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HomeMy WebLinkAbout176106 08/19/2009 CITY OF CARMEL, INDIANA VENDOR: 354565 Page 1 of 1 ONE CIVIC SQUARE ST PAUL TRAVELERS CHECK AMOUNT: $4,131.26 CARMEL, INDIANA 46032 13607 COLLECTION CENTER off CHICAGO IL 60693 CHECK NUMBER: 176106 CHECK DATE: 8/19/2009 D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AM DESCRIPTION 1120 4347500 326093 1,291.00 GENERAL INSURANCE 7 1205 4347500 326093 2,840.26 GENERAL INSURANCE TRAVELS PAGE i DEDUCTIBLE INVOICE AGENT COPY 1 111 1 1 GP09313908 5216X7087 07/31/2009 000326093 08/15/2009 10,227.96 MAIL PAYMENT TO: AGENT: TRAVELERS HYLANT GROUP INC 13607 COLLECTIONS CENTER DRIVE PO BOX 40925 CHICAGO, IL 60693 INDIANAPOLIS IN 46280 -0925 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. 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. '1 1 1 1 1 1 1 1 1aLLILLY 1 1111 1 1 GPO9313908 521GX7087 07/31/2009 000326093 08/15/2009 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 P6 Ce �e� LOSS 1,862.36 CLAIM TOTAL 1,882.36 CLAIM AGN3773 DATE OF LOSS: 04/15/2009 DESCRIPTION: C- STAHLY, CRAIG FLUSING OF WATER LINES LEAD TO OVER PRESSURE EVENT CAU CLAIMANT: DON BURFEIND to Tl 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 Po lice 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 CHARGES $5,088.28 TRAVELERS PAGE 2 DEDUCTIBLE INVOICE GPO9313908 5216X7087 07/31/2009 000326093 08/15/2009 10,227.96 ACCOUNT SUMMARY CURRENT CHARGES 5,088.26 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN 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 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 Travelers Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 1-1 DOL: 05/18/2009 ,862.36 07/31/0 Total 1 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 N9 8 11 7109 WAR RANT NO. St 'rte- rte- 21 laj' TIFF =l.- ALLOWED 20 Dri ve IN SUM OF Chic IL 60693 $2,840.26 ON ACCOUN&PNtWA JP�N6N FOR 1205 Administration Board Members PO# or DEPT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or 93 475 $1,862.36 bill(s) is (are) true and correct and that the 1205 materials or services itemized thereon for 90 which charge is made were ordered and received except 20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund 08111/2009 16.23 #078 P.001/001 9 RAVELERS i PAGE 1 DEDUCTIBLE INVOICE AGENT COPY 1 1 1 1 1 1 GP09313908 5216X7067 07/31/2009 000326093 08/15/2009 10,227.96 MAIL PAYMENT TO: AGENT: TRAVELERS HYLANT GROUP INC 13607 COLLECTIONS CENTER DRIVE PO BOX 40925 CHICAGO, IL 60693 INDIANAPOLIS IN 46280 -0925 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS, PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK, TRAVELERS PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. 1 1 1 1 1 GPO9313908 5216X7087 07/31/2009 000326093 08/15/2009 10,227.96 CURRENT CLAIM A5E1516 DATE OF LOSS: 05/18/2009 DESCRIPTION: PER FAX C- SNYDER, MARY ELLEN -IV CV WERE STOPPED IN TRAFFIC 6 IVD THO CLAIMANT: MARY -ELLEN SNYDER P6�lCe ��f LOSS 1,862.36 CLAIM TOTAL 1,882.36 CLAW: A043773 DATE OF LOSS: 04/15/2009 DESCRIPTION: C- STAHLY, CRAIG FLUSING OF WATER LINES LEAD TO OVER PRESSURE EVENT CAU u+L It 41 c�s CLAIMANT: DON BURFEIND LOSS 957.00 CLAIM TOTAL 967.00 CLAIM CES0074 DATE OF LOSS: 03/11/2008 DESCRIPTION: C BELL, LOGAN ALLEGATIONS THAT CPD TOOK UNREASONABLE ACTIONS IN LIEU Po It Gci CLAIMANT: LOGAN BELL EXPENSE 977,80 CLAIM TOTAL 977.90 CLAIM CES0118 DATE OF LOSS: 01/06/2008 DESCRIPTION: C HOFF. MARGARET. CLMNT WAS FOUND UNRESPONSIVE CARMEL FIRE DEPT RE Ki CLAIMANT: MARGARET C HDFF re EXPENSE 11291.00 CLAIM TOTAL 1,291.00 CURRENT CHARGES $5,088.28 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)) $1,291.00 1 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. WARRAN N ALLOWED 20 Travblers IN SUM OF 13607 Collections Center Drive Chicago, IL 60693 $1,291.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 43- 475.00 $1,291.00 I hereby certify that the attached invoice(s), or 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 AUG 17 2009 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund