HomeMy WebLinkAbout177976 10/13/2009 CITY OF CARMEL, INDIANA VENDOR: 354565 Page 1 of 1
ONE CIVIC SQUARE ST PAUL TRAVELERS
I CHECK AMOUNT: $8,526.32
CARMEL, INDIANA 46032 13607 COLLECTION CENTER
CHICAGO IL 60693 CHECK NUMBER: 177976
CHECK DATE: 10/1312009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION,
1205 4347500 330916 8,526.32 GENERAL INSURANCE
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DEDUCTIBLE INVOICE
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GP09311918 0018277244 09/30/2009 000330916 10/15/2009 8,526.32
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL
13607 COLLECTIONS CENTER DRIVE ATTENTION: B COOK
CHICAGO, IL 60693 1 CIVIC SQUARE
CARMEL IN 46032
RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS.
PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK.
TRAVELERS PAGE 1
GP09311918 0018277244 09/30/2009 000330916 10/15/2009 8,526.32
CURRENT
CLAIM#: CAW2701 DATE OF LOSS: 08/14/2005
DESCRIPTION: LORI MCCANN -CLMT FILED SUIT PAPERS AGAINST INSD /INSD
EMPLOYEES
CLAIMANT: LORI MCCANN
Gib EXPENSE 8,526.32
CLAIM TOTAL 8,526.32
CURRENT CHARGES $8,526.32
ACCOUNT SUMMARY
CURRENT CHARGES 8,526.32 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 8,526.32
__DISPUTED ITEMS 0.00
ACCOUNT BALANCE 8,526.32
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
PrescribeNby 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))
3Z.
Total 32
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
IN SUM OF
?e69-3
ON ACCOUNT OF APPROPRIATION FOR
1 Z�5 G e,veCa� v11
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1 S2L- 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
ASianat
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund