HomeMy WebLinkAbout174081 06/24/2009 CITY OF CARMEL, INDIANA VEND05: 362876 Page 1 of 1
ONE CIVIC SQUARE /J TRAVELERS
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $2,881.80
CHICAGO IL 60693 CHECK NUMBER: 174081
CHECK DATE: 6/24/2009
DEPARTMENT ACCOUNT PO N UMBER INV N UMBER AMOUNT DES
1120 4347500 321094 2,881.80 GENERAL INSURANCE
T AVELER PAGE 1
Rt
DEDUCTIBLE INVOICE
GP09313908 521GX7087 05/29/2009 000321094 06/15/2009 13,583.40
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.
TR VELES I PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
i i i i
x
GP09313908 521GX7087 05/29/2009 000321094 06/15/2009 13,583.40
CURRENT
CLAIM ASC7407 DATE OF LOSS: 12/23/2008 n
DESCRIPTION: C CELADON TRUCKING INSD FIRE TRUCK RESPONDING TO A V
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 LQ�
A WET ROAD HITT
CLAIMANT: PATRICK K DAVISON O
LOSS 1,231.40
CLAIM TOTAL 1,231.40
CLAIM CES0074 DATE OF LOSS: 03/11/2008 x., C
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
TR A VELERS I PAGE 2
DEDUCTIBLE INVOICE
GPO9313908 521GX7087 05/29/2009 000321094 06/15/2009 13,583.40
CURRENT
CLAIM CES2627 DATE OF LOSS: 05/08/2009 E
DESCRIPTION: C DENNNNO, 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 4 1 .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) B17 -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
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))
CES2627 $1,621.18
CES0119 $1,086.10
A5C7407 $174.52
1 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. WAR NO.
ALLOWED 20
Travelers
IN SUM OF
13607 Collections Center Drive
Chicago, IL 60693
$2,881.80
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 CES2627 43- 475.00 $1,621.18 1 hereby certify that the attached invoice(s), or
1120 CES0119 43 475.00 $1,086.10 bill(s) is (are) true and correct and that the
1120 A5C7407 1 43- 475.00 $174.52
materials or services itemized thereon for
which charge is made were ordered and
received except
JIIN 2 Ana
�•1 m
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund