162241 08/07/2008 CITY OF CARMEL, INDIANA VENDOR: 354565 Page 1 of 1
0 ONE CIVIC SQUARE ST PAUL TRAVELERS CHECK AMOUNT: $3,997.58
CARMEL, INDIANA 46032 13607 COLLECTION CENTER
CHICAGO IL s06W CHECK NUMBER: 162241
CHECK DATE: 8/7/2008
,PARTMENT ACCOUNT PO N IN VOIC E N UMB ER AMO DESCRIP
1205 4347500 293233 3,412.50 GENERAL INSURANCE
.1205 4347500 293447 585.08 GENERAL INSURANCE
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TRAVELERS PAGE 1
GPO9311918 0018277244 06/30/2008 000293233 07/15/2008 8,342.51
CURRENT
CLAIM ASF1302 DATE OF LOSS: 10/11/2006
DESCRIPTION: CLMT.,BLAINE HOLLOWAY, ALLEGES THAT HE HAS DAMAGE TO
HIS PERSONAL VEH.
CLAIMANT: BLAINE HOLLOWAY
LOSS 630.01
CLAIMANT: TIMOTHY G HOLLOWAY
LOSS 4,300.00
CLAIM TOTAL 4,930 -01
CLAIM CAW2701 DATE OF LOSS: 08/14/2005
ESCRIPTION: LORI MCCANN -CLMT FILED SUIT PAPERS AGAINST INSD /INSD
EMPLOYEES
C AIMANT: LORI MCCANN��
EXPENSE 3,412.50
CLAIM TOTAL 3,412.50 .1
a- CURRENT CHARGES $8,342.51
ACCOUNT SUMMARY
CURRENT CHARGES
°8;'34"2`-5'1 INSURED_ NAME: CITY OF CARMEL
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 8,342.51
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 8,342.51
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 -355 -4098 EXT. 08900: JULIE HUPPERT
MC -1GRC
TRAVELERS
3$5 WASHINGTON STREET
ST PAUL MN 55102 -1396
39659
CITY OF CARMEL
ATTENTION: B COOK
1 CIVIC SQUARE
CARMEL IN 46032
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TPAVELERS JJ PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
IM
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GPO9313908 521GX7087 06/30/2008 000293447 07/15/2008 3,060.43
CURRENT
CLAIM A6P1247 DATE OF LOSS: 05/28/2008
DESCRIPTION: C BRADLYE, STEVEN IV BACKED OUT OF A PARKING
STALL AND STRUCK THE AS
CLAIMANT: STEVEN BRADLEY
LOSS 585.08
CLAIM TOTAL 585.08
CURRENT CHARGES $585.08
ACCOUNT SUMMARY
CURRENT CHARGES 585.08 INSURED NAME: CITY OF CARMEL
PAST DUE CHARGES 2,475.35 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 3,060.43
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 3,060.43
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
MC IGRC
TRAVELERS
385 WASHINGTON STREET
ST PAUL MN 55102 -1396
38738
CITY OF CARMEL
ONE CIVIC SQUARE
CARMEL IN 46032
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Prescribed fir State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 5995
T� CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
ywhom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
T ravelers Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
06130108 293233 DOL: 08/1412005 2756__.--
06130/08 293447 5/28/2008
Total
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
VOUCHEb WARRANT NO.
St. Paul Traveler's ALLOWED 20
13607 Collections Center Drive IN SUM OF
hiesigo, 1L 6E)693
$3,997.58
ON ACCOUNT OF APPROPRIATION FOR
GENERALFUND
1205 Administration
Board Members
PO4f or
DEPT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
1 9 05 292222 476 $3,412.6 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
1205 293447 475 $585.08 which charge is made were ordered and
received except
20
igyture
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund