HomeMy WebLinkAbout206836 02/28/2012 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1
ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $801.83
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE
CHICAGO IL 60693 CHECK NUMBER: 206836
CHECK DATE: 2/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 ESP6086 -HO81 801.83 GENERAL INSURANCE
AW
TRAVELEM
One Tower Square
Third Party Deductible Unit 0000 -MS05A
Hartford CT 06183
February 7, 2012
CITY OF CARMEL,CARMEL CLAY
1 CIVIC SQ
CARMEL, IN 46032
Attention:
Claim Policy 4: ESP6086 /H0810 3036P64A Net Paid Amount: $801.83
Date of Loss: 01/19/2012 Deductible: $801.83
Location of Loss: CARMEL, IN
Claimant: SCOT SWENBERG
Your Agent: HYLANT GROUP INC
Agent Phone: (3 17) 817 -5000
Dear CITY OF CARMEL,CARMEL CLAY:
Travelers Insurance has made claim payment(s) relative to the above incident. Your policy specifies a deductible
for such losses. in accordance with the terms of your policy, the deductible is now due.
Please send your check for 5801.83 made payable to Travelers Insurance within thirty (30) days. In order to
expedite payment processing, please detach and mail the lower portion of this bill with your payment in the
enclosed envelope.
Your prompt attention to this matter is most appreciated. If you have any questions regarding this matter, please
call us at (860) 277 -9816.
Sincerely, n
Third Party Deductible Unit
One Tower Square 0000 -05MSA FEB 2 7 2012
Hartford, CT 061.83
BY
VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF
13607 Collections Center Drive
Chicage, IL 60693
$801.83
t
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO# l Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1205 SP60861H0810 43- 475.00 $801.83 I 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
Monday, February 27, 2012
AM
Director, Administraton
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))
02/07/12 ESP6086 /1-10810 $801.83
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