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