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Home My WebLink About169742 03/17/2009 CITY OF CARMEL, INDIANA VENDOR: 354565 Page 1 of 1 ONE CIVIC SQUARE ST PAUL TRAVELERS O t CHECK AMOUNT: $2,568.18 CARMEL, INDIANA 46032 13607 COLLECTION CENTER CHICAGO IL 60693 CHECK NUMBER: 169742 CHECK DATE: 3/17/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4347500 314936 530.18 GENERAL INSURANCE 1205 4347500 314936 2,038.00 GENERAL INSURANCE I i T� ?A` LERS J� PAGE 1 THIS ACCOUNT IS SCHEDULED TO GO TO A COLLECTION AGENCY IF PAYMENT IS NOT RECEIVED ON OR BEFORE THE DUE DATE. GP09313908 5216X7087 02/27/2009 000314936 03/15/2009 3,161.44 CURRENT CLAIM A5C6810 DATE OF LOSS: 12/18/2008 Sk (LCJ DESCRIPTION: PER CLAIM A5C5410: IV SLID OFF ROAD AND STRUCK TREE DURING ICY CONDITI CLAIMANT: ED DALTON LOSS 1,100.00 CLAIM TOTAL 1,100.00 CLAIM A5C9306 DATE OF LOSS: 12/18/2008 DESCRIPTION: PER CLAIM A5C8629: FIRE ENGINE ON AN EMERGENCY RUN n SLID ON THE ICE A�`(� CLAIMANT: TOM MCF_LMURRY LOSS 468.18 CLAIM TOTAL 468.18 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 938.00 CLAIM TOTAL 938.00 CLAIM CES0119 DATE OF LOSS: 01/06/2008 DESCRIPTION: C HOFF, MARGARET. CLMNT WAS FOUND UNRESPONSIVE CARMEL FIRE DEPT RE CLAIMANT: MARGARET C HOFF \1_� EXPENSE 62.00 CLAIM TOTAL 62.00 CURRENT CHARGES $2,568.18 L TRAVELERS J PAGE 2 DEDUCTIBLE INVOICE GP09313908 521GX7087 02/27/2009 000314936 03/15/2009 3,161.44 ACCOUNT SUMMARY CURRENT CHARGES 2,568.18 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 3,161.44 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 3,161.44 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) �a 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 Traveler Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 09197/nci 314936 DOL: 12118/08, 01/09106 ,038.00 Total 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 'n,/161A9_WARRANT NO. aul Traveler's ALLOWED 20 IN SUM OF 13607 Collections Center Drive Ghir--age, IL 60693 $2,038.00 ON ACCOUNT OF APPROPRIATION FOR GENERAL FUND 1205 Administration Board Members PO# or DEPT INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or 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 J �Sig(lature 1 tt Title Cost distribution ledger classification if claim paid motor vehicle highway fund T J PAGE 1 DEDUCTIBLE INVOICE i w5u MIA i' GP09313908 521GX7087 02/27/2009 000314936 03/15/2009 3.161.44 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. GP09313908 521GX7087 02/27/2009 000314936 03/15/2009 3,161.44 CURRENT CLAIM#: A5C6810 DATE OF LOSS: 12/18/2008 y\(Q DESCRIPTION: PER CLAIM A5C5410: IV SLID OFF ROAD AND STRUCK TREE DURING ICY CONDITI CLAIMANT: ED DALTON LOSS 1,100.00 CLAIM TOTAL 1,100.00 CLAIM#: A5C9306 DATE OF LOSS: 12/18/2008 DESCRIPTION: PER CLAIM A5C8629: FIRE ENGINE ON AN EMERGENCY RUN SLID ON THE ICE A CLAIMANT: TOM MCELMURRY LOSS 468.18 CLAIM TOTAL 468.18 CLAIM#: ASQ6415 DATE OF LOSS: 01/09/2006 DESCRIPTION: ON 1 /D6WDEFECDENT'S TERMINATED PLANTIFF FROM HIS EMPLOYMENT CLAIMANT: JOHN NIKOLOFF EXPENSE 938.00 CLAIM TOTAL 938.00 CLAIM#: CES0119 DATE OF LOSS: 01/06/2008 DESCRIPTION: C HOFF, MARGARET. CLMNT WAS FOUND UNRESPONSIVE CARMEL FIRE DEPT RE CLAIMANT: MARGARET C HOFF \ZQl EXPENSE 62.00 CLAIM TOTAL 62.00 CURRENT CHARGES $2,568.18 TRAVELER! J PAGE 2 DEDUCTIBLE INVOICE 6P09313908 521GX7087 02/27/2009 000314936 03/15/2009 3,161.44 ACCOUNT SUMMARY CURRENT CHARGES 2,568.18 INSURED NAME: CITY OF CARMEL.CARMEL CLAY PARKS BUILOIN PAST DUE CHARGES 593.26 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000 TOTAL DUE 3,161.44 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 3,161.44 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 (Re• 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)) CES0119 EMS Run $62.00 A5C9306 Mailbox Damage $468.18 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 VOU NO. WARRA N ALLOWED 20 Travelers IN SUM OF 13607 Collections Center Drive Chicago, IL 60693 $530.18 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 CES0119 43- 475.00 $62.00 1 hereby certify that the attached invoice(s), or 1120 A5C9306 43- 475.00 $468.18 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 MAR 19 7 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund