The URL can be used to link to this page

Home My WebLink About207353 03/26/2012 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1 z ONE CIVIC SQUARE TRAVELERS CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $23,570.24 CHICAGO IL 60693 CHECK NUMBER: 207353 CHECK DATE: 3/26/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 404071 13,941.80 GENERAL INSURANCE 1205 4347500 404157 7,508.80 GENERAL INSURANCE 1205 4347500 404674 2,119.64 GENERAL INSURANCE TRAVELERS) PAGE 1 DEDUCTIBLE SELF INSURED INVOICE 1 1 I 1 1 GP09315757 5216X7087 02/29/2012 000404167 03/15/2012 7,508.80 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL, CARMEL CLAY PARKS BUILD 13607 COLLECTIONS CENTER DRIVE ONE CIVIC SQUARE CHICAGO, IL 60693 CARMEL IN 46032 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK. AIM TR VELERS PAGE 1 12 1 14 1 1 I 1 I GP09315757 521GX7087 02/29/2012 000404167 03/15/2012 7,508.80 CURRENT CLAIM CES9583 DATE OF LOSS: 10/17/2011 DESCRIPTION: C CRIDER CRIDER INC. V HAGERMAN CONST, CITY OF CARMEL, REDEVELOPME CLAIMANT: CRIDER AND CRIDER !l "C3 EXPENSE 3,864.00 CLAIM TOTAL 3,864.00 CLAIM#: EPS2377 DATE OF LOSS: 02/19/2011 DESCRIPTION: C- PARK,GREG VS CITY OF CARMEL POLICE MERIT BOARD. COMPLAINT FILED AGAI CLAIMANT: GREG PARK`' EXPENSE 2,425.20 CLAIM TOTAL 2,425.20 CLAIM EQR4757 DATE OF LOSS: 06/13/2011 DESCRIPTION: C MYERS, TERRY ALLEGATION OF DISCRIMINATION DUE TO AGE. EEOC COMPLAI CLAIMANT: TERRY D MYERS EXPENSE 1,219.60 CLAIM TOTAL 1,219.60 CURRENT CHARGES $7,508.80 ACCOUNT SUMMARY CURRENT CHARGES 7,508.80 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 7,508.80 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 7,508.80 CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR 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 TRAVELERS NON- FUNDED DEPARTMENT ONE TOWER SQUARE -9MN HARTFORD, CT 06183 39139 CITY OF CARMEL, CARMEL CLAY PARKS BUILD ONE CIVIC SQUARE CARMEL IN 46032 a 0 a 0 0 0 N O Q O t o TRAVELERS J PAGE 1 DEDUCTIBLE SELF INSURED INVOICE 1 1 I 1 I I I 303GP64A -810 521GX7087 02/29/2012 000404674 03/15/2012 2,119.64 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL,CARMEL CLAY 13607 COLLECTIONS CENTER DRIVE ONE CIVIC SQUARE CHICAGO, IL 60693 CARMEL IN 46032 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK. Aftk TRAVELERS J PAGE 1 1 1 I 1 1 I 3036PG4A -810 521GX7087 02/29/2012 000404674 03/15/2012 2,119.64 CURRENT CLAIM ESPSO40 DATE OF LOSS: 01/13/2012 DESCRIPTION: IV REARENDED OV, OV AT A STOP LIGHT WHEN IV PROCEEDED TO GO AND OV WAS CLAIMANT: KELLI NEWMAN' LOSS 624.29 CLAIM TOTAL 624.29 CLAIM ESPS086 DATE OF LOSS: 01/19/2012 DESCRIPTION: C SWENBERG, SCOT CARMEL CITY SALT TRUCK HIT THE REAR END OF THE CV. CLAIMANT: SCOT SWENBERG( LOSS 801.83 CLAIM TOTAL 801.83 CLAIM ESP9578 DATE OF LOSS: 02/14/2012 DESCRIPTION: IV ATTEMPTED TO STOP AND COULD NOT STOP IN TIME AND HIT OV IN FRONT OF CLAIMANT: BRANDON ROBINSON�, LOSS 693.52 CLAIM TOTAL 693.52 CURRENT CHARGES $2,119.64 ACCOUNT SUMMARY CURRENT CHARGES 2,119.64 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 5000 TOTAL DUE 2,119.64 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 2,119.64 CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR 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 TRAVELERS NON- FUNDED DEPARTMENT ONE TOWER SQUARE -9MN HARTFORD, CT 06183 39138 CITY OF CARMEL,CARMEL CLAY ONE CIVIC SQUARE CARMEL IN 46032 m m 0 a r e 0 v 0 0 0 ry 0 0 0 A =k TRAVELERS J PAGE 1 DEDUCTIBLE SELF INSURED INVOICE GPO9313908 521GX7087 02/29/2012 000404071 03/15/2012 13,941.80 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL; CARMEL CLAY PARKS 13607 COLLECTIONS CENTER DRIVE ATTN: JIM SPELBRING CHICAGO, IL 60693 ONE CIVIC SQUARE CARMEL IN 46032 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK, TRAIVELERSJ PAGE 1 12 1 1 Ob Nil 111 ml .1 ljlllulEl��M GPO9313908 521GX7087 02/29/2012 000404071 03/15/2012 13,941.80 CURRENT CLAIM CES1821 DATE OF LOSS: 01/27/2009 DESCRIPTION: IVD WAS DRIVING A SNOW PLOW ON FOREST AVE AS HE WAS TRYING TO TURN EA CLAIMANT: JOYCE A GLAZE "m LOSS 10,000.00 CLAIM TOTAL 10,000.00 CLAIM CES6844 DATE OF LOSS: 06/13/2010 DESCRIPTION: C ROBERTS, MARY TORT NOTICE ALLEDGING BATTERY, TRESPASS, FALSE ARR CLAIMANT: BILLYJOE ROBERTS EXPENSE 817.80 CLAIM TOTAL 817.80 CLAIM EMS6617 DATE OF LOSS: 04/16/2010 DESCRIPTION: TORT NOTICE ARISING OUT OF THE ARREST MADE BY CPD OF THE CLAIMANT FOR CLAIMANT: SHARRON ATKINS�' EXPENSE 2,362.60 CLAIM TOTAL 2,362.60 CLAIM ESA6198 DATE OF LOSS: 09/08/2009 DESCRIPTION: CLAIMANT ALLEGES HIS RIGHTS WERE VIOLATED BY MEMBERS OF CARMEL POLICE CLAIMANT: DENNIS W CARLYLEE �J�C EXPENSE 761.40 CLAIM TOTAL 761.40 CURRENT CHARGES $13,941.80 TRAVELERS NON- FUNDED DEPARTMENT ONE TOWER SQUARE -9MN HARTFORD, CT o6183 39141 CITY OF CARMEL; CARMEL CLAY PARKS ATTN: JIM SPELBRING ONE CIVIC SQUARE CARMEL IN 46032 a c n 0 a 0 a 0 0 0 N 0 0 0 TRAVELERS J PAGE 2 DEDUCTIBLE SELF INSURED INVOICE GPOS313908 521GX7087 02/29/2012 000404071 03/15/2012 13,941.80 ACCOUNT SUMMARY CURRENT CHARGES 13,941.80 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 13.941.80 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 13,941.80 CONTACT AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR 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 TRAVELERS NON- FUNDED DEPARTMENT ONE TOWER SQUARE -9MN HARTFORD, CT 06183 39140 CITY OF CARMEL; CARMEL CLAY PARKS ATTN: JIM SPELBRING ONE CIVIC SQUARE CARMEL IN 46032 d m r 0 a 0 a 0 0 0 a 0 0 VOUCHER NO. WAR NO. ALLOWED 20 Travelers IN SUM OF 13607 Collections Center Drive Chicage, IL 60693 $2 3,5 7 0.2 4 ON ACCOUNT OF APPROPRIATION FOR Administration Department PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members 1205 000404167 43- 475.00 .$7,508.80 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1205 000404674 43- 475.00 $2,119.64 materials or services itemized thereon for 1205 000404071 I 43- 475.00 I $13,941.80 which charge is made were ordered and received except Friday, March 23, 2012 V Director, Administration Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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)) 02129/12 000404167 $7,508.80 02/29/12 000404674 $2,119.64 02/29/12 I 000404071 I $13,941.80 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