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Home My WebLink About158263 04/15/2008 CITY OF CARMEL, INDIANA VENDOR: 354565 Page 1 of 1 ONE CIVIC SQUARE ST PAUL TRAVELERS CAR'MEL, INDIANA 46032 13607 COLLECTION CENTER CHECK AMOUNT: $6,795.39 CHICAGO IL 60693 CHECK NUMBER: 158263 CHECK DATE: 4/15/2008 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 287791 3,214.02 GENERAL INSURANCE 1205 4347500 288033 3,581.37 GENERAL INSURANCE i TRA`✓j E#,-ERSJ PAGE 1 DEDUCTIBLE INVOICE all GPO9311918 0018277244 03/31/2008 000287773 04/15/2008 4,759.43 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 6 ACCOUNT NUMBER ON YOUR CHECK. TRAVELERS J PAGE 1 THIS ACCOUNT IS SCHEDULED TO GO TO A COLLECTION AGENCY IF PAYMENT IS NOT RECEIVED ON OR BEFORE THE DUE DATE. GPO9311918 0018277244 03/31/2008 000287773 04/15/2008 4,759.43 ACCOUNT SUMMARY CURRENT CHARGES 0.00 INSURED NAME: CITY OF CARMEL PAST DUE CHARGES 5,202.24 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 442.81 AGENT PHONE: (317) 817 -5000 TOTAL DUE 4,759.43 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 4,759.43 CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE COVERAGE. FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE HELPOESK @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 39636 CITY OF CARMEL ATTENTION: B COOK 1 CIVIC SQUARE CARMEL IN 46032 U r n r m ry 0 O O N O Q O f j' TRA E.'-ERS J PAGE 1 DEDUCTIBLE INVOICE i GPO9313908 521GX7087 03/31/2008 000287791 04/15/2008 4,319.66 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 J� PAGE 1 THIS ACCOUNT IS SCHEDULED TO GO TO A COLLECTION AGENCY IF PAYMENT IS NOT RECEIVED ON OR BEFORE THE DUE DATE. GPO9313908 521GX7087 03/31/2008 000287791 04/15/2008 4,319.66 CURRENT CLAIM##: A9Q6359 DATE OF LOSS: 07/04/2007 DESCRIPTION: C- SMITH, ZACHARY ALLEGATIONS THAT POLICE OFFICER FRAUDULENTLY INDUCED CLAIMANT: ZACHARY SMITH EXPENSE 398.14 CLAIM TOTAL y398.14 CLAIMf#: CAW7614 DATE OF LOSS: 08/04/2007 DESCRIPTION: IV ON EMERGENCY RUN ENTERED INTERSECTION AND OV IN SE LANE DID NOT STO CLAIMANT: WANDA ANDERSON LOSS 2,815.88 CLAIM TOTAL 2,815.8 CURRENT CHARGES $3,214.02 ACCOUNT SUMMARY r CURRENT CHARGES 0 214. 02' 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 4,319.66 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 4,319.66 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 38709 CITY OF CARMEL ONE CIVIC SQUARE CARMEL IN 46032 0 m 0 N O O O N O Q O O 11 TRAVEJ_ERS Amok PAGE 1 DIRECT COLLECTIONS DEDUCTIBLE INVOICE r i r r r i GPO9309872 0018277203 03/31/2008 000288033 UPON RECEIPT 7,284.08 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. TRAVELERS J PAGE 1 THIS ACCOUNT HAS BEEN REFERRED TO AN OUTSIDE COLLECTION AGENCY. PLEASE CONTACT RECEIVABLE MANAGEMENT SERVICES AT 1 -800 -222 -1970. r r r r r r GPO9309872 0018277203 03/31/2008 000288033 UPON RECEIPT 7,284.08 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 LAWHORN EXPENSE 4,945.40 58 CLAIM TOTAL $4,945.40 $3 -`58 "1.37 TOTAL CLAIM(S) DUE $4,945.40 $3,581.37 ACCOUNT SUMMARY CURRENT CHARGES 4.,94.5,._4Q INSURED NAME: CITY OF CARMEL PAST DUE CHARGES 3, AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 1'2 AGENT PHONE: (317) 817 5000 TOTAL DUE 7.284.08 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 7,284.08 CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE COVERAGE. RECEIVABLE MANAGEMENT SERVICES PO Box 26446 RICHMOND VA 23261 -6446 99918 CITY OF CARMEL 1 CIVIC SQUARE CARMEL IN 46032 m 0 m m 0 0 o o a 0 r Prescribbd by Stagy= 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 Travelers Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 03/31/0 03/31/00 287791 DOL: 07704/2607 v 03/31/08 287791 DOL: 08/04/2007 0/2003 $3,581.37 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 N@4 /14ffi WARRANT NO. S ALLOWED 20 36U 1 IN SUM OF Gollections Center Drive Chicago IL 60693 $J 1:54 IRE ON ACCOUNT OF APPROPRIATION FOR GENERAL FUND 1205 Administration Board Members PO# or DEPT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or i •2o ,g 7 bil(s) is (are) true and correct and that the materials or services itemized thereon for 205 2737791 5 $398.14 which charge is made were ordered and 1205. 287791 475 received except 205 288033 475 $3,581.37 20 Signa ure Ti e Cost distribution ledger classification if claim paid motor vehicle highway fund