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Home My WebLink About171705 04/29/2009 CITY OF CARMEL, INDIANA VENDOR: 354565 Page 1 of 1 ONE CIVIC SQUARE ST PAUL TRAVELERS CARMEL, INDIANA 46032 13607 COLLECTION CENTER CHECK AMOUNT: $1,727.05 CHICAGO IL 60693 CHECK NUMBER: 171705 CHECK DATE: 4/29/2009 DEPARTMENT A CCOUN T PO NUMBER INVOI NU MBER AM OUNT DESCRIPTION 1205 4347500 290894 2,524.65 GENERAL INSURANCE 1120 4347500 305836 843.20 GENERAL INSURANCE 1205 4347500 308416 1,500.00 GENERAL INSURANCE ,1120 4347500 317474 198.40 GENERAL INSURANCE 1205 4347500 317474 1,710.10 GENERAL INSURANCE TRA V S J PAGE 1 DEDUCTIBLE INVOICE y 1 i GPO9313908 521GX7087 03/31/2009 000317474 04/15/2009 8,701.76 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. TRPKIVELERS J A PAGE 1 THIS ACCOUNT IS SCHEDULED TO GO TO A COLLECTION AGENCY IF PAYMENT IS NOT RECEIVED ON OR BEFORE THE DUE DATE. Y GPO9313908 521GX7087 03/31/2009 000317474 04/15/2009 8,701.76 CURRENT CLAIM#: AGN0173 DATE OF LOSS: 11/23/2008 DESCRIPTION: C- GRAY, CHAD TORT NOTICE CITY SEWER BACKUP CAUSED n 1000+ GALLONS OF CLAIMANT: CHAD GRAY LOSS 5.000.00 CLAIM TOTAL 5,000.00 CLAIM#: CES0074 DATE OF LOSS: 03/11/2008 DESCRIPTION: C BELL, LOGAN ALLEGATIONS THAT CPD TOOK UNREASONABLE ACTIONS IN LIEU Do CLAIMANT: LOGAN BELL 1 EXPENSE 1,585.80 CLAIM TOTAL 1,585.80 CLAIM#: CES0119 DATE OF LOSS: 01/0612008 DESCRIPTION: C HOFF, MARGARET. CLMNT WAS FOUND UNRESPONSIVE CARMEL FIRE DEPT RE 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 r�\ THIRD PARTY DEF CLAIMANT: FRANK NELSON EXPENSE 124.30 CLAIM TOTAL 124.30 CLAIM#: CES1746 DATE OF LOSS: 01/21/2009 DESCRIPTION: OV SLOWING DOWN FOR ROUND ABOUT AND IV WAS BEHIND, DID NOT SLOW DOWN I CLAIMANT: LAURA GALYAN LOSS 1,200.00 U CLAIM TOTAL 1,200.00 CURRENT CHARGES $8,108.50 TRAVELERSJ PAUt DEDUCTIBLE INVOICE 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 8,701.7G 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 Return DEDUCTIBLE INVOICE (copy) POLICY ACCOUNT BILL BILL PAYMENT TOTAL NUMBER NUMBER DATE NUMBER DUE DUE GP09313908 5216X7087 11/26/2008 305836 12/15/2008 $11,372.53 MAIL PAYMENT TO: PAYER 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 ACCOUNT NUMBER ON YOUR CHECK. i 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 11/26/2008 305836 12/15/2008 $11,372.53 CURRENT CLAIM A9Q6415 DATE OF LOSS: 01/09/2006 DESCRIPTION: ON 1/9/2006 DEPENDENT'S TERMINATED PLANTIFF FROM HIS EMPLOYMENT WITH C CLAIMANT: JOHN NIKOLOFF EXPENSE $266.00 CLAIM TOTAL $266.00 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 $843.20 CLAIM TOTAL $843.20 CLAIM FZP0593 DATE OF LOSS: 09/26/2008 DESCRIPTION: C- STARR, BARBARA IV STRUCK A PARKED UNOCCUPIED VEH WHILE BACKING OUT file: //CAD ocuments and Settings \slingelbaugh \Local Settings \Temporary Internet Files \Co... 4/15/2009 Page l of 2 Return DEDUCTIBLE INVOICE (copy) POLICY ACCOUNT BILL BILL PAYMENT TOTAL NUMBER NUMBER DATE NUMBER DUE DUE GP093 l 3908 5216X7087 12/31/2008 308416 1/15/2009 $13,278.15 MAIL PAYMENT TO: PAYER ADDRESS: TRAVELERS CITY OF CARMEL 13607 COLLECTIONS CENTER ONE CIVIC SQUARE DRIVE CHICAGO, IL 60693 CARMEL IN 46032 RETURN THIS PORTION IVITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE WRITE THE POLICY ACCO UNT NUMBER ON YO UR CHECK. i 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 12/31/2008 308416 1/15/2009 $13,278.15 CURRENT CLAIM A5C4815 DATE OF LOSS: 12/05/2008 DESCRIPTION: IV FORWARD AND HIT OV IN THE REAR. CLAIMANT: JAMES FREMDER LOSS $676.11 r'1,AIM TOTAL $676.1.1 CLAIM A8D2199 DATE OF LOSS: 04/24/2008 DESCRIPTION: PER FAX: C STEIN, CHARLOTTE IRON COVER OVER ACCESS HOLE TO WATER P CLAIMANT: CHARLOTTE K STEIN LOSS $1,500.00 CLAIM TOTAL $1,500.00 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 $93.15 file: /C:\Documents and Settings \slingelbaugh \Local Settings \Temporary Internet Files \Co... 4/15/2009 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) $936.35 FD Portion $198.40 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 NO. WARRANT NO. ALLOWED 20 Travelers IN SUM OF 13607 Collections Center Drive Chicago, IL 60693 $1,134.75 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 43- 475.00 $936.35 1 hereby certify that the attached invoice(s), or 1120 43- 475.00 $198.40 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 APR 2 7 2009 V Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund TRAVELERS) PAGE 1 DEDUCTIBLE INVOICE 1 1 I 1 1 1 GP09313908 521GX7087 03/31/2009 000317474 04/15/2009 8,701.76 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. GP0931390B 521GX7087 03/31/2009 000317474 04/15/2009 8,701.76 CURRENT CLAIM ASNO173 DATE OF LOSS: 11/23/2008 1 DESCRIPTION: C- GRAY, CHAD TORT NOTICE CITY SEWER BACKUP CAUSED n 1000+ GALLONS OF CLAIMANT: CHAD GRAY LOSS 5,000.00 CLAIM TOTAL 5,000.00 CLAIM CES0074 DATE OF LOSS: 03/11/2008 DESCRIPTION: C BELL, LOGAN ALLEGATIONS THAT CPD TOOK UNREASONABLE ACTIONS IN LIEU CLAIMANT: LOGAN BELL EXPENSE 1,585.80 CLAIM TOTAL 1,585.80 CLAIM CES0119 DATE OF LOSS: 01/06/2008 DESCRIPTION: C HOFF, MARGARET. CLMNT WAS FOUND UNRESPONSIVE CARMEL FIRE DEPT RE y 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 Gib g, THIRD PARTY DEF CLAIMANT: FRANK NELSON EXPENSE 124.30 CLAIM TOTAL 124.30 CLAIM CE S1746 DATE OF LOSS: 01/21/2009 DESCRIPTION: OV SLOWING DOWN FOR ROUND ABOUT AND IV WAS BEHIND, DID NOT SLOW DOWN I CLAIMANT: LAURA GALYAN LOSS 1,200.00 CLAIM TOTAL 1,200.00 CURRENT CHARGES $8,108.50 AIMW TRAVELERS J PAGE 2 DEDUCTIBLE INVOICE GPO9313908 5216X7087 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 Page 1 of 1 Q Return DEDUCTIBLE INVOICE (copy) POLICY ACCOUNT BILL BILL PAYMENT ACCOUNT NUMBER NUMBER DATE NUMBER DUE BALANCE GP09311918 0018277244 5/30/2008 290894 DO NOT PAY ($2,524.65) MAIL PAYMENT TO: PAYER ADDRESS: TRAVELERS CITY OF CARMEL 13607 COLLECTIONS CENTER ATTENTION: B COOK DRIVE CHICAGO, IL 60693 1 CIVIC SQUARE CARMEL IN 46032 19 THIS ACCOUNT HAS A CREDIT BALANCE. PLEASE CONTACT THE ACCOUNTING SPECIALIST LISTED BELOW. POLICY ACCOUNT BILL BILL PAYMENT ACCOUNT NUMBER NUMBER DATE NUMBER DUE BALANCE GP09311918 0018277244 5/30/2008 290894 DO NOT PAY ($2,524.65) ACCOUNT SUMMARY CURRENT CHARGES $0.00 INSURED NAME: CITY OF CARMEL PAST DUE CHARGES $0.00 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS ($2,524.65) AGENT PHONE (317) 817 -5000 TOTAL DUE ($2,524.65) DISPUTED ITEMS $0.00 ACCOUNT BALANCE ($2,524.65) 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: DEDUCTIBLE HELP DESK file: //C: \Documents and Settings \slingelbaugh \Local Settings \Temporary Internet Files \Co... 4/24/2009 Pagel of 2 Q Return DEDUCTIBLE INVOICE (copy) POLICY ACCOUNT BILL BILL PAYMENT TOTAL NUMBER NUMBER DATE NUMBER DUE DUE GP09313908 5216X7087 12/31/2008 308416 1/15/2009 $13,278.15 MAIL PAYMENT TO: PAYER 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 ACCOUNT NUMBER ON YOUR 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 12/31 /2008 308416 1/15/2009 $13,278.15 CURRENT CLAIM A5C4815 DATE OF LOSS: 12/05/2008 DESCRIPTION: IV FORWARD AND HIT OV IN THE REAR. CLAIMANT: JAMES FREMDER LOSS $676.11 CLAIM TOTAL $676.11 CLAIM A8D2199 DATE OF LOSS: 04/24/2008 DESCRIPTION: PER FAX: C STEIN, CHARLOTTE IRON COVER OVER ACCESS HOLE TO WATER P CLAIMANT: CHARLOTTE K STEIN LOSS $1,500.00 CLAIM TOTAL $1,500.00 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 $93.15 fileWCADocuments and Settings \slingelbaugh \Local Settings \Temporary Internet Files \Co... 4/15/2009 Page 2 of 2 CLAIM TOTAL $93.15 CURRENT CHARGES $2 ACCOUNT SUMMARY CURRENT CHARGES $2,269.26 INSURED NAME: CITY OF CARMEL PAST DUE CHARGES $11,008.89 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS $0.00 AGENT PHONE (317) 817 -5000 TOTAL DUE $13,278.15 DISPUTED ITEMS $0.00 ACCOUNT BALANCE $13,278.15 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 file: //C:\Documents and Settings \slingelbaugh \Local Settings \Temporary Internet Files \Co... 4/15/2009 Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 7995) 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)) 03/31/09 317474 DOL: 03/11/2008 $1 5 85.80 03/31/09 317474 DOL: 06/17/2008 $124.30 Total 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 N(U NO. rave Fe r s ALLOWED 20 Collections Center Drive IN SUM OF ChicaCIn,ll 60693 $685.45 ON ACCOUNT OF APPROPRIATION FOR GENERAL FUND 1205 Administration Board Members PO# or D PT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or 1205 290894 47 5 bill(s) is (are) true and correct and that the materials or services itemized thereon for 475 $1,500.00 which charge is made were ordered and 1205 0 received except 1205 317474 475 $124.30 20 S yre Title Cost distribution ledger classification if claim paid motor vehicle highway fund