HomeMy WebLinkAbout204582 12/13/2011 CITY OF CARMEL, INDIANA VENDOR: 365068 Page 1 of 1
ONE CIVIC SQUARE INDIANA INSURANCE COMPANY
i I CHECK AMOUNT: $975.00
�..ro CARMEL, INDIANA 46032 Po aox soot
HAMILTON OH 45012 -5001 CHECK NUMBER: 204582
CHECK DATE: 12/1312011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4347500 750005067093 975.00 GENERAL INSURANCE
ACCOUNT NUMBER ACCOUNT BALANCE
750005061093 $975.00
Indiana 9450 Seward Road, Fairfield Ohio 45014 BILLING DATE DUE DATE
Insurance. www.indiana- ins.com/seivices [2102/2011 01/03/2012
M..h.r M liberty Mutual Group MINIMUM DUE
$975.00
Premium Due
PAYOR AGENT AGENT'S PHONE NO.
/DIANA L CORDRAY /CITY OF CARMEL RMD /PATTI INS FINANCIAL SVCS (317) 845 -1547
1 CIVIC SQ 7116 E 71st St
CARMEL IN 46032 -2584 rr Indianapolis IN 46256 -997
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Dear Customer, If you need assistance, contact your agent at
Thank you for continuing your Bond with your the above number, or for billing inquires phone
IndependentAgent 1 -800- 543 -1953.
Please pay the current
payment due by the due date.
4
Account Detail for DIANA L CORDRAYICITY OF CARMEL
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SURETY 01/0112012 01/01/2013 $300,000.00 RENEWAL $975.00
SNO 05067093
Principatlinsured: DIANA L CORDRAY107Y OF CARMEL Obligee: CITYOFCARMEL
Underv✓rittenby. Ohio Casualty Insurance Company Description: TREASURERS
Total $975.00 $975.00
For your Records: Amount Paid Date Paid Check No
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or ill(s))
r
r
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 NO. WARRANT NO.
n n ALLOWED 20
IN SUM OF
r, 3 V 1
H 4 iZ a b 1
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
5—' 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
�j A m 20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund