HomeMy WebLinkAbout168843 02/17/2009 CITY OF CARMEL, INDIANA VENDOR: 354565 Page 1 of 1
ONE CIVIC SQUARE ST PAUL TRAVELERS
CARMEL, INDIANA 46032 13607 COLLECTION CENTER CHECK AMOUNT: $2,084.08
ti; Lo CHICAGO IL 60693 CHECK NUMBER: 168843
CHECK DATE: 2/17/2009
DEPA ACC PO NUMB INVO NUM BER AMO UNT DE T
1205 4347500 310862 1,265.00 GENERAL INSURANCE
1205 4347500 311035 819.08 GENERAL INSURANCE
TRM E LERSJ
tl PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
GP09313908 521GX7087 01/30/2009 000311035 02/15/2009 13,421.12
I RRE IT
CLAIM A5C4815 DATE OF LOSS: 12/05/2008
DESCRIPTION: IV FORWARD AND HIT OV IN THE REAR.
CLAIMANT: JAMES FREMDER
LOSS 48.26
CLAIM TOTAL 48.26
CLAIM A5C7394 DATE OF LOSS: 12/22/2008
DESCRIPTION: C- FERRER, EDWARD -IV BACKED OUT OF PARKING SPACE
STRUCK CV.
CLAIMANT: EDWARD J FERRER
VVV LOSS 460.82
CLAIM TOTAL 460.82
CLAIM CES1387 DATE OF LOSS: 06/17/2008
DESCRI PTION: C NELSON, FRANK; HOWELL, KELLY VS CARMEL POLICE DEPT
THIRD PARTY DEF
CLAIMANT: FRANK NELSON
EXPENSE 310.00
CLAIM TOTAL 310.00
CURRENT CHARGES $819.08
Y V I ELERS PAGE 2
DEDUCTIBLE INVOICE
GP09313908 521GX7087 01/30/2009 000311035 02/15/2009 13,421.12
ACCOUNT SUMMARY
CURRENT CHARGES 819.08 INSURED NAME: CITY OF CARMEL
PAST DUE CHARGES 12,602.04 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 13,421.12
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 13,421.12
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
Amk
TRAVELERS JJ PAGE 1
GPO9311918 0018277244 01/30/2009 000310862 02/15/2009 1,265.00
CURRENT
CLAIM 09TO17 DATE OF LOSS: 01/01/2004
DESCRIPTION: CLAIMANT (WILLIS) ALLEGES PHYSICAL, EMOTIONAL
PSYCHOLOGICAL INJURIES S
CLAIMANT: SENSITIVE CLAIM
EXPENSE 1,265.00
CLAIM TOTAL 1,265.00
CURRENT CHARGES $1,265.00
ACCOUNT SUMMARY
CURRENT CHARGES 1,265.00 INSURED NAME: CITY OF CARMEL
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 1,265.00
DISPUTED ITEMS 0.00
ACCOUNT 6ALANCE 1,265.00
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
Travelers Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
311036 DOL: 12105/08, 12/22108, 06117108 01/30/09 $819.08
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
VOUCH ERdR%ffi NO.
St. Paul Traveler ALLOWED 20
1 3607 Collections Center Drive IN SUM OF
Ghieage, 1L 60693
$2,084.08
ON ACCOUNT OF APPROPRIATION FOR
GENERALFUND
1205 Administration
Board Members
PO# or
DEPT INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
41296 475 $819 bill(s) is (are) true and correct and that the
8
materials or services itemized thereon for
1205 310862 475 1,265.00 which charge is made were ordered and
received except
20
$ign t e
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund V