HomeMy WebLinkAbout175568 08/06/2009 CITY OF CARMEL, INDIANA VENDOR: 35456 Page 1 of 1
ONE CIVIC SQUARE ST PA' QTRAVELERS CHECK AMOUNT: $5,000.00
CARMEL, INDIANA 46032 13607 COL ON CENTED
CHICAGO IL 60693 CHECK NUMBER: 175568
CHECK DATE: 8/6/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 322387 5,000.00 GENERAL INSURANCE
TE 'NELER5.1 PAGE 1
DEDUCTIBLE INVOICE
1 1 1 I 1 1
GPO9309872 0018277203 05/29/2009 000322387 06/15/2009 5,000.00
t MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL
13607 COLLECTIONS CENTER DRIVE 1 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.
AW
TRAVELERS J PAGE 1
THIS ACCOUNT IS SCHEDULED TO GO TO A COLLECTION AGENCY
IF PAYMENT IS NOT RECEIVED ON OR BEFORE THE DUE DATE.
1 l RIWAN ollfild .1 4AW1019 0 k ai III I q IN 0 111 il, m 4 mm 1 1 1
GP09309872 0018277203 05/29/2009 000322387 06/15/2009 5,000.00
ACCOUNT SUMMARY
CURRENT CHARGES 0.00 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 5,000.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 5,000.00
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 5,000.00
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE.- HELPDESK @TRAVELERS.COM1 OR,
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1- 800 356 -4098 EXT. 08900: ANTONIO CONTRERAS
F( ribed 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
Travelers Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
n5igglog, 322387-
vQ.QQ
Total $5 000 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 P81 03/09 WARRANT NO.
ALLOWED 20
Collect Center Drive
IN SUM OF
Chicago, IL 60693
$5,000.00
ON ACCOU8�ff,��PF, FOR
1205 Administration
Board Members
PO# or
DEPT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
1205 322387 475 $5,000.00 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
,l Si ure
!�1 Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund