HomeMy WebLinkAbout167767 01/20/2009 CITY OF CARMEL, INDIANA VENDOR: 354565 Page 1 of 1
0 ONE CIVIC SQUARE ST PAUL TRAVELERS
CARMEL, INDIANA 46032 13607 COLLECTION CENTER CHECK AMOUNT: $6,217.40
CHICAGO IL 60693
CHECK NUMBER: 167767
CHECK DATE: 1/20/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 308238 5,541.29 GENERAL INSURANCE
1205 4347500 308416 676.11 GENERAL INSURANCE
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TR- AVFLERS^J PAGE
DEDUCTIBLE INVOICE
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GP 5216X7087 12/31/2008 000308416 01/15/2009 13,278.15
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.
TRAVELERS PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
GPO9313908 521GX7087 12/31/2008 000308416 01/15/2009 13,278.15
CURRENT
A5C485 DATE OF LOSS: 12/05/2008
DESCRI PTION: C e
DESCRIPTION: IV FO AND HIT OV IN THE REAR. y
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 1���
HOLE TO WATER P 1 J w'
CLAIMANT: CHARLOTTE K STEIN
LOSS 1,500.00 J
-CLAIM TOTAL 1 500.00 J
CIAIM "7CES0119... DATE OF LOSS: 01106/2008
DESCRIPTION: C HOFF, MARGARET. CLMNT WAS FOUND UNRESPONSIVE
CARMEL FIRE DEPT RE
CLAIMANT: MARGARET C HOFF �i\
EXPENSE 93.15
CLAIM TOTAL 93.15
CURRENT CHARGES $2 269.26
TF�AVELERS J PAGE 2
DEDUCTIBLE INVOICE
G909313908 521GX7087 12/31/2008 000308416 01/15/2009 13,278.15
S
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
TRAVELERS J PAGE 1
DEDUCTIBLE INVOICE
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GP09311918 0018277244 12/31/2008 000308238 01/15/2009 5,541.29
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MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL
13607 COLLECTIONS CENTER DRIVE ATTENTION: B COOK
CHICAGO, IL 60693 1 CIVIC SQUARE
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
GP09311918 0018277244 12/31/2008 000308238 01/15/2009 5,541.29
Q-�- CURRENT
CLAIM CAW2701 DATE OF LOSS: 08/14/2005
DESCRIPTION: LORI MCCANN -CLMT FILED SUIT PAPERS AGAINST INSD /INSD 1
EMPLOYEES
CLAIMANT: LORI MCCANN
EXPENSE 5,541.29
CLAIM TOTAL 5,541.29
CURRENT CHARGES $5,541.29
ACCOUNT SUMMARY
CURRENT CHARGES 5,541.29 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 5,541.29
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 5,541.29
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
•'+'rescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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))
12/31/Od 308416 D
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 rM./I618g_WARRA T O.
au Traveler's
ALLOWED 20
13607 Collections Center Drive IN SUM OF
rrhicago 1 L 60693
$6,217.40
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 29 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
1205 30 475 $676.11 which charge is made were ordered and
received except
20
S natur
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund