HomeMy WebLinkAbout157349 03/18/2008 CITY OF CARMEL, INDIANA VENDOR: 354565 Page 1 of 1
ONE CIVIC SQUARE ST PAUL TRAVELERS CHECK AMOUNT: $5,625.93
CARMEL, INDIANA 46032 13607 COLLECTION CENTER
CHICAGO IL 60693 CHECK NUMBER: 1$7349
CHECK DATE: 3/18/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUM AMOUNT. DESCRIPTION
1205 4341500 283913 251.78 GENERAL INSURANCE
1205 4347500 284112 4,131.46 GENERAL INSURANCE
1205 .4347500 285685 1,242.69 GENERAL INSURANCE
TRAVELERS PAGE i
DEDUCTIBLE INVOICE
1 1 ff.10FITRUi 1 1 1 I
GPO9313908 521GX7087 02/29/2008 000284112 03/15/2008 11,023.06
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.
Mk
TRA'VELERSA J PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
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GPO9313908 521GX7087 02/29/2008 000284112 03/15/2008 11,023.06
CURRENT
CLAIM ABF8356 DATE OF LOSS: 12/12/2007
DESCRIPTION: C- EMERY, JAMES BASEMENT FLOODED WHEN STORMS DRAINED
PIPE IN BACK YARD
CLAIMANT: JAMES EMERY
LOSS 187.18
CLAIM TOTAL 187.18
CLAIM ABG7470 DATE OF LOSS: 12/21/2007
DESCRIPTION: IV WAS BACKING OUT OF DRIVEWAY AND STRUCK MIRROR OF
PARKED AND UNOCCUP
CLAIMANT: JARED A DAETTMER
LOSS 297.36
CLAIM TOTAL 297.36
CLAIM ASG7712 DATE OF LOSS: 02/06/2008
DESCRIPTION: IV WAS ON OFF RAMP AND REAR -END OV
CLAIMANT: BENJAMIN FOULKE
LOSS 2,369.32
CLAIM TOTAL 2,369.32
CLAIM A9L4993 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 642.18
CLAIM TOTAL 642.18
MC- 1GRC
TRAVELERS
385 WASHINGTON STREET
ST PAUL MN 55102 -1396
38737
CITY OF CARMEL
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERSJ PAGE 2
DEDUCTIBLE INVOICE
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GP09313908 521GX7087 02/29/2008 000284112 03/15/2008 11,023.06
CURRENT
CLAIM#: A9Q6359 DATE OF LOSS: 07/04/2007
DESCRIPTION: C- SMITH, ZACHARY ALLEGATIONS THAT POLICE OFFICER
FRAUDULENTLY INDUCED
CLAIMANT: ZACHARY SMITH
EXPENSE 635.42
CLAIM TOTAL 635.42
CURRENT CHARGES $4,131 :46..........
ACCOUNT SUMMARY
CURRENT CHARGES 4,131.46 INSURED NAME: CITY OF CARMEL
PAST DUE CHARGES 6,891.60 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 11,023.06
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 11,023.06
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE- HELPDESKPSTPAULTRAVELERS.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
38736
CITY OF CARMEL
ONE CIVIC SQUARE
CARMEL IN 46032
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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))
1 913 DOE U8 1226 fflu 5 251.78 107 $187.18
02/29/08 284112 DOL: 12/21/07
02/29/08 284112 DOL: 02/06/08 2 369.32
02129108 284112 DOL
10/12/07
-02/2 07/04/ $642.18
ng/gq/nR 985685 F)01 $635.42
81.37
Total �Q&A- &`1F�1
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 (39/.17108_ WARRANT NO.
Paul rave er s ALLOWED 20
Collections Center Drive IN SUM OF
Chicaqn, ii AnF;a.'4
$7,964.61
ON ACCOUNT OF APPROPRIATION FOR
GENERAL FUND
1205 Administration
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify hat the attached invoice(s), or
DEPT. y y
1205 8 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
1205 284112 475 $187.18 which charge is made were ordered and
1 20.1i 284112 6 received except
1205 284112 475 P,369.32
q 285 284112 410 8
1205 284112
475 $3,581.37 20
Sig a re
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund