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Home My WebLink About172189 05/13/2009 CITY OF CARMEL, INDIANA «swo0n 354565 Page 1 of 1 ONE CIVIC SQUARE sT PAUL TRAVELERS o*�Cn��UNT� �1o0156 C*RMEL.|womNx4O032 `a�rooucrrmwcc�En CHICAGO /Lm06o CHECK NUMBER: '172189 c*sono�rs� 5/13/2009 DEPARTMENT AC COUNT PONUMBER msmuMosn AMOUNT oEaoropnom �wII25 4358400 298276 681.56 REFUNDS AWARDS ZNDE II25 4358400 3l7474 1,200.00 REFUNDS AWARDS Z0DE Page 2 of 2 CLAIMANT: JUNG PARK LOSS $681.29 CLAIM TOTAL $681,29 CLAIM CBZ4900 DATE OF LOSS: 07/15/2008 DESCRIPTION: C KLITZING, MICHAEL PARKED VEH HAS A CRACKED WINDSHIELD FROM A MOW CLAIMANT: DAVID GORIS LOSS $681.56 CLAIM TOTAL $681.56 CURRENT $11,533.58 CHARGES ACCOUNT SUMMARY CURRENT CHARGES $11,533.58 INSURED NAME: CITY OF CARMEL PAST DUE CHARGES $4,484.13 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS $0.00 AGENT PHONE (317) 817 -5000 TOTAL DUE $16,017.71 DISPUTED ITEMS $0.00 ACCOUNT BALJANCE $16,017.71 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: JULIE RUPPERT R Z 4 7009 APk a BY BY:............... file: /C:\Documents and Settings \slingelbaugh \Local Settings \Temporary Internet Files \Co... 4/15/2009 1 UJE� �S Page 1 of 2 F Return DEDUCTIB E- VOICE (copy) POLICY ACCOUNT BILL BILL PAYMENT TOTAL NUMBER NUMBER DATE NUMBER DUE DUE GP09313908 5216X7087 8/29/2008 298276 9/15/2008 16,017.71 MAIL PAYMENT TO: ER ADDRESS: TRAVELERS CITY OF CARMEL 13607 COLLECTIONS CENTER ONE CIVIC SQUARE DRIVE CHICAGO, IL 60693 CARMEL IN 46032 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE. TO TRAVELERS. PLEASE WRITE THE POLICY ACCO UNT NUMBER ON YO UR CHECK. THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. POLICY ACCOUNT BILL BILL PAYMENT TOTAL NUMBER NUMBER DATE NUMBER DUE DUE GP09313908 5216X7087 8/29/2008 298276 9/15/2008 $16,017.71 CURRENT CLAIM A9Q6415 DATE OF LOSS: 01/09/2006 DESCRIPTION: ON 1/9/2006 DEFENDENT'S TERMINATED PLANTIFF FROM HIS EMPLOYMENT WITH C CLAIMANT: JOHN NIKOLOFF EXPENSE $1,414.00 CLAIM TOTAL $1,414.00 CLAIM A9Y1907 DATE OF LOSS: 01/09/2008 DESCRIPTION: C- CARLTON,LYNN, IV ON A EMERGENCY RUN AND ENTERED THE INTERSECTION ON CLAIMANT: LYNN P CARLTON LOSS $8,756.73 CLAIM TOTAL $8,756.73 CLAIM CBZ4447 DATE OF LOSS: 07/17/2008 DESCRIPTION: OV WAS PARKED WHEN AN INSD LAWNMOWER PASSED OV AND SHOT A LARGE ROCK I file: /C: \Documents and Settings \slingelbaugh \Local Settings \Temporary Internet Files \Co... 4/15/2009 T'RAV LERS J: PAGE 1 DEDUCTIBLE INVOICE amalm GPO9313908 521GX7087 03/31/2009 000317474 04/15/2009 0 117 0,1.76 APR 2 9 2009 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL; CARMEL CLAY PARKS 13607 COLLECTIONS CENTER DRIVE ONE CIVIC SQUARE PUrdlM 32 "C CHICAGO, IL 60693 CARMEL IN 460 p@g0a ��'lC_ @yr..�,,� P.0.8 POrF RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO Q- Fi FRS PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUIBUtIgOVK Purchases p9ft Approval o TRAVELERS J THIS ACCOUNT IS SCHEDULED TO GO TO A COLLECTION AGENCY IF PAYMENT IS NOT RECEIVED ON OR BEFORE THE DUE DATE. Dim GP09313908 5216X7087 03/31/2009 000317474 04/15/2009 8,701.76 CURRENT CLAIM#: A6NO173 DATE OF LOSS: 11/23/2008 DESCRIPTION: C- GRAY, CHAD TORT NOTICE CITY SEWER BACKUP CAUSED pp 1000+ GALLONS OF� CLAIMANT: CHAD GRAY LOSS 5,000.00 CLAIM TOTAL 5,000.00 CLAIM CES0074 DATE OF LOSS: 03/11/2008 C DESCRIPTION: C BELL, LOGAN ALLEGATIONS THAT CPD TOOK UNREASONABLE ACTIONS IN LIEU CLAIMANT: LOGAN BELL EXPENSE 1,585.80 CLAIM TOTAL 1,585.80 CLAIM CES0119 DATE OF LOSS: 01/06/2008 VJ DESCRIPTION: C HOFF, MARGARET. CLMNT WAS FOUND UNRESPONSIVE CARMEL FIRE DEPT RE i CLAIMANT: MARGARET C HOFF EXPENSE 198.40 CLAIM TOTAL 198.40 CLAIM CES1387 DATE OF LOSS: 06/17/2008 DESCRIPTION: C NELSON, FRANK; HOWELL, KELLY VS CARMEL POLICE DEPT( THIRD PARTY DEF� CLAIMANT: FRANK NELSON EXPENSE 124.30 CLAIM TOTAL 124.30 CLAIM# CES1.7.46 DATE -OF LOSS: "01/21 %2009 DESCRIPTION: OV SLOWING DOWN FOR ROUND ABOUT AND IV WAS BEHIND, DID NOT SLOW DOWN I� CvL'AIMANT LAURA GACYANI LOSS 1,200.00 CLAIM TOTAL 1;x200.00~ CURRENT CHARGES $8,108.50 O fiv TRAQELER5 J AUt DEDUCTIBLE INVOICE 1 GP09313908 521GX7087 03/31/2009 000317474 04/15/2009 8,701.76 ACCOUNT SUMMARY CURRENT CHARGES 8,108.50 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 593.26 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000 TOTAL DUE 8,701.76 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 8 701.76 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 ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. 354565 Travelers Terms 13607 Collections Center Drive Chicago, IL 60693 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 8/29108 298276 Claim CBZ4900 7/15/08 D.Goris 681.56 3/31/09 317474 Claim CES1746 1/21/09 Galyan 1,200.00 Total 1,881.56 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. Warrant No. 354565 Travelers Allowed 20 13607 Collections Center Drive Chicago, IL 60693 In Sum of 1,881.56 ON ACCOUNT OF APPROPRIATION FOR 101 -General Fund PO# or INVOICE NO. ACCT #/TITL AMOUNT Board Members Dept 1125 298276 4358400 $V 681.56 I hereby certify that the attached invoice(s), or 1125 317474 4358400 1,200.00 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 7 -May 2009 Signature 1,881.56 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund