The URL can be used to link to this page

Home My WebLink About178594 10/28/2009 f CITY OF CARMEL, INDIANA VENDOR: 354565 Page 1 of 1 ONE CIVIC SQUARE ST PAUL TRAVELERS CHECK AMOUNT: $139.70 CARMEL, INDIANA 46032 13607 COLLECTION CENTER o� CHICAGO IL 60693 CHECK NUMBER: 178594 s CHECK DATE: 10/28/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4347500 324870 139.70 GENERAL INSURANCE Page 1 of 2 r Return DEDUCTIBLE INVOICE (copy) POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE GP09313908 5216X7087 6/30/2009 324870 7/15/2009 $9,476.29 MAIL PAYMENT TO: PAYER ADDRESS: TRAVELERS CITY OF CARMEL; CARMEL CLAY PARKS 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. X d THIS ACCOUNT IS SCHEDULED TO GO TO A COLLECTION AGENCY IF PAYMENT IS NOT RECEIVED ON OR BEFORE THE DUE DATE. POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE GP09313908 5216X7087 6/30/2009 324870 7/15/2009 $9,476.29 CURRENT CLAIM A3T2823 DATE OF LOSS: 05/20/2009 DESCRIPTION: C GARLING, RENEE IV N ON 1 ST AVE NW PREPARING TO DRIVE ACROSS THE ST CLAIMANT: RENEE GARLING LOSS $2,495.59 CLAIM TOTAL $2,495.59 CLAIM CES0074 DATE OF LOSS: 03/11/2008 DESCRIPTION: C BELL, LOGAN ALLEGATIONS THAT CPD TOOK UNREASONABLE ACTIONS IN LIEU CLAIMANT: LOGAN BELL EXPENSE $469.90 CLAIM TOTAL $469.90 file: /C: \Documents and Settings \dbristow \Local Settings \Temporary Internet Files \OLK71 \GP09313908 J... 10/16/2009 Page 2 of 2 CLAIM CES0119 DATE OF LOSS: 01/06/2008 DESCRIPTION: C HOFF, MARGARET. CLMNT WAS FOUND UNRESPONSIVE CARMEL FIRE DEPT RE CLAIMANT: MARGARET C HOFF EXPENSE $139.70 CLAIM TOTAL $139.70 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 $139.70 CLAIM TOTAL $139.70 CURRENT CHARGES $3,244.89 ACCOUNT SUMMARY CURRENT CHARGES $3,244.89 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDII` PAST DUE CHARGES $9,113.20 AGENT NAME: HYLANT GROUP INC UNAPPLIED I PAYMENTS ($2,881.80) AGENT PHONE: (317) 817 -5000 TOTAL DUE $9,476.29 DISPUTED ITEMS $0.00 ACCOUNT BALANCE $9,476.29 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 file: /C: \Documents and Settings \dbristow \Local Settings \Temporary Internet Files \OLK71 \GP09313908 J... l0 /l6 /2009 TRAVELERS J PAGE 2 4 DEDUCTIBLE INVOICE GP09313908 521GX7087 09/30/2009 000331097 10/15/2009 11,667.47 CURRENT CLAIM CES0119 DATE OF LOSS: 01/06/2008 DESCRIPTION: C HOFF, MARGARET. CLMNT WAS FOUND UNRESPONSIVE CARMEL FIRE DEPT RE CLAIMANT: MARGARET C HOFF EXPENSE 12.70 CLAIM TOTAL 12.70 CLAIM CES1387 DATE OF LOSS: 06/17/2008 DESCRIPTION: C NELSON, FRANK; HOWELL, KELLY VS CARMEL POLICE DEPT THIRD PARTY DEF CLAIMANT: FRANK NELSON c- EXPENSE 50.80 CLAIM TOTAL 50.80 CURRENT CHARGES $3,067.98 ACCOUNT SUMMARY CURRENT CHARGES 3,067.98 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 8,599.49 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000 TOTAL DUE 11,667.47 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 11 667.47 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) $12.70 $139.70 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. WARRANT NO. ALLOWED 20 Travelers IN SUM OF 13607 Collections Center Drive Chicago, IL 60693 $152.40 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 43- 475.00 $12.70 1 hereby certify that the attached invoice(s), or 1120 43- 475.00 $139.70 bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and J� received except Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund