HomeMy WebLinkAbout206105 02/14/2012 ;a CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1
ONE CIVIC SQUARE TRAVELERS
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $24,147.62
CHICAGO IL 60693 CHECK NUMBER: 206105
CHECK DATE: 2/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000401554 8,500.00 GENERAL INSURANCE
1205 4347500 000401632 1,812.50 GENERAL INSURANCE
1205 4347500 000401731 2,724.00 GENERAL INSURANCE
1205 4347500 000402275 11,111.12 GENERAL INSURANCE
TRAVELERSJp PAGE 1
DEDUCTIBLE l SELF INSURED INVOICE 15
}Z-s
I Rq tllli l IN otiliTil:14MAl MI II
303GP64A -810 521GX7087 01/31/2012 000402275 02/15/2012 11,111.12
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL,CARMEL CLAY
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.
1' RAVELE rySJ PAGE 1
12 1 1RITMI 1 1 m ill i
1 1
303GP64A 810 521GX7087 01/31/2012 000402275 02/15/2012 11,111.12
CURRENT
iC�
CLAIM EQR6255 DATE OF LOSS: 08/17/2011
DESCRIPTION: IV DRIVER WAS DISTRACTED AND STRUCK REAR OV1 AND OV1
HIT OV 2 REAR
CLAIMANT: /THE HERTZ CORPORATION
LOSS 8,698.05
CLAIM TOTAL 8,698.05
CLAIM 4 ESP0008 DATE OF LOSS: 11/21/2011
DESCRIPTION: THE IV WAS NORTHBOUND ON SHADELAND TRIED TO AVOID A
COLLISION AND SLID
CLAIMANT: BRANT BENNETT
LOSS 323.20
CLAIMANT: JANET HARRISON
LOSS 2,736.27
CLAIM TOTAL 2,413.07
CURRENT CHARGES $11,111.12
ACCOUNT SUMMARY
CURRENT CHARGES 11,111.12 INSURED NAME: CITY OF CARMEL,CARMEL CLAY
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 11,111.12
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 11,111.12
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE- HELPDESK @TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1- 800-356 -4098 EXT. 08900: ANTONIO CONTRERAS
F L1
3 2012
By
TRAVELERS
NON- FUNDED DEPARTMENT
ONE TOWER SQUARE -9MN
HARTFORD, CT o6183
39117
CITY OF CARMEL,CARMEL CLAY
ONE CIVIC SQUARE
CARMEL IN 46032
0
r
ry
N
O
a
O
O
O
N
O
Q
O
O
aw
TRAVELERS /J PAGE 1
DEDUCTIBLE SELF INSURED INVOICE 12 12 5
GP09315757 521GX7087 01/31/2012 000401731 02/15/2012 2,724.00
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL, CARMEL CLAY PARKS BUILD
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.
TRAVELERS PAGE 1
GP09315757 521GX7087 01/31/2012 000401731 02/15/2012 2,724.00
CURRENT
CLAIM CES9536 DATE OF LOSS: 06/01/2011
DESCRIPTION: C PACK, JOHN CHILD HAD HIS HAND ON THE BATHROOM DOOR
FRAME WIND C
CLAIMANT: JOHN -PAUL L PACK
LOSS 750.00
CLAIM TOTAL 750.00
CLAIM EQR4757 DATE OF LOSS: 06/13/2011
DESCRIPTION: C MYERS, TERRY ALLEGATION OF DISCRIMINATION DUE TO
AGE. EEOC COMPLAI
CLAIMANT: TERRY D MYERS
EXPENSE 1,974.00
CLAIM TOTAL 1,974.00
CURRENT CHARGES $2,724.00
ACCOUNT SUMMARY
CURRENT CHARGES 2,724.00 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 2,724.00
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 2,724.00
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE- HELPDESK @TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1- 800 356 -4098 EXT. 08900: ANTONIO CONTRERAS
D Q
FEB 13 2012
By
TRAVELERS
NON- FUNDED DEPARTMENT
ONE TOWER SQUARE -9MN
HARTFORD, CT 06183
39118
CITY OF CARMEL, CARMEL CLAY PARKS BUILD
ONE CIVIC SQUARE
CARMEL IN 46032
m
0
0
a
0
0
0
0
a
0
Amo►
TRAVELERS J P-5 PAGE 1
DEDUCTIBLE SELF INSURED INVOICE
GP09311918 0018277244 01/31/2012 000401554 02/15/2012 8,500.00
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
GP09311918 0018277244 01/31/2012 000401554 02/15/2012 8,500.00
CURRENT
CLAIM CBV0078 DATE OF LOSS: 11/11/2006
DESCRIPTION: IV PULLED OUT IN FRONT OF OV WAS STRUCK ON FRONT
LEFT CORNER BY OV
CLAIMANT: CATHERINE LAUGHLIN
LOSS 8,500.00
CLAIM TOTAL 8,500.00
CURRENT CHARGES $8,500.00
ACCOUNT SUMMARY
CURRENT CHARGES 8,500.00 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 8,500.00
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 8,500.00
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE- HELPDESK @TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1- 800 356 -4098 EXT. 08900: ANTONIO CONTRERAS
D
Q 0
F EB 13 2012
By
TRAVELERS
NON- FUNDED DEPARTMENT
ONE TOWER SQUARE -9MN
HARTFORD, CT 06183
39923
CITY OF CARMEL
ATTENTION: B COOK
1 CIVIC SQUARE
CARMEL IN 46032
N
m
n
O
a
N
O
O
O
O
O
O
Q
O
O
TRAVELERS PAGE 1
DEDUCTIBLE SELF INSURED INVOICE
GPO9313908 5216X7087 01/31/2012 000401632 02/15/2012 1,812.50
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL; CARMEL CLAY PARKS
13607 COLLECTIONS CENTER DRIVE ATTN: JIM SPELBRING
CHICAGO, IL 60693 ONE 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
GP09313908 521GX7087 01/31/2012 000401632 02/15/2012 1,812.50
�01 lcL CURRENT
CLAIM#: �4 CES6844 DATE OF LOSS: 06/13/2010
DESCRIPTION: C ROBERTS, MARY TORT NOTICE ALLEDGING BATTERY,
TRESPASS, FALSE ARR
CLAIMANT: BILLYJOE ROBERTS
EXPENSE 1,438.00
CLAIM TOTAL 1,438.00
CLAIM#: EMS6617 DATE OF LOSS: 04/16/2010
DESCRIPTION: TORT NOTICE ARISING OUT OF THE ARREST MADE BY CPD OF
THE CLAIMANT FOR
CLAIMANT: SHARRON ATKINS
EXPENSE 346.30
CLAIM#: ESA6198 DATE OF LOSS: 09/08/20 CLAIM TOTAL 346.30
DESCRIPTION: CLAIMANT ALLEGES HIS RIGHTS WERE VIOLATE D Y MZ5
OF CARMEL POLICE
CLAIMANT: DENNIS W CARLYLE FEB 13 2012
EXPENSE 28.20
CLAIM TOTAL 28.20
B y CURRENT CHARGES $1,812.50
ACCOUNT SUMMARY
CURRENT CHARGES 1,812.50 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 1.812.50
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 1,812.50
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE- HELPDESK @TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1- 800 356 -4098 EXT. 08900: ANTONIO CONTRERAS
TRAVELERS
NON- FUNDED DEPARTMENT
ONE TOWER SQUARE -9MN
HARTFORD, CT 06183
39119
CITY OF CARMEL; CARMEL CLAY PARKS
ATTN: JIM SPELBRING
ONE CIVIC SQUARE
CARMEL IN 46032
m
0
m
0
a
0
0
0
0
a
0
0
VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF
13607 Collections Center Drive
Chicage, IL 60693
$24,147.62
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1205 000402275 43- 475.00 $11,111.12 I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1205 000401731 43- 475.00 $2,724.00
materials or services itemized thereon for
1205 000401554 43- 475.00 $8,500.00
which charge is made were ordered and
1205 000401632 43- 475.00 $1,812.50 received except
Monday, February 13, 2012
r
Director, A ministration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
01/31/12 000402275 $11,111.12
01/31/12 000401731 $2,724.00
01/31/12 000401554 $8,500.00
01/31/12 000401632 $1,812.50
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