HomeMy WebLinkAbout178595 10/28/2009 CITY OF CARMEL, INDIANA VENDOR: 354565 Page 1 of 1
ONE CIVIC SQUARE ST PAUL TRAVELERS
CHECK AMOUNT: $957.00
CARMEL, INDIANA 46032 13607 COLLECTION CENTER
CHICAGO IL 60693 CHECK NUMBER: 178595
CHECK DATE: 10/28/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 326093 957.00 INSURANCE
1
Page 1 of 2
F R etu
DEDUCTIBLE INVOICE (copy)
POLICY ACCOUNT BILL BILL PAYMENT TOTAL
NUMBER NUMBER DATE NUMBER DUE DUE
GP09313908 5216X7087 7/31/2009 326093 8/15/2009 $10,227.96
MAIL PAYMENT TO: PAYER ADDRESS:
TRAVELERS CITY OF CARMEL; CARMEL CLAY PARKS
13607 COLLECTIONS CENTER ONE CIVIC SQUARE
DRIVE
CHICAGO, IL 60693 CARMEL IN 46032
RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRA VELERS.
PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK.
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
POLICY ACCOUNT BILL BILL PAYMENT TOTAL
NUMBER NUMBER DATE NUMBER DUE DUE
GP09313908 5216X7087 7/31/2009 326093 8/15/2009 $10,227.96
CURRENT
CLAIM A5E1515 DATE OF LOSS: 05/18/2009
DESCRIPTION: PER FAX -C- SNYDER, MARY ELLEN -IV CV WERE STOPPED
IN TRAFFIC IVD THO
CLAIMANT: MARY -ELLEN SNYDER LOSS $1,862.36
CLAIM TOTAL $1,862.36
CLAIM A6N3773 DATE OF LOSS: 04/15/2009
DESCRIPTION: C- STAHLY, CRAIG FLUSING OF WATER LINES LEAD TO
OVER PRESSURE EVENT CAU
CLAIMANT: DON BURFEIND LOSS $957.00
CLAIM TOTAL $957.00
CLAIM CES0074 DATE OF LOSS: 03/11/2008
DESCRIPTION: C BELL, LOGAN ALLEGATIONS THAT CPD TOOK
UNREASONABLE ACTIONS IN LIEU
file://C: \Documents and Settings \lkempa \Local Settings \Temporary Internet Files \OLK11... 10/15/2009
Page 2 of 2
CLAIMANT: LOGAN BELL EXPENSE $977.90
CLAIM TOTAL $977.90
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 $1,291.00
CLAIM TOTAL $1,291.00
CURRENT $5,088.26
CHARGES
ACCOUNT SUMMARY
CURRENT CHARGES $5,088.26 INSURED NAME: CITY OF CARMEL,CARMEL CLAY F
PAST DUE CHARGES $5,139.70 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS $0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE $10,227.96
DISPUTED ITEMS $0.00
ACCOUNT BALANCE $10,227.96
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO
YOUR POLICY OR DEDUCTIBLE COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-
HELPDESK*TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-800-356-4098 EXT. 08900:
ANTONIO CONTRERAS
file:HC:\Documents and Settings\lkempa\Local Settings\Temporary Internet Files\OLKI I... 10/15/2009
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
R
Payee
T2291
TRAVELERS Purchase Order No.
13607 COLLECTIONS CENTER DRIVE Terms
CHICAGO, IL 60693 Due Date 10/23/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/23/200$ A6N3773 $957.00
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
VOUCHER 093416 WARRANT ALLOWED
T2291 IN SUM OF
TRAVELERS
13607 COLLECTIONS CENTER DRIVE
CHICAGO, IL 60693
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
6
A6N3773 01- 675606 $957.00
Voucher Total $957.00
Cost distribution ledger classification if
claim paid under vehicle highway fund