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Home My WebLink About168324 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 354565 Page 1 of 1 r ONE CIVIC SQUARE ST PAUL TRAVELERS CHECK AMOUNT: $12,008.78 CARMEL, INDIANA 46032 13607 COLLECTION CENTER CHICAGO IL 60693 CHECK NUMBER: 168324 CHECK DATE: 2/4/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NU AMOUNT DESCRIPTION 1046 4358400 A9Q9 2,008.78 REFUNDS AWARDS INDE _1046 4358400 FZT0568 5,000.00 REFUNDS AWARDS INDE 1047 4358400 FZT6305 5,000.00 REFUNDS AWARDS INDE I TRAVELERS J PAGE 1 DEDUCTIBLE INVOICE GP09313 521GX7087 07/31/2008 000295873 08/15/2008 10,494.66 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL 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_ �RM LER S J �`-i l VP�� 1 AUG 0 6 2000 THE TOTAL DUE INCLUDES PAST DUE CHARGES. BY. g X02 PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY: GP09313908 521GX7087 07/31/2008 000295873 08/15/2008 10,494.66 CURRENT CLAIM A6P4648 DATE OF LOSS: 03/04/2008 DESCRIPTION: SALT TRUCK SLID OFF ROAD AND HIT A TELEPHONE POLE CLAIMANT: /IN PO LOSS 5,425.45 TOTAL 5,425.45 CLAIM A909599 DATE OF LOSS: 03/14/2008 0 DESCRIPTION: C NICHOLAS CHILD AGE 8 WAS CLIMBING ON OR UNDER A CAFETERIA T CLAIMANT: NICHOLAS LYNEM LOS'S' 2,:008.78 CLAIM TOTAL 2,008.78 CURRENT CHARGES $7,:434.23 ACCOUNT SUMMARY CURRENT CHARGES 7,434.23 INSURED NAME: CITY OF CARMEL PAST 'DUE CHARGES 3,060.43 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000 TOTAL DUE 10 494.66 DISPUTED. ITEMS 0,00 ACCOUNT BALANCE 10,494.66 CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE COVERAGE. FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE HELPDESK @STPAULTRAVELERS.COM OR CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-800 -356 -4098 EXT. 08900.: JULIE HUPPERT Purchase Se� e r.�2hfi Description m P.O. N /R i ParF c.L.# /o41(0-- 1 j-/v Line D escr e ?urchaser nproval 8 6 T RAVELERS J PAGE 1 DEDUCTIBLE INVOICE G 0 09313908 521GX7087 11/26/2008 000305836 12/15/2008 11,372.53 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL 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 AVELERSJ PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. IL GPO9313908 521GX7087 11/26/2008 000305836 12/15/2008 11,372.53 CURRENT CLAIM ASQ8415 DATE OF LOSS: 01/09/2006 DESCRIPTION: ON 1/9/2006 DEFENDENT'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 RE11v` CLAIMANT: MARGARET C HOFF EXPENSE 843.20 CLAIM TOTAL 843.20 j CLAIM FZP0593 DATE OF LOSS: 09!26/2008 DESCRIPTION: C- STARR, BARBARA IV STRUCK A PARKED UNOCCUPIED VEH WHILE BACKING OUT CLAIMANT: BARBARA STARR LOSS 97.64 CLAIM TOTAL 97.64 CLAIM FZTO568 DATE OF LOSS: 03/08/2007 DESCRIPTION: C PANKRATZ, JACK INSD OPERATES AFTER SCHOOL PROGRAM CHERRY TREE E CLAIMANT: JACK PANKRATZ LOSS 5,000.00 CLAIM TOTAL 5,000.00 Pu/Chaft CURRENT CHARGES $5,206.84 p*m To r 4 J 1 1 W Gill m.L. t 8� Bud at Line Desar Purchaser Date qp Date rage i of L Refurn DEDUCTIBLE INVOICE (copy) POLICY ACCOUNT BILL BILL PAYMENT TOTAL NUMBER NUMBER DATE NUMBER DUE DUE GP09313908 5216X7087 5/30/2008 291088 6/15/2008 $8,216.37 MAIL PAYMENT TO: PAYER ADDRESS: TRAVELERS CITY OF CARMEL 13607 COLLECTIONS CENTER ONE CIVIC SQUARE DRIVE JAN 2 9 2009 CHICAGO, IL 60693 CARMEL IN 46032 LLY: RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK. POLICY ACCOUNT BILL BILL PAYMENT TOTAL NUMBER NUMBER DATE NUMBER DUE DUE GP09313908 5216X7087 5/30/2008 291088 6/15/2008 $8,216.37 CURRENT CLAIM A8G7712 DATE OF LOSS: 02/06/2008 DESCRIPTION: IV WAS ON OFF RAMP AND REAR -END OV CLAIMANT: BENJAMIN FOULKE LOSS $206.37 CLAIM TOTAL $206.37 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 $3,010.00 CLAIM TOTAL $3,010.00 CLAIM FZT6305 DATE OF LOSS: 08/03/2007 DESCRIPTION: PER FAX: C- ROBINSON, CARLISLE CLMT INTERVIEWED FOR A POSITION AS A LIF CLAIMANT: CARLISLE A ROBINSON LOSS $5,000.00 CLAIM TOTAL $5,000.00 CURRENT CHARGES $8,216.37 file://C:\Documents and Settings \pschlemmer \Local Settings \Temporary Internet Files \Con... 1/29/2009 Page 2 of 2 ACCOUNT SUMMARY CURRENT CHARGES $8,216.37 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 $8,216.37 DISPUTED ITEMS $0.00 ACCOUNT BALANCE $8,216.37 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 HUPPERT file:HC:\Documents and Settings \pschlemmer \Local Settings \Temporary Internet Files \Con... 1/29/2009 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. Terms Travelers 13607 Collections Center Drive Chicago, IL 60693 Invoice Invoice Description Date Number or note attached invoices) or bill(s)) Amount 2,008.78 7/31/08 A9Q9599 3/14/08 Date of loss Tort claim Lynem 5 000.00 11/26/08 FZT0568 3/8/07 Date of loss tort claim Pankratz 5,000.00 5/31%08 FZT6305 8/3/07 Date of loss tort claims Robinson Total 12,008.78 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 1 20_ Clerk- Treasurer Voucher No. Warrant No. I Travelers Allowed 20 13607 Collections Center Drive Chicago, IL 60693 In Sum of 12,008.78 ON ACCOUNT OF APPROPRIATION FOR 104 Program Fund PO# or Board Members Dept INVOICE NO. ACCT #MTLE AMOUNT 1046 A9Q9599 4358400 2,008.78. 1 hereby certify that the attached invoice(s), or 1046 FZT0568' 4358400 5,000.00 bill(s) is (are) true and correct and that the 1047 FZT6305 4358400 5,000.00 materials or services itemized thereon for which charge is made were ordered and received except 2 -Feb 2009 Signature 12,008.78 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund