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HomeMy WebLinkAbout159188 05/12/2008 CITY OF CARMEL, INDIANA VENDOR: 354565 Page 1 of 1 ONE CIVIC SQUARE ST PAUL TRAVELERS 0 s•, �`ro CARMEL, INDIANA 46032 13607 COLLECTION CENTER CHECK AMOUNT: $6,326.35 CHICAGO IL 60693 CHECK NUMBER: 159188 CHECK DATE: 5/12/2008 DEPARTMENT ACCOUNT PO NUM INVOICE NUMBER AMOUNT DESCRIPTION -'1205 4347500 18277203 3,702.71 GENERAL INSURANCE 1205 4347500 18277244 1,518.00 GENERAL INSURANCE 1205 4347500 290182 1,105.64 GENERAL INSURANCE i AW TRAVELERSJJ p DEDUCTIBLE INVOICE i i GP09311918 0018277244 04/30/2008 000288537 05/15/2008 6,277.43 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL 13607 COLLECTIONS CENTER DRIVE ATTENTION: B COOK CHICAGO, IL 60693 1 CIVIC SQUARE CARMEL IN 46032 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK. TRAVELERS PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. GP09311918 0018277244 04/30/2008 000288537 05/15/2008 6,277.43 CURRENT CLAIM#: 09T017 DATE OF LOSS: 01/01/2004 DESCRIPTION: CLAIMANT (WILLIS) ALLEGES PHYSICAL, EMOTIONAL PSYCHOLOGICAL INJURIES S CLAIMANT: SENSITIVE CLAIM EXPENSE 1,518.00 CLAIM TOTAL 1,518.00 CURRENT CHARGES $1,518.00 ACCOUNT SUMMARY CURRENT CHARGES 1,518.00 INSURED NAME: CITY OF CARMEL PAST DUE CHARGES 4,759.43 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000 TOTAL DUE 6,277.43 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 6,277.43 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 -1GRC TRAVELERS 385 WASHINGTON STREET ST PAUL MN 55102 -1396 39638 CITY OF CARMEL ATTENTION: B COOK 1 CIVIC SQUARE CARMEL IN 46032 m m mo r m m m N O O O O Q O O t S, AMk TRAVELERS J PAGE 1 DEDUCTIBLE INVOICE GP09313908 521GX7087 04/30/2008 000290182 05/15/2008 1,105.64 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. TRAVELERS PAGE THIS ACCOUNT IS SCHEDULED TO GO TO A COLLECTION AGENCY IF PAYMENT IS NOT RECEIVED ON OR BEFORE THE DUE DATE. GP09313908 521GX7087 04/30/2008 000290182 05/15/2008 1,105.64 ACC OUNT SUMMARY CURRENT CHARGES 0.00 INSURED NAME: CITY OF CARMEL PAST DUE CHARGES 1,105.64 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000 TOTAL DUE 1,105.64 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 1,105.64 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 38745 CITY OF CARMEL ONE CIVIC SQUARE CARMEL IN 46032 m N m O N O O O N O Q O TRAVELERSJ� PAGE 1 DIRECT COLLECTIONS DEDUCTIBLE INVOICE GP09309872 0018277203 04/30/2008 000290405 UPON RECEIPT 1� 3,702.71 MAIL PAYMENT TO: PAYER: RECEIVABLE MANAGEMENT SERVICES CITY OF CARMEL PO BOX 26446 1 CIVIC SQUARE RICHMOND, VA 23261 -6446 CARMEL IN 46032 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO RECEIVABLE MANAGEMENT SERVICES, PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK. Al TRAVELERS PAGE 1 THIS ACCOUNT HAS BEEN REFERRED TO AN OUTSIDE COLLECTION AGENCY. PLEASE CONTACT RECEIVABLE MANAGEMENT SERVICES AT 1- 800 222 -1970. GP09309872 0018277203 04/30/2008 000290405 UPON RECEIPT 3,702.71 CURRENT PAST DUE CLAIM 09T061 DATE OF LOSS: 08/10/2003 DESCRIPTION: C- LAWHORN SHATAWN AND WELTON MARSHALL ALLEDGE FALSE ARREST, ILLEGAL S CLAIMANT: SHATAWN LOWHORN EXPENSE 0.00 3,702.71 CLAIM TOTAL $0.00 $3,702.71 TOTAL CLAIM(S) DUE $0.00 $3,702.71 ACCOUNT SUMMARY CURRENT CHARGES 0.00 INSURED NAME: CITY OF CARMEL PAST DUE CHARGES 3,702.71 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000 TOTAL DUE 3,702.71 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 3,702.71 i r CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE COVERAGE./ l` i� 1 4 RECEIVABLE MANAGEMENT SERVICES PO BOX 26446 RICHMOND VA 23261 -6446 �i 99919 CITY OF CARMEL 1 CIVIC SQUARE CARMEL IN 46032 0 0 0 0 0 0 0 a 0 0 J� i a f e Y I L h.r 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 Travelers Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 288537 %J1101/2004 $1,518.00 04/30/OE 290405 DOL: 08/10/2003 3 702.71 Total I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6. 20 Clerk- Treasurer VOUCHER Sf12e$_WARRANT NO. St. Paul Traveler's ALLOWED 20 IN SUM OF 13607 Collections Center Drive Ghieage, I L 60693 $6,326.35 ON ACCOUNT OF APPROPRIATION FOR GENERALFUND 1205 Administration Board Members or D t INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or 00 bill(s) is (are) true and correct and that the materials or services itemized thereon for 1205 290182 475 $1 which charge is made were ordered and: 1285 290405 4 .71 received except 14:11 20 t Sig atur Title Cost distribution ledger classification if claim paid motor vehicle highway fund