HomeMy WebLinkAbout179063 11/10/2009 CITY OF. CARMEL, INDIANA VENDOR: 354565 Page 1 of 1
ONE CIVIC SQUARE ST PAUL TRAVELERS CHECK AMOUNT: $20,597.50
CARMEL, INDIANA 46032 13607 COLLECTION CENTER
CHICAGO IL 60693
CHECK NUMBER: 179063
CHECK DATE: 11/10/2009
DEPARTMENT ACCOUNT PO NUMB INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 333554 20,597.50 GENERAL INSURANCE
IRAVELERS J' ,4 PAGE 1
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DEDUCTIBLE INVOICE
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GP09313908 5216X7087 10/30/2009 000333554 11/15/2009 41,964.02
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL; CARMEL CLAY PARKS
13607 COLLECTIONS CENTER DRIVE ONE CIVIC SQUARE
CHICAGO, IL 60693 CARMEL IN 46032
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RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. "I� AIf11i to U �(fo(j
PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK. u U a
BY 0
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TRAVELERS J� PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
GP093i3908 5216X7087 10/30/2009 000333554 11/15/2009 41,964.02
CURRENT
CLAIM CES0074 DATE OF LOSS: 03/11/2008
DESCRIPTION: C BELL, LOGAN ALLEGATIONS THAT CPD TOOK UNREASONABLE
ACTIONS IN LIEU
CLAIMANT: LOGAN BELL
LOSS 20,201.10
CLAIM TOTAL 20,201.10
'CLAIM CES0119 DATE OF LOSS: 01/06/2008
DESCRIPTION: C HOFF, MARGARET. CLMNT WAS FOUND UNRESPONSIVE
CARMEL FIRE DEPT RE
CLAIMANT: MARGARET C HOFF
LOSS 20,652.85
CLAIM TOTAL 20,652.85
CLAIM CES1387 DATE OF LOSS: 06/17/2008
DESCRIPTION: C NELSON, FRANK; HOWELL, KELLY VS CARMEL POLICE DEPT
THIRD PARTY DEF
CLAIMANT: FRANK NELSON
EXPENSE 396.40
CLAIM TOTAL 396.40
CLAIM CES3623 DATE OF LOSS: 09/02/2009
DESCRIPTION: C GLOBE TRANSPORT DRIVER OF AMBULANCE REAR ENDED THE
OV WHEN SHE MAD
CLAIMANT: /GLOBE TRANSPORT INC
LOSS 700.97
CLAIM TOTAL 700.97
CURRENT CHARGES $41,951.32
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TRAVELERS
NON- FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
39019
CITY OF CARMEL; CARMEL CLAY PARKS
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS J7 PAGE 2
DEDUCTIBLE INVOICE
GP09313908 521GX7087 10/30/2009 000333554 11/15/2009 41,964.02
ACCOUNT SUMMARY
CURRENT CHARGES 41,951.32 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 12.70 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 41,964.02
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 41,964.02
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE- HELPDESK @TRA�IELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1- 800 356 -4098 EXT. 08900: ANTONIO CONTRERAS
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
I (�•ve� -SS Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
�0 3 i t ��o3s355� �o \icy C1G�>^�1 vN1 ZJ '59 SJ
Total c r 7. 5D
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. 1\ WARRANT NO.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
jZ 3-->o3 n3s5 4 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
ig tuts
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund