156852 02/21/2008 CITY OF CARMEL, INDIANA VENDOR: 360889 Page 1 of 1
ONE CIVIC SQUARE TRAVELERS
CARMEL, INDIANA 46032 C/O RECEIVABLE MANAGEMEN'1 SERVICES CHECK AMOUNT: $1,242.69
PO BOX 26446
CHECK NUMBER: 156852
RICHMOND VA 23261 -6446
CHECK DATE: 212112008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4347500 283318 1,242.69 GENERAL INSURANCE
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TRAVELERS J PAGE 1
AW DIRECT COLLECTIONS DEDUCTIBLE INVOICE
a ll 1 1 I 1 1
GPO9309872 0018277203 01/31/2008 000283318 UPON RECEIPT 331.01
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7FEB 0 3 2008
MAIL PAYMENT.TO: PAYER:
RECEIVABLE MANAGEMENT SERVICES CITY OF CARMEL BY:
PO BOX 26446 1 CIVIC SQUARE
RICHMOND, VA 23261 -6446 CARMEL IN 46032 ((Jjr�
w ��c-r�
RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO RECEIVABLE MANAGEMENT SERVICES.
PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK. �v� Ck
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TRAVELERSJ PAGE 1
THIS ACCOUNT HAS BEEN REFERRED TO AN OUTSIDE COLLECTION AGENCY.
PLEASE CONTACT RECEIVABLE MANAGEMENT SERVICES AT 1- 800- 222 -1970.
1 1 I I i I
GPO930 001.8.2.7 -7. 2 008.. 000283318 �PON RECEIPT 1' 331.CA.
^C.URRENT PAS I u
CLAIM 09T021 DATE OF LOSS: 07/03/2003
DESCRIPTION: CLAIMANT,VICKI MORRIS, ALLEGES THAT SHE WAS ROLLER
BLADING IN MONON TR
CLAIMANT: VICKI MORRIS
LOSS 0.00 9
CLAIM TOTAL $0.00 $1,242.69
CLAIM{:, 09T061 DATE OF LUSS: 08T1'O/2003
DESCRIPT'I -ON: C- LAWHOR ATAWN AND WELTON�MARSHALL AL EDGE FALSE
ARREST, I GAL S
CLAIMANT: SH \WN LOWHO N
EXPENSE 88.32 0.00
CLAM TOTAL $88.32 $0.00
TOTAL CLAMS) DUE $88.32 $1,242.69
ACCOUNT SUMMARY
CURRENT CHARGES 88.32 INSURED NAME: CITY OF CARMEL
PAST DUE CHARGES 1,242.69 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 1,331.01
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 1,331.01
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE COVERAGE.
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RECEIVABLE MANAGEMENT SERVICES
P'0 BOX 26446
RICHMOND VA 23261 -6446
99886
CITY OF CARMEL
1 CIVIC SQUARE
CARMEL IN 46032
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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
c/o Receivable Management Services
PO Box 26446
Richmond, VA 23261 -6446
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/31108 283318 Monon tort claim 1,242.69
Total 1,242.69
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
c/o Receivable Management Services
PO Box 26446
Richmond, VA 23261 -6446 In Sum of
1,242.69
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 283318 4347500 1,242.69 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
f Si at re
'1,242.69 Business S rvic Manager
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund