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Home My WebLink About156461 02/21/2008 a CITY OF CARMEL, INDIANA VENDOR: 354565 Page 1 of 1 ONE CIVIC SQUARE ST PAUL TRAVELERS CHECK AMOUNT: $5,785.96 CARMEL, INDIANA 46032 13607 COLLECTION CENTER CHICAGO IL 60693 CHECK NUMBER: 156461 CHECK DATE: 2/21/2008 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1125 4347500 279307 1,368.23 GENERAL INSURANCE 1205 4347500 281740 2,078.78 GENERAL INSURANCE 1205 4347500 283083 2,338.95 GENERAL INSURANCE i i I TRAVELERS J� PAGE 1 DEDUCTIBLE INVOICE i i GPOS313908 521GX7087 01/31/2008 000281740 02/15/2008 6,891.60 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. AW TRAVELERS J PAGE i GP09313908 521GX7087 01/31/2008 000281740 02/15/2008 6,891.60 CURRENT CLAIM ABF8356 DATE OF LOSS: 12/12/2007 DESCRIPTION: C- EMBRY, JAMES BASEMENT FLOODED WHEN STORMS DRAINED PIPE IN BACK YARD CLAIMANT: JAMES EMBRY LOSS 4,812.82 CLAIM TOTAL 4,812.82 CLAIM ASL2850 DATE OF LOSS: 09/13/2007 DESCRIPTION: IV PROCEEDED TO CHANGE INTO L LANE AND STRUCK OV CLAIMANT: MOLLY HAMMOND LOSS 233.64 CLAIM TOTAL 233.64 CLAIM ASL4993 DATE OF LOSS: 10/12/2007 DESCRIPTION: C- LUBITZ, KELLEY. IV STOPPED AND STARTED TO BACK UP AND STRUCK THE OV CLAIMANT: JON LUBITZ LOSS 1,119.33 CLAIM TOTAL 1,119.33 CLAIM A9L9522 DATE OF LOSS: 12/11/2007 DESCRIPTION: IV STRUCK CV, CV PUSHED INTO FENCE *COMPANION CLAIM TO A9L9089 CLAIMANT: DEBRA COLEMAN LOSS 710.81 CLAIM TOTAL 710.81 CLAIM CAW7554 DATE OF LOSS: 01/04/2007 DESCRIPTION: C JACKSON, CHAD TORT NOTICE ARISNG OUT OF ALLEGED INJURIES THE CLA CLAIMANT: CHAD JACKSON EXPENSE 15.00 CLAIM TOTAL 15.00 CURRENT CHARGES $6,891.60 MC IGRC TRAVELERS 385 WASHINGTON STREET ST PAUL MN 55102 -1396 38693 CITY OF CARMEL ONE CIVIC SQUARE CARMEL IN 46032 0 r m N 0 0 0 N O a 0 0 r AW D I 1 1RAVELERS J PAGE 2 DEDUCTIBLE INVOICE '1 1 I III] 1 GP09313908 521GX7087 01/31/2008 000281740 02/15/2008 6,891.60 ACCOUNT SUMMARY CURRENT CHARGES 6,891.60 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 6,891.60 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 6,891.60 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 38692 CITY OF CARMEL ONE CIVIC SQUARE CARMEL IN 46032 m ao o a m ry 0 a 0 a a JAR AVE E®S PAGE 1 DEDUCTIBLE INVOICE GPO9311918 0018277244 01/31/2008 000283083 02/15/2008 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 ACCOUNT NUMBER ON YOUR CHECK. TRAVELERS) PAGE 1 THIS ACCOUNT IS SCHEDULED TO GO TO A COLLECTION AGENCY IF PAYMENT IS NOT RECEIVED ON OR BEFORE THE DUE DATE. 1 a a IT 141 GPO9311918 0018277244 01/31/2008 000283083 02/15/2008 4,759.43 CURRENT CLAIM#: OST017 DATE OF LOSS: 01/01/2004 DESCRIPTION: CLAIMANT (WILLIS) ALLEGES PHYSICAL, EMOTIONAL PSYCHOLOGICAL INJURIES S v CLAIMANT: SENSITIVE CLAIM EXPENSE 299.00 CLAIM TOTAL 299.00 CLAIM 09TO64 DATE OF LOSS: 06/16/2005 DESCRIPTION: C WALTON, DEBORAH V CITY OF CARMEL ETAL ARISING OUT OF AN ALLEGED FE CLAIMANT: DEBORAH WALTON EXPENSE 1,500.00 CLAIM TOTAL 1,500.00- CLAW: 09T104 DATE OF LOSS: 08/26/2005 DESCRIPTION: C- AYDANIAN MARIUS TORT NOTICE AGAINST CARMEL POLICE y DEPT FOR FAILURE CLAIMANT: MARIUS J AYDANIAN LOSS 1,000.00 EXPENSE 1,039.95 CLAIM TOTAL 2,039.95 CURRENT CHARGES $838.95 MC -iGRC TRAVELERS 385 WASHINGTON STREET ST PAUL MN 55102 -1396 39618 CITY OF CARMEL ATTENTION: B COOK 1 CIVIC SQUARE CARMEL IN 46032 m 0 0 m N O O O N O Q 0 N A AMW TRAVEL,ERSJ PAGE 2 DEDUCTIBLE INVOICE i Eamm GP09311918 0018277244 01/31/2008 000283083 02/15/2008 4,759.43 ACCOUNT SUMMARY CURRENT CHARGES 838.95 INSURED NAME: CITY OF CARMEL PAST DUE CHARGES 4,363.29 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- 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 39617 CITY OF CARMEL ATTENTION: B COOK 1 CIVIC SQUARE CARMEL IN 46032 0 m 0 M m N O O O a 0 N Prescribed by State Board of Accounts City Form No. 261 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be property 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 Tra velers Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 01/31/08 281740 233.6 4 01/31/08 281740 DOL: 12/11/07 3 281740 DOL: 1/4/07 %Pi 11J.01 -0- al 51W 283083 DUL: 04 et:_ Bull �U /'U- $299.00 $2,039.95 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 102/ WARRANT NO. ALLOWED 20 Collections enter Drive IN SUM OF Chicago, IL 60693 $4,417.73 ON ACCOUNT OF APPROPRIATION FOR GENERAL FUND 1205 Administration Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT I hereby ertify that the attached invoice(s), or DEPT. y j 1205 281740 475 4 bill(s) is (are) true and correct and that the materials or services itemized thereon for 5 $1,119, 3' Which charge is made were ordered and 1205 1 received except 1205 281740 475 $15.00 120,19 283983 -rf 0 1205 283083 475 2 039 20 (gnat rte,, n Title Cost distribution ledger classification if claim paid motor vehicle highway fund XULH5 J rH �ac i DEDUCTIBLE INVOICE 1 1 1 I 1 I GPO9313908 521GX7087 12/31/2007 000279307 01/15/2008 16,875.68 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL JAN 2 2 2008 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 1 1 1 1 1 I GP09313908 521GX7087 12/31/2007 000279307 01/15/2008 16,875.68 CURRENT :LAIM#: A9L8824 DATE OF LOSS: 12/07/2007 )ESCRIPTION: C- LOVEALL, WILLIAM INSD DRIVER TERRY MYERS WAS MOVING A TRUCK IN THE :LAIMANT: WILLIAM LOVEALL LOSS CLAIM TOTAL ,368.23 :LAIM{J: A9L9522 DAT OF L055: 12/11/2007 )ESCRI�TT N: IV ST CV, CV P H INTO FENCE *COMPANION CLAIM J TO A 90 9 :LATANT: D RA COL A V (J LOSS 6 :LAIMANT: THOMAS MILLER 44 LOSS 650.00 CLAIM TOTAL 6,738.85 :LAIMf/• CAW5259 DATE OSS: 06/22/2007 )ESC PTIO THE IV A ON AN EM GENCY UN. T IV LOST CONTROL ON A WE ROAD ITT :LAIMANT: ATRICK K ITT ON LOSS 8,768.60 CLAIM TOTAL 8,768.60 CURRENT CHARGES $16,875.68 LINE Y y 3ti s o �escr �,cS �v TRAVELERS J DEDUCTIBLE INVOICE 1 qRsilh k m 01111 toml 1 q IN r r 1 r GPO9313908 521GX7087 12/31/2007 000279307 01/15/2008 16,875.68 ACCOUNT SUMMARY ,URRENT CHARGES 16,875.68 INSURED NAME: CITY OF CARMEL 'AST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC JNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 --5000 T OTAL DUE 16,875.68 )ISPUTED ITEMS 0.00 1CCOUNT BALANCE 16 875.68 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 i 1 ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. Travelers Terms 13607 Collections Center Dr. Chicago, IL 60693 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 12/31/07 279307 Vehicle accident deductible 1,368.23 Total 1,368.23 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. Travelers Allowed 20 13607 Collections Center Dr. Chicago, IL 60693 In Sum of 1,368.23 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1125 279307 4347500 1,368.23 1 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 15 -Feb 2008 Sig 1,368.23 Business S rvices Manager Cost distribution ledger classification if Title claim paid motor vehicle highway fund