155622 01/23/2008 CITY OF CARMEL, INDIANA VENDOR: 354565 Page 1 of 1
ONE CIVIC SQUARE ST PAUL TRAVELERS CHECK AMOUNT: $17,343.58
CARMEL, INDIANA 46032 13607 COLLECTION CENTER
CHICAGO IL 60693 CHECK NUMBER: 155622
CHECK DATE: 1/2312008
,REPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 279307 17,343.58 GENERAL INSURANCE
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01/17/2008 09:11 3175712615 CARMEL FIRE PAGE X 01/01
Avopowk
T7AVELERS J
DEDUCTIBLE INVOICE
Rom
GP093139p8 5216X7087 12/31/2007 000279307 01/15/2008 16,875.68
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 MAOE PAYABLE TO TRAVELERS.
PLEASE WRITE THE POLICY 9 ACCOUNT NUMBER ON YOUR CHECK.
AW
TRAVELERS J PAGE 1
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GPOS313909 5216X7087 12/31/2007 000278307 01/15/2008 16,575.68
CURRENT
CLAIM ABLER24 DATE OF LOSS: 12/07/2007
DESCRIPTION: C LOVEALL, WILLIAM INSD DRIVER TERRY MYERS WAS MOVING
A TRUCK IN THE
CLAIMANT: WILLIAM LOVEALL
LOSS 1
CLAIM TOTAL 1,368.23
CLAIM ABLUB22 DATE OF LOSS: 12/11/2007
DESCRIPTION: IV STRUCK CV, CV PUSHED INTO FENCE *COMPANION CLAIM
TO A9L9089
CLAIMANT: DEBRA COLEMAN
LOSS 6,088.85
CLAIMANT; THOMAS MILLER
LOSS 650.00
CLAIM TOTAL 6,738.85
CLAIM CAW52139 DATE Of LOSS: 06/22/2007
DESCRIPTION: THE IV WAS ON AN EMERGENCY RUN, THE IV LOST CONTROL ON
A WET ROAD HITT
CLAIMANT: PATRICK K DAVISON
LOSS 8,768.60
CLAIM TOTAL 8,758.50
v o l CURRENT CHARGES $15,875.88
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TRAVELERS J PAGE 1
DEDUCTIBLE INVOICE
•1
GPO9309872 0018277203 12/31/2007 000280660 01/15/2008 1,242.69
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL
13607 COLLECTIONS CENTER DRIVE 1 CIVIC SQUARE
CHICAGO, IL 60693 CARMEL IN 46032
RETURN THIS PORTION WITH YOUR CHECK MAOE 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.
•1 E
GPO9309872 0018277203 12/31/2007 000280660 01/15/2008 1,242.69
CURRENT
CLAIM#: OST061 DATE OF LOSS: 08/10/2003
DESCRIPTION: C- LAWHORN SHATAWN AND WELTON MARSHALL ALLEDGE FALSE
ARREST, ILLEGAL S
CLAIMANT: SHATAWN LAWHORN
EXPENSE 25.09
CLAIM TOTAL 25.09
CURRENT CHARGES $25.09
ACCOUNT SUMMARY
CURRENT CHARGES 25.09 INSURED NAME: CITY OF CARMEL
PAST DUE CHARGES 5,000.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 3,782.40 AGENT PHONE: (317) 817 -5000
TOTAL DUE 1,242.69
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 1,242.69
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
39574
CITY OF CARMEL
1 CIVIC SQUARE
CARMEL IN 46032
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TRAIVELERSJ PAGE 1
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DEDUCTIBLE INVOICE
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GPO9311918 0018277244 12/31/2007 000280666 01/15/2008 4,363.29
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.
GP09311918 0018277244 12/31/2007 000280666 01/15/2008 4,363.29
CURRENT
CLAIM#: 09TO17 DATE OF LOSS: 01/01/2004
DESCRIPTION: CLAIMANT (WILLIS) ALLEGES PHYSICAL, EMOTIONAL
PSYCHOLOGICAL INJURIES S
CLAIMANT: SENSITIVE CLAIM
EXPENSE 419.75
CLAIM TOTAL 419.75
CLAIM#: 09T104 DATE OF LOSS: 08/26/2005
DESCRIPTION: C- AYDANIAN MARIUS TORT NOTICE AGAINST CARMEL POLICE
DEPT FOR FAILURE
CLAIMANT: MARIUS J AYDANIAN
EXPENSE 1,391.29
CLAIM TOTAL 1,391.29
CURRENT CHARGES $1,811.04
ACCOUNT SUMMARY
CURRENT CHARGES 1,811.04 INSURED NAME: CITY OF CARMEL
PAST DUE CHARGES 2,552.25 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 4,363.29
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 4,363.29
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
MC -1GRC
TRAVELERS
385 WASHINGTON STREET
ST PAUL MN 55102 -1396
39573
CITY OF CARMEL
ATTENTION: 8 COOK
1 CIVIC SQUARE
CARiMEL IN 46032
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Prescribed by State 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
�`,46ivoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/31/0 28066 L_ 8/10/03 5.09
12/31/0 280666 DOL: 8/26/05
12/31/07 279307 DOL: 12/11/07 $6,738.85
121 1/07 2793UT DOL 22/07 $8,758.60
Total 1 7.333 58
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 I'M. /18� WARRANT O.
au rave er S ALLOWED 20
13 607 Collections Center Drive IN SUM OF
.hi BTU �n�a�
$17,343.58
ON ACCOUNT OF APPROPRIATION FOR
GENERAL FUND
1205 Administration
Board Members
o °T INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
1205 0c, bill(s) is (are) true and correct and that the
materials or services itemized thereon for
1205 280666 475 $419.75 Which charge is made were ordered and
29 received except
1205 279307 475 $6,738.85
1285 2791307" 475 10, 0
20
T�) ignat
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund