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Home My WebLink About174716 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 354565 Page 1 of 1 ONE CIVIC SQUARE ST PAUL TRAVELERS CHECK AMOUNT: $4,336.59 CARMEL, INDIANA 46032 13607 COLLECTION CENTER CHICAGO IL 60693 CHECK NUMBER: 174716 CHECK DATE: 7/22/2009 L= PARTM ACCO PO NUM INVOICE N UMBER AMOUNT DESCRIPTION 1205 4347500 321094 1,231.40 GENERAL INSURANCE ,1205 4347500 324870 3,105.19 GENERAL INSURANCE TRAVELERS PAGE DEDUCTIBLE INVOICE GPO9313908 521GX7087 06/30/2009 000324870 07/15/2009 9,476.29 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL; CARMEL CLAY PARKS 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 THIS ACCOUNT IS SCHEDULED TO GO TO A COLLECTION AGENCY IF PAYMENT IS NOT RECEIVED ON OR BEFORE THE DUE DATE. l GP09313908 521GX7087 06/30/2009 000324870 07/15/2009 9,476.29 CURRENT CLAIM A3T2823 DATE OF LOSS: 05/20/2009 DESCRIPTION: C GARLING, RENEE IV N ON 1ST AVE NW PREPARING TO DRIVE ACROSS THE ST CLAIMANT: RENEE GARLING LOSS 2,495.59 CLAIM TOTAL 2,495.59 CLAIM CES0074 DATE OF LOSS: 03/11/2008 DESCRIPTION: C BELL, LOGAN ALLEGATIONS THAT CPD TOOK UNREASONABLE ACTIONS IN LIEU CLAIMANT: LOGAN BELL Y EXPENSE 469.90 CLAIM TOTAL 469.90 CLAIM CES0119 DATE OF LOSS: 01/06/2008 DESCRIPTION: C HOFF, MARGARET. CLMNT WAS FOUND UNRESPONSIVE CARMEL FIRE DEPT RE CLAIMANT: MARGARET C HOFF EXPENSE 139.70 CLAIM TOTAL 139.70 CLAIM CES1387 DATE OF LOSS: 06/17/2008 DESCRIPTION: C NELSON, FRANK; HOWELL, KELLY VS CARMEL POLICE DEPT y THIRD PARTY DEF t�� CLAIMANT: FRANK NELSON EXPENSE 139.70 CLAIM TOTAL 139.70 CURRENT CHARGES $3,244.89 TRAVELERS J PAGE 2 DEDUCTIBLE INVOICE GP09313908 521GX7087 06/30/2009 000324870 07/15/2009 9,476.29 ACCOUNT SUMMARY CURRENT CHARGES 3,244.89 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 9,113.20 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 2,881.80 AGENT PHONE: (317) 817 -5000 TOTAL DUE 9,476.29 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 9,476.29 _CONTACT_YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY, OR DEDUCTIBLE, 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 Page 1 of 2 Q Return DEDUCTIBLE INVOICE (copy) POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE GP09313908 5216X7087 5/29/2009 321094 6/15/2009 $13,583.40 MAIL PAYMENT TO: PAYER ADDRESS: TRAVELERS CITY OF CARMEL; CARMEL CLAY PARKS 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. 0 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE GP09313908 5216X7087 5/29/2009 321094 6/15/2009 $13,583.40 CURRENT CLAIM A5C7407 DATE OF LOSS: 12/23/2008 DESCRIPTION: C CELADON TRUCKING INSD FIRE TRUCK RESPONDING TO A MEDICAL EMERGENCY CLAIMANT: /CELADON TRUCKING SERVICE LOSS $174.52 CLAIM TOTAL $174.52 CLAIM CAW5269 DATE OF LOSS: 06/22/2007 DESCRIPTION: THE IV WAS ON AN EMERGENCY RUN. THE IV LOST CONTROL ON A WET ROAD HITT CLAIMANT: PATRICK K DAVISON LOSS $1,231.40 CLAIM TOTAL $1,231.40 CLAIM CES0074 DATE OF LOSS: 03/11/2008 DESCRIPTION: C BELL, LOGAN ALLEGATIONS THAT CPD TOOK UNREASONABLE ACTIONS IN LIEU CLAIMANT: LOGAN BELL EXPENSE $1,054.10 CLAIM TOTAL $1,054.10 CLAIM CES0119 DATE OF LOSS: 01/06/2008 DESCRIPTION: C HOFF, MARGARET. CLMNT WAS FOUND UNRESPONSIVE CARMEL FIRE DEPT RE CLAIMANT: MARGARET C HOFF EXPENSE $1,086.10 CLAIM TOTAL $1,086.10 CLAIM CES2627 DATE OF LOSS: 05/08/2009 file: /C:\Documents and Settings \slingelbaugh \Local Settings \Temporary Internet Files \Cont... 7/9/2009 Page 2 of 2 DESCRIPTION: C DENNINO, KEITH IV ROLLED INTO THE BACK OF A MOTORCYCLE CAUSING THE CLAIMANT: KEITH A DENINNO LOSS $1,621.18 CLAIM TOTAL $1,621.18 CURRENT CHARGES $5,167.30 ACCOUNT SUMMARY CURRENT CHARGES $5,167.30 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES $8,416.10 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS $0.00 AGENT PHONE: (317) 817 -5000 TOTAL DUE $13,583.40 DISPUTED ITEMS $0.00 ACCOUNT BALANCE $13,583.40 CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE 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 fik.l K -.\Documents and Settings \slingelbaugh \Local Settings \Temporary Internet Files \Cont... 7/9/2009 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 Travelers Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 06130/09 324870w- L -,L! 03/11/2008 $469.90 06/30/09 324870 nol 06.117.12008 $139.70 05/29/09 321094 DOL: 06/22/2007 06/30/09 324870 DOL: 05/20/2009 $2 Total tA 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 N8 NO. 1f f Ral ALLOWED 20 Drive IN SUM OF Chic ago, IL 60693 $4,336.59 ON ACCOUNt§L9Ntff&I`91ffl6 N FOR 1205 Administration Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or DEPT. 120 870 475 $469.90 bill(s) is (are) true and correct and that the 1205 materials or services itemized thereon for 0 which charge is made were ordered and 1205 321094 475 1 40 received except 2,495.59 20 1 Signat Title Cost distribution ledger classification if claim paid motor vehicle highway fund