Loading...
HomeMy WebLinkAbout169468 03/04/2009 CITY OF CARMEL, INDIANA VENDOR: 00352999 Page 1 of 1 ONE CIVIC SQUARE HYLANT GROUP CARMEL, INDIANA 46032 P o Box 1910 CHECK AMOUNT: $164.00 CARMEL IN 46082 CHECK NUMBER: 169468 CHECK DATE: 314/2009 s DEPARTMENT ACCOUNT PO NUM INVOIC NUMBER AM OUNT DESCRIPTION 1192 4347500 T 50.00 GENERAL INSURANCE 902 4460892 682853 114.00 APOSTOLIC CHURCH SITE j HLANT PO. Box 1910 Carmel, IN, 46082 Y GR OUP page j, Up Lpcal: 317-817-5000 INVOICE# 682853 ACCO&i CARME80 8Y 02/16/09 PRO CERi W. Michael Wells DUE ON'-. 02/16/09 '?AMOUNT PAID DUE 114.00 City of Carmel Steve Engelking One Civic Square Carmel, IN 46032 Eft Type "T 6a1�rn'* Policy 4 INVOICE 682853 01/01/09 +EN PCKG GP09313908 Add Property Travelers Insurance Companies 114.00 Dept: CRC, Add 12990 N. Old Meridian, Carmel, IN Invoice Balance: 114.00 HYLANT GROUP www.hylant.com 501 Congressional Blvd Suite 300 P0. Box 1910 Carmel, IN 46032 Local: 317-817-5000 Fax: 317-817-5151 M to to 0 o DELIVERY INVOICE meStPaul U U v Company: ST. PAUL MERCURY INSURANCE COMPANY 0 0 I CITY OF CARMEL; CARMEL CLAY PARKS Policy Inception /Effective Date: 01/01/09 I- N BUILDING CORPORATION; CARMEL CLAY Agency Number: 1307412 0 S BOARD OF PARKS RECREATION; CARMEL 0 U CLAY REDEVELOPMENT COMMISSION Transaction Type: R ONE CIVIC SQUARE ENDORSEMENT OF POLICY o E CARMEL IN 46032 Transaction number: 004 D Processing date: 02/11/09 17:50 Policy Number: GP09313908 r m r A HYLANT GROUP INC o G P.O. BOX 1910 M E CARMEL IN 46082 -4910 m N o T a 0 N Policy Description Amount Surtax/ o Number Surcharge U r GP09313908 ENDORSEMENT PREMIUM $114.00 40724 Ed.12 -90 Printed in U.S.A. Page 1 INSURED COPY m :n Ln 0 o POLICY CHANGE ENDORSEMENT �St�ul This endorsement summarizes the changes to U your policy. All other terms of your policy not affected by these changes remain the same. v O O How Your Policy Is Changed O O O H N O PROPERTY m ro a Item 007 is added to your Property Protection, see the Property Protection o Coverage Summary. m m m m O a N O O U Premium Change Which Is Due Now Additional premium $114.00 Returned Premium If issued after the date your policy Policy issued to begins, these spaces must be completed CITY OF CARMEL; CARMEL CLAY PARKS and our representative must sign below. BUILDING CORPORATION; CARMEL CLAY BOARD OF PARKS RECREATION; CARMEL CLAY REDEVELOPMENT COMMISSION Authorized representative Endorsement takes effect Policy Number 01/01/09 GP09313908 Processing Date: 02/11/09 17 :50 004 40704 Ed.5 -84 Printed in U.S.A. Endorsement ©St.Paul Fire and Marine Insurance Co. 1984 All Rights Reserved Page 1 M �n LO o PROPERTY PROTECTION COVERAGE SUMMARY STPAUL o TRAVELERS This Coverage Summary describes each insured item and shows the limits and extent of coverage under your property protection. a Description and location of covered property. 0 0 Item 007 o ONE STORY, FRAME BUILDING 0 0 OCCUPIED AT CHURCH 12990 N OLD MERIDIAN ST N CARMEL, IN 46032 0 Limit Of Coverage Valuation N co m Building $400,000 RC m Coinsurance 901 m 0 a C7 N o Business Personal Property Business Income Blanket Earnings And Expense Deductibles Or Waiting Period Your Property Protection deductible per loss event is $25,000. (unless otherwise indicated below) Other Coverages Or Options Name of Insured Policy Number GP09313908 Effective Date 01/01/09 CITY OF CARMEL; CARMEL CLAY PARKS Processing Date 02/11/09 17:50 004 42563 Rev. 4 -06 Coverage Summary 2006 The St. Paul Travelers Companies, rnc. All Rights Reserved Page 1 of rn Lo In o o POLICY CHANGE ENDORSEMENT TwStFaul This endorsement summarizes the changes to your policy. All other terms of your policy not affected by these changes remain the same. N O How Your Policy Is Changed O 0 O PROPERTY Item 008 is added to your Property Protection, see the Property Protection Coverage Summary. r ADDITIONAL PREMIUM WAIVED. ro 0 rn M M am 0 a C7 N O O U (0 i Premium Change Which Is Due Now Additional premium $0.00 Returned Premium $0.00 If issued after the date your policy Policy issued to begins, these spaces must be completed CITY OF CARMEL and our representative must sign below. Authorized representative Endorsement takes effect Policy Number 12/29/08 GP09313908 Processing Date: 02/11/09 17 :44 026 40704 Ed.5 -84 Printed in U.S.A. Endorsement ©St.Paul Fire and Marine Insurance Co.1984 All Rights Reserved Page 1 m .n LO o PROPERTY PROTECTION COVERAGE SUMMARY STPAUL TRAVELERS This Coverage Summary describes each insured item and shows the limits and extent of coverage under your property protection. Description and location of covered property. N O Item 008 o ONE STORY, FRAME BUILDING o OCCUPIED AT OLD CHURCH 12990 N OLD MERIDIAN ST CARMEL, IN 46032 0 Limit Of Coverage Valuation N W m Building $400,000 RC Coinsurance 90% m O a N o Business Personal Property Business Income Blanket Earnings And Expense Deductibles Or Waiting Period Your Property Protection deductible per loss event is $25,000. (unless otherwise indicated below) Other Coverages Or Options Name of Insured Policy Number GP09313908 Effective Date 12/29/08 CITY OF CARMEL Processing Date 02/11/09 17 :44 026 42563 Rev. 4 -06 Coverage Summary 2006 The St. Paul Travelers Companies, Inc. All Rights Reserved Page 1 of ,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. J Payee Purchase Order No. /'CJ UX gl� Terms �a rr�rr �'UGO� Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) //y 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. ALLOWED 20 �iL /9 U` ^GUS° IN SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 9a2 6 FS i 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 20 6 ej Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund State Form 40889 (R71 1-03) Approved by Stale Board of Accounts, 1997 TODD ROIGTA SECRETARY OF STATE NOTARY PUBLIC APPLICATION" Including: Request to be appointed a Notary Public Notarial Oath Notarial Bond Instructions IC 33- 16 -2 -1: (as amended) Sec. 1 (a) Any applicant for a commission as a notary public shall possess the following qualifications: (1) be at least eighteen (18) years of age; and (2) be a legal resident of the State of Indiana. (b) A notary public shall be appointed and commissioned by the Governor. A notary public shall hold office for eight (8) years. A notary public, when so qualified, shall be authorized to act within the State of Indiana. A person may request an application to become a notary public from the Secretary of State. The application shall be prescribed by the Secretary of State and shall include the applicant's county of residence, oath of office, and official bond. The application shall also contain any additional information necessary for the efficient administration of this chapter. The applicant shall personally appear, with an application, before an officer authorized by law to administer oaths who shall administer an oath of office to the applicant. The applicant shall secure an official bond, with freehold or corporate security, to be approved by the Secretary of State in the sum of five thousand dollars ($5,000). The official bond shall be conditioned upon the faithful performance and discharge of the duties of the office of notary pubfic, in all things according to law, for the use of any person injured by a breach of the condition. The completed application shall be forwarded to the Secretary of State. The Secretary of State shall forward each commission: issued by the Governor to the applicant or the applicant's surety company. Notary Department Secretary of State's Office Room 201 State House Indianapolis, Indiana 46204 317 232 -6542 This application should also be filled out by current notaries public desiring to extend their commission for another term. There is no separate renewal form or procedure. IT IS A CRIME TO PERFORM ANY OF THE DUTIES OF A NOTARY PUBLIC UNTIL COMMISSIONED BY THE GOVERNOR. IT IS IMPORTANT THAT YOU POSSESS A CURRENT, VALID COMMISSION BEFORE ACTING AS A NOTARY PUBLIC. THE FILING OF THIS APPLICATION OR THE TAKING OF THE OATH CONTAINED AS PART OF THIS APPLICATION DOES NOT AUTHORIZE YOU TO ACT AS A NOTARY PUBLIC. Do Not Write In This Box For Office Use Onl Comm ission li Expiration Date of New C ommi ss ion APPLICATION FOR APPOINTMENT AS A NOTARY PUBLIC IN THE STATE OF LNDIANA Complete and Return to: Notary Department, Secretary of State, Room 201, State House Indianapolis, Indiana 46204: Telephone: 317 232 -6542 To: THE GOVERNOR OF INDIANA 1 respectfully request that 1 be appointed and commissioned a Notary Public. In support of my application, I submit herewith the required bond, oath of office, and fee of FIVE DOLLARS ($5), payable to the Secretary of State, in the form of a check or money order. (Do not send currency in the mail.) (IC 33- 16 -2 -1) PRINT OR TYPE r� A 1 1. NAME `C H E I'1 l— I� 13 ©0 Yottrlegal signatraein which commission wit be issued -see instruction H) 2. HOME ADDRESS O 20 ILCSS(� V Mtmbem street I N ZZO Ciy state 3. COUNTY OF RESIDENCE I" t Al 1 0 y 4. Business or Employer's Name S. Business or Employer's Address (y C SQ. C Y W 0 Z I s Strwt city State ZIP -de 6. HOME PHONE ���f) 0 OFFICEPHONE 30 Ara Code N er Area God. M1um r 7. If you have a current valid notary commission, show your expiration date: N/ A 20 S. If you are now a notary public and your name or county has changed since your last application, please give both old and new information. OLD: NEW: 9. NOTARIAL OATH STATE OF INDIANA, SS: COUNTY OF C tarry m to o rs r n+mamr� I do solemnly swear (or affirm) that I will support the Constitution of the United States, and the Constitution ofthe State of Indiana; that I am duly qualified to hold office under the Constitution and laws of the State; that i am 18 years of age or over; that I am of good moral character and integrity; that I am a resident of Indiana; that my answers to questions on this application are true and complete to the best of my knowledge; that I have carefully read all of the instructions which came with this application, and that I will faithfully and impartially discharge the duties of NOTARY PUBLIC if so commissioned by the Governor, according to the best of my skill and ability, so help me God (orunder the pains and penalties of perjury). �t n Signature of appl am -Place Officer's Seal He?e Subscribed and sworn or affirmed to before me, this A.- day of h A.D- 20 IN TEST] t WHEREOF, 1, L�.1 Sr4 i i Printed ortyped name of o�mr 1i k, a for the Sigma ofntata<y ublic ororhe off ice authorisd w admivata oaths Office County of '7 State of Indiana. ON ml's mun ty ofresiden ce i My commission expires: NOTE: T he Form, starting with 910 on the back of this application, must be completed before mailing to the Secretary of State. The applicant must sign again in #10. 10. NOTAR1ALBOND Q l �1, KNOW ALL BY THESE PRESENT'S, that we T tG H M 00 N C as principal ame o A ie..t (applicant) and of Name of Surety and County as Stmt ad ms; ury, state Zlf code freehold or corporate surety, are held and firstly bound unto the State of Indiana, in the penal sum of FIVE THOUSAND DOLLARS ($5,000), the payment of which, well and truly to be made, we bind ourselves, our heirs, executors and administrators, firmly by these presents. WITNESS our signatures as acknowledged below. THE CONDITION OF THE ABOVE OBLIGATION IS AS FOLLOWS, TO -WIT. WHEREAS, the above bound principal has applied for appointment by the Governor of the State of Indiana as a Notary Public, in and for the State of Indiana, for a eight -year term. Now, if the said principal shall truly and faithfully perform and discharge the duties of said office of Notary Public, in all things according to law, then the above obligation to be null and void, otherwise to remain in full force and virtue in law. The term of this bond is from the effective date of the principal's commission to the expiration date of the same. Si Rzeireofeppucmrt. Mu%bewknowledgedbdowin Nlf Signamreofswery. Must be adtnowle&,W below in# 12 11. ACKNOWLEDGEMENT OF APPLICANT'S SIGNATURE BY A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED BY LAW TO TAKE ACKNOWLEDGEMENTS. STATE OF 3 ✓1 ✓t 4 COUNTY OF t SS: un m which aclmowledger ent is bung made Before me the undersigned, an officer authorized to take the acknowledgement of deeds (Notary Public, County Clerk, etc.) personally appeared D/ and acknowledged the execution of the foregoing bond for the uses and Prmtvdo,1yped­.1 pprc2M purposes therein expressed, without condition or reservation. have hereunto set my j W1 3 1 �to ^t yV( Tiaec Ofia;erS sea[bcr IN TESTIMONY WHEREOF, I tl si Pnntdw typed mmneofof5cer hand and 6fticial seal, this R l k day of 20 0 Si more of adtonzd o tear office for the County of f� X11 State of officers county o rest ence My commission expires: .12. ACKNOWLE.DGEMENT OF SURETY'S SIGNATURE (Freehold or Corporate) BY A NOTARY PUBLIC OR OTHER OFFICER t.1CiiftOI2IZGEA BY LAW TO TAKE ACKNOWLEDGEMENTS. (NOTE. The officer can not acknowledge his/her own signature) STATE OF COUNTY OF SS: Cow:,y in which adatowkdgrment is de being ma Before me the undersigned, an officer authorized to take the acknowledgement of deeds (Notary Public, County Clerk, etc) personally appeared and acknowledged the execution of the foregoing bond for the uses and Printed ortypednamao ind%ridualsitmingass=iy purposes therein expressed, without condition or reservation. Place Officer's seal here IN TESTIMONY WHEREOF, 1 have hereunto set my Prinwd ar typed naroeo o car hand and official seal, this day of 20 a Signal= of WthWiZed officer office for the County of State of OfScds muntyo tart mce My commission expires: 13. SUPPORTING AFFIDAVIT TO BE USED IN SUPPORT OF A FREEHOLD SURETY. STATE OF INDIANA, COUNTY OF SS: Couory in which acknowledgement is mg made The undersigned surety, being duly sworn or affirmed, says that he /she is the owner in fee simple of Real Estate in County, of the fair Cash Value of over and, above all encumbrances and exemptions. &Unanxeofsurery Place Officers seal here IN TESTIMONY WHEREOF, I I have hereunto set my n ntd or typed none of officer hand and official seal, this day of 1 20 a Signmure of w rizd officer o ce for the County of State of accts wnnty o rat urcc My commission expires: For the statute pertaining to surety company bonds, see Indiana Code 27 -1 -22. For the statutes pertaining to Officer's Bonds and Oaths, see Indiana Code 5 -4. i NOTARY APPLICATION INS'T'RUCTIONS 1. Application for Notary Public may be obtained from the Secretary of State, the Clerk of the Circuit Court, or a bonding company. Applications can be photocopied if all parts of the application remain on the front and back of one piece of paper. 2. The application must be filled out completely. The application must be typewritten or printed. Do not leave any blanks. If any item is not applicable to you, please indicate that fact with the words "not applicable" or "none" or "NA 3_ In giving your name in item #1 on the application, you should print or type your name the way you will sign your name as a notary public. Your first or middle name may be initialed, but we suggest either your first full name or your second full name or both, whichever you prefer. For example: John S. Smith, J. Samuel Smith, or John Samuel Smith; but not J. S. Smith. Your commission will be issued in the name given in item #1 and when performing a notarial act you should always sign your name the way it appears on your commission. This requirement is for identification purposes and is for your protection. 4. If you are making reapplication, it is important for you to complete item #7 on the application and show your ex- piration date so that when your new commission is issued there will be no lapse or overlap. (If your commission has recently expired do not show your old expiration date in 97. Show an expiration date only if your commission is still in effect when you complete the application.) Reapplications should not be sent to the Secretary of State's office earlier than sixty (60) days before the expiration date. 5. After the first seven items of the application have been filled out, take the application to an officer authorized by law to administer oaths (e.g. another notary public, the Clerk of the Circuit Court, etc.). The oath of office (item 49 of the application) will be administered to you by that officer. Be sure to read instructions #6, 7, 8, 9 and 10 below. PLEASE NOTE: BEFORE TAKING THE OATH IT IS IMPORTANT TO DETERMINE IF YOU ARE QUALIFIED TO BE A NOTARY PUBLIC. A. INDIANA LAW STATES THAT IT SHALL BE AN INDISPENSABLE QUALIFICATION FOR PERSONS TO HOLD ANY OFFICE WITHIN THE STATE OF INDIANA, EITHER BY ELECTION OR APPOINTMENT, THAT SUCH PERSONS SHALL NEVER HAVE BEEN CONVICTED OF ANY CRIME AGAINST THE LAWS OF THE UNITED STATES WHERE THE SENTENCE IMPOSED EXCEEDED SIX (6) MONTHS (IC 5- 8 -3 -1). B. NO PERSON HOLDING ANY LUCRATIVE OFFICE OR APPOINTMENT UNDER THE UNITED STATES OR UNDER THIS STATE, AND PROHIBITED BY THE CONSTITUTION OF THIS STATE FROM HOLDING MORE THAN ONE SUCH LUCRATIVE OFFICE, SHALL SERVE AS A NOTARY PUBLIC, AND HIS ACCEPTANCE OF ANY SUCH OFFICE SHALL VACATE HIS APPOINTMENT AS SUCH NOTARY; BUT THIS PROVISION SHALL NOT APPLY TO ANY PERSON HOLDING ANY LUCRATIVE OFFICE OR APPOINTMENT UNDER ANY CIVIL OR SCHOOL CITY OR TOWN OF THIS STATE. (IC 33- 16 -2 -7) C. EVERY PERSON ELECTED OR APPOINTED TO ANY OFFICE UNDER THIS CONSTITUTION SHALL, BEFORE ENTERING ON THE DUTIES THEREOF; TAKE AN OATH OR AFFIRMATION TO SUPPORT THE CONSTITUTION OF THIS STATE, AND OF THE UNITED STATES, AND ALSO AN OATH OF OFFICE. (Indiana Constitution, Article 15, Section 4) 6. An official bond, with freehold or corporate security, must be secured in the sum of 55,000. The applicant must sign in item #10 and have his signature acknowledged in #11. (Freehold security must be approved by the Secre- tary of State and item #13 of the application is only completed in the case of a freehold bond. A freehold bond is when someone other than the applicant, who owns land worth at least $5,000, is the surety.) Corporate security can be obtained by taking the application to a bonding company for completion. Insurance companies and agents are often qualified to provide corporate security. Items 910, 11 and 12 of the application make up the bond. 7. In the case of a corporate security, a power of attorney showing that the individual signing for the bonding company has authority to execute the bond should be attached to the application when it is submitted to the Secretary of State. 8. The completed application, including the oath of office and bond, should be forwarded to the Secretary of State with a fee of five dollars ($5), payable to the of State, in the form of a check or money order. Do not send cur- rency in the mail. 9. The Secretary of State will forward your commission to you (or to your surety company, if requested to do so by enclosing a self- addressed return envelope with the application.) 10. Please tear off and keep these instructions. FW: Notary Apglication Page 1 of 1 Stewart, Lisa M From: Sue Morlock [Sue.Morlock @Hylant.com] Sent: Tuesday, February 24, 2009 10:26 AM To: Stewart, Lisa M Subject: FW: Notary Application Attachments: notary app_200901 21 1 241 54.pdf Lisa, Attached is the Notary application you requested. <<notary app_20090121124154.pdf>> Please complete items #1 through #8 and sign on items #9 and #10. A notary public needs to complete items #9 and #11. Please return the completed application along with a $5.00 check payable to the Secretary of State and a $50.00 check payable to Hylant Group and return to my attention. Thank you, Sue Morlock 817 -5162 Notice: The contents of this communication are privileged and confidential. If you are not the intended recipient of this transmission, you are hereby notified that distributing, copying, or disclosing this communication, or reliance on the contents thereof, are strictly prohibited. If you have received this communication in error, please notify the sender immediately, then destroy the original and all copies thereof. 2/24/2009 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 02/24/09 Notary fees Rachel $50.00 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. WA NO. ALLOWED 20 Hylant Group Sue I,vlorlock IN SUM OF 501 Congressional Blvd. Carmel, IN 46032 $50.00 ON ACCOUNT OF APPROPRIATION FOR Carmel DOCS Department PO# Dept. INVOICE NO. CT #/TITLE AMOUNT Board Members 1192 43- 475.00 $50.00 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 r. which charge is made were ordered and LA 00 received except V I Monday, March 02, 2009 bl (Airector, KS Titl Cost distribution ledger classification if claim paid motor vehicle highway fund