monda September 12, 2011
i
e
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund