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Home My WebLink About180291 12/08/2009 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1 ONE CIVIC SQUARE TRAVELERS i CHECK AMOUNT: $2,752.04 CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE ti roN `o CHICAGO IL 60693 CHECK NUMBER: 180291 CHECK DATE: 12/8/2009 DEPARTMENT ACCOUNT PO NUMBER IN VOICE NUMBER AMOUNT DESCRIPTION 2201 4350900 000336057 881.12 OTHER CONT SERVICES 1120 4347500 CES0119 652.85 GENERAL INSURANCE 1120 4347500 CES3623 1,218.07 GENERAL INSURANCE From: 12/0412009 15:10 #190 P,0041004 TRAY LEES J PAGE 1 DEDUCTIBLE INVOICE I r GPO9313908 5216X7087 11/30/2009 000336057 12/15/2009 2,515.57 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 B ACCOUNT NUMBER ON YOUR CHECK, TRA VET. ERR j�'' PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. ralmwagiligiij 1 GPO9313909 5716X7087 11/30/2009 000336057 12/15/2009 2.515,57 CURRENT CLAIM#: AGN8445 DATE OF LOSS: 07/30/2009 DESCRIPTION: C- POPE, CLAUDIA LAWN MOWER EJECTED A PIECE OF METAL THAT DAMAGED CLM CLAIMANT: CLAUDIA L POPE LOSS 881.12 CLAIM CES0119 DATE OF LOSS: 01/06/2008 CLAIM TOTAL 881.12 DESCRIPTION: C HOFF, MARGARET, CLMNT WAS FOUND UNRESPONSIVE CARMEL FIRE DEPT RE CLAIMANT: MARGARET C HOFF LOSS 20,000.00 CLA114 TOTAL 20,000.00 CLAIM CES3623 DATE OF LOSS: 09/02/2009 DESCRIPTION: C GLOBE TRANSPORT DRIVER OF AMBULANCE REAR ENDED THE OV WHEN SHE MAD CLAIMANT: DEBORAH A PERCIFIELD LOSS 517.10 CLAIM TOTAL 517.10 CLAIM EGV3970 DATE OF LOSS: 10/28/2009 DESCRIPTION: IV DRIVER'S SHOE WAS COVERED IN MUD, AND HIS FOOT SLIPPED OFF THE BRAK CLAIMANT: RICKY A HUDSON LOSS 860.23 CLAIM TOTAL 860.23 CURRENT C14ARGES $17,741.55- 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)) 11/30/09 000336057 $881.12 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 VOU NO. WARRANT NO. ALLOWED 20 Travelers IN SUM OF 13607 Collections Center Drive Chicago, IL 60693 $881.12 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Member 2201 000336057 43- 509.00 J$881.12 1 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 Friday, December 04, 200`r Street Commissioner Title Cost distribution ledger classification if claim paid motor vehicle highway fund From: 12/04/2009 15:10 #190 P.0041004 R 'R AVELERS I PAGE 1 DEDUCTIBLE INVOICE la i R 1410 [1] jjl:jl.Ew A N 0 111 Nl-14.=3 14M PY 1 KIM.] cmLMIT40 I Wil i GPO9313908 521GX7087 11/30/2009 000336057 12/15/2009 2,515.57 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. TRAVELERS PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. 4 GPO9313908 521GX7087 11/30/2009 000336057 12/15/2009 2,515.57 CURRENT CLAIM A6N8445 DATE OF LOSS: 07/30/2009 DESCRIPTION: C- POPE, CLAUDIA LAWN MOWER EJECTED A PIECE OF METAL THAT DAMAGED CLM y CLAIMANT: CLAUDIA L POPE LOSS 881.12 CLAIM TOTAL 881.12 CLAIM CES0119 DATE OF LOSS: 01/06/2008 DESCRIPTION: C HOFF, MARGARET. CLMNT WAS FOUND UNRESPONSIVE CARMEL FIRE DEPT RE CLAIMANT: MARGARET C HOFF �-tl 20 LOSS ,000.00 (CLAIM TOTAL 20,000.pO CLAIM CES3623 DATE OF LOSS: 09/02/2009 DESCRlP710Ni C GLOBE TRANSPORT DRIVER OF AMBULANCE REAR ENDED THE OV WHEN SHE MAD CLAIMANT: DEBORAH A PERCIFIELD' CLAIM OSS D517, TAL CLAIM EGV3970 DATE OF LOSS: 10/28/2009 DESCRIPTION: IV DRIVER`S SHOE WAS COVERED IN MUD, AND HIS FOOT SLIPPED OFF THE BRAK CLAIMANT: RICKY A HUDSON LOSS 860.23 CLAIM TOTAL 860.23 CURRENT CHARGES $17,741,55- TRAVELERS T RAVELERS T PAGE 1 DEDUCTIBLE INVOICE AGENT COPY •I I 41NIM 1 fill i j [Jim GPO9313908 521GX7087 10/30/2009 000333554 11/15/2009 41,964.02 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 8 ACCOUNT NUMBER ON YOUR CHECK. RAVELERSJ I PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. i I I GP09313908 521GX7087 10/30/2009 000333554 11/15/2009 41,964.02 CURRENT :LAIM#; CES0074 DATE OF LOSS: 03/11/2008 )ESCRIPTION: C BELL, LOGAN ALLEGATIONS THAT CPD TOOK UNREASONABLE pO�I ACTIONS IN LIEU :LAI LOGAN BELL LOSS 20,201.10 CLAIM TOTAL 20, 201. 10 :LAIM#- CES0119 DATE OF LOSS: 01/06/2008 ESCRIPTION: C HOFF, MARGARET. CLMNT WAS FOUND UNRESPONSIVE FtrB CARME L FIRE DEPT RE LAIMANT: MARGARET C HOFF LOSS 20,652.85 CLAIM TOTAL 20,652.$5 LAIMH: CES1387 DATE OF LOSS: 06/17/2008 ESCRIPTLON: C NELSON, FRANK; HOWELL, KELLY VS CARMEL POLICE DEPT P [I Cje THIRD PARTY DEF _AIMANT: FRANK NELSON EXPENSE 396.40 CLAIM TOTAL 396.40 .AIM#: CES3623 DATE OF LOSS: 09/02/2009 :SC RIPTION: C GLOBE TRANSPORT DRIVER OF AMBULANCE REAR ENDED THE OV WHEN SHE MAD .ATMANT: /GLOBE TRANSPORT INC LOSS 700.97 CLAIM TOTAL 700.97 CURRENT CHARGES $41,951.3 TRAVELERS•J PAGE 2 t DEDUCTIBLE INVOICE AGENT COPY GPOS313908 521GX7087 10/30/2009 000333554 11/15/2009 41,964.02 ACCOUNT SUMMARY CURRENT CHARGES 41,951.32 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 12.70 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000 TOTAL DUE .41 984.02 DISPUTED ITEMS 0,00 ACCOUNT BALANCE 41,964.02 CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE COVERAGE. FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE HELPDESK@TRAVELERS.CDM 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) CES0119 ($20,000.00) CES3623 $700.97 CES0119 $20,652.85 CES3623 $517.10 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. WARRANT NO. Travelers ALLOWED 20 IN SUM OF 13601 Collections Center Drive Chicago, IL 60693 $1,870.92 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT /TITLE A4 AMOUNT Board Members 1120 CES01 19 43- 475.00 $20,000.00) I hereby certify that the attached invoice(s), or 1120 CES3623 43- 475.00 $700.97 bill(s) is (are) true and correct and that the 1120 CES0119 43- 475.00 $20,652.85 materials or services itemized thereon for 1120 CES3623 43- 475.00 $517.10 which charge is made were ordered and received except DEC -`7 2009 r Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund