HomeMy WebLinkAbout160222 06/10/2008 CITY OF CARMEL, INDIANA VENDOR: 354565 Page 1 of 1
0 ONE CIVIC SQUARE ST PAUL TRAVELERS CHECK AMOUNT: $3,216.37
CARMEL, INDIANA 46032 13607 COLLECTION CENTER
CHICAGO IL 60693 CHECK NUMBER: 160222
CHECK DATE: 6/10/2008
DEPARTMENT ACC OUNT PO NUMBER INVOICE NU AM DESCRIPTION
1205 4347500 2910888 3,216.37 GENERAL INSURANCE
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TRAVELERS PAGE 1
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DEDUCTIBLE INVOICE
GPO9313908 521GX7087 05/30/2008 000291088 06/15/2008 8,216.37
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL
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_
TR A VEL CRSJ PAGE 1
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GPO9313908 521GX7087 05/30/2008 000291088 06/15/2008 8,216.37
CURRENT
CLAIM ABG7712 DATE OF LOSS: 02/06/2008
DESCRIPTION: IV WAS ON OFF RAMP AND REAR -END OV
CLAIMANT: BENJAMIN FOULKE
LOSS 206.37
CLAIM TOTAL 206.37
CLAIM ASQ6415 DATE OF LOSS: 01/09/2006
DESCRIPTION: ON 1/9/2006 DEFENDENT'S TERMINATED PLANTIFF FROM HIS
EMPLOYMENT WITH C
CLAIMANT: JOHN NIKOLOFF
EXPENSE 3,010.00
CLAIM TOTAL 3,010.00
CLAIM FZT6305 DATE OF LOSS: 08/03/2007
DESCRIPTION: PER FAX: C- ROBINSON, CARLISLE CLMT INTERVIEWED FOR A
POSITION AS A LIF
CLAIMANT: CARLISLE A ROBINSON
LOSS 5,000.00
CLAIM TOTAL 5,000.00
CURRENT CHARGES $8,216.37
ACCOUNT SUMMARY
CURRENT CHARGES 8,216.37 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_.216.37
DISPUTED ITEMS 0.00
ACCOUNT BALANCE_ 8,216.37
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 -1GRC
TRAVELERS
385 WASHINGTON STREET
ST PAUL MN 55102 --1396
38772
CITY OF CARMEL
ONE CIVIC SQUARE
CARMEL IN 46032
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TR A VE LL RS PAGE 1
DEDUCTIBLE INVOICE
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GP09311918 0018277244 05/30/2008 000290894 00 NOT PAY 2,524.65
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL
13607 COLLECTIONS CENTER DRIVE ATTENTION: B COOK
CHICAGO, IL 60693 1 CIVIC SQUARE
CARMEL IN 46032
law
TRAVELERS J PAGE 1
THIS ACCOUNT HAS A CREDIT BALANCE.
PLEASE CONTACT THE ACCOUNTING SPECIALIST LISTED BELOW.
1 1 1 I I 1
GP09311918 0018277244 05/30/2008 000290894 DO NOT PAY 2,524.65
ACCOUNT SUMMARY
CURRENT CHARGES 0.00 INSURED NAME: CITY OF CARMEL
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 2,524.65 AGENT PHONE: (317) 817 -5000
TOTAL DUE 2,524.65
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 2,524.65
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: DEDUCTIBLE HELP DESK
MC- 1GRC
TRAVELERS
385 WASHINGTON STREET
ST PAUL MN 55102 -1396
39670
CITY OF CARMEL
ATTENTION: B COOK
1 CIVIC SQUARE
CARMEL IN 46032
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Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
A 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
Travelers Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
051301W 29108j9 DOL: 02/96/2008 05/30/0 291088 D $206.00 $3,01 1
Total
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 %_WARRANT NO.
au Travelers ALLOWED 20
13607 Collections Center Drive IN SUM OF
$3,216.37
ON ACCOUNT OF APPROPRIATION FOR
GENERALFUND
1205 Administration
Board Members
PO# or INVOICE NO. ACCT /TITLE AMOUNT I hereby certify that the attached invoices
DEPT. y y or
1205 7 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
1205 291088 475 $3,010.00 which charge is made were ordered and
received except
20
Sign re-
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund