HomeMy WebLinkAbout178019 10/14/2009 CITY OF CARMEL, INDIANA VENDOR: 354565 Page 1 of 1
ONE CIVIC SQUARE ST PAUL TRAVELERS
CARMEL, INDIANA 46032 13607 COLLECTION CENTER CHECK AMOUNT: $11,654.77
CHICAGO IL 60693
CHECK NUMBER: 178019
CHECK DATE: 10/14/2009
DEPA RTMENT ACCOUNT PO NUMBER I NVOICE NUMBER AM OUNT DESC
J 1205 4347500 11,654.77 GENERAL INSURANCE
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TAV'E LERS I PAGE 1
DEDUCTIBLE INVOICE
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GP09313908 521GX7087 09/30/2009 000331097 10/15/2009 11,667.47
MAIL PAYMENT TO: PAYER:
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 PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK.
TRAVELERS J PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
GP09313908 521GX7087 09/30/2009 000331097 10/15/2009 11,667.47
CURRENT
CLAIM A4P0980 DATE OF LOSS: 09/28/2007
DESCRIPTION: C FLYNN, MICHAEL POLICE OFFICER FILING CHARGES
AGAINSTCITY HIS EMPLO
CLAIMANT: MICHAEL FLYNN
EXPENSE 1,554.00
CLAIM TOTAL 1,554.00
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CLAIM A5E5425 DATE OF LOSS: 08/20/2009
DESCRIPTION: IV LOOK.DOWN FOR A SECOND WHEN LOOK UP TRAFFIC WAS
STOP AND R/E OV
CLAIMANT: DAVID THOMAS G.
LOSS 422.51
CLAIM TOTAL 422.51
CLAIM AGN6445 DATE OF LOSS: 07/30/2009
DESCRIPTION: PER FAX: C ZULOAGA, ALEJANDRO STREET DEPT MOWING AND
DEBRIS FLEW ONT
CLAIMANT: ALEJANDRO ZULOAGA"
LOSS 977.17
CLAIM TOTAL 977.17
CLAIM CES0074 DATE OF LOSS: 03/11/2008
DESCRIPTION: C BELL, LOGAN ALLEGATIONS THAT CPD TOOK UNREASONABLE
ACTIONS IN LIEU
CLAIMANT: LOGAN BELL
Q/ EXPENSE 50.80
CLAIM TOTAL 50.80
TRAVELERSJ PAGE 2
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
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Prescribed 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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
3� o� 0 ,0033• I� GS'� 27
Total
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. L z WARRANT NO.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
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Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
Z�S �-33 0 97 ►1 L5q 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
SFgna ur
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund