HomeMy WebLinkAbout178593 10/28/2009 CITY OF CARMEL, INDIANA VENDOR: 354565 Page 1 of 1
ONE CIVIC SQUARE ST PAUL TRAVELERS CHECK AMOUNT: $5,000.00
CARMEL, INDIANA 46032 13607 COLLECTION CENTER
CHICAGO IL 60693 CHECK NUMBER: 178593
CHECK DATE: 10/28/2009
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
'651 5023990 324846 5,000.00 DEDUCTIBLE
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DEDUCTIBLE INVOICE
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GP09309872 0018277203 06/30/2009 000324846 07/15/2009 5,000.00
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL
13607 COLLECTIONS CENTER DRIVE 1 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.
TRAVEL EX'S) PAGE 1
THIS ACCOUNT IS SCHEDULED TO GO TO A COLLECTION AGENCY
IF PAYMENT IS NOT RECEIVED ON OR BEFORE THE DUE DATE.
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GP09309872 0018277203 06/30/2009 000324846 07/15/2009 5,000.00
ACCOUNT SUMMARY
CURRENT CHARGES 0.00 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 5,000.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 5
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 5
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
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Prescribed by State Board of Accounts City Form No. 201 (Rev 1995) 47
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
362876
TRAVELERS Purchase Order No.
13607 COLLECTIONS CENTER DRIVE Terms
CHICAGO, IL 60693 Due Date 7/28/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/28/2009 324846 $5,000.00
hereby certify that the attached invoice(s), or bill(s) is (are) true and
orrect and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Officer
VDUCHER 096112 WARRANT ALLOWED
h�2£s IN SUM OF
TRAVELERS'
13607 COLLECTIONS CENTER DRIVE
CHICAGO, IL 60693
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
324846 01- 7570 -01 $5,000.00
Voucher Total $5,000.00
Cost distribution ledger classification if
claim paid under vehicle highway fund