173185 06/09/2009 CITY OF CARMEL, INDIANA VENDOR 362876 Page 1 of 1
ONE CIVIC SQUARE TRAVELERS
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $6,117.87
CHICAGO IL 60693 CHECK NUMBER: 173185
CHECK DATE: 61912009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4358400 318676 3,416.10 REFUNDS AWARDS INDE
1205 4347500 320922 1,647.67 GENERAL INSURANCE
1205 4347500 321094 1,054.10 GENERAL INSURANCE
TRAVELERS J PAGE 1
GJ DEDUCTIBLE INVOICE
1 1 I 1 1 1
GPO9311918 0018277244 05/29/2009 000320922 06/15/2009 1,647.67
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 J PAGE 1
1 1 I 1 1 I
GP 9311918 0018277244 05/29/2009 000320922 06/15/2009 1,647.67
CURRENT
CLAIM#{: CAW2701 DATE OF LOSS: 08/14/2005
DESCRIPTION: LORI MCCANN -CLMT FILED SUIT PAPERS AGAINST INSD /INSD
EMPLOYEES
CLAIMANT: LORI MCCANN
EXPENSE 576.00
CLAIM TOTAL 576.00
CLAIM##: 09TO17 DATE OF LOSS: 01/01/2004
DESCRIPTION: CLAIMANT (WILLIS) ALLEGES PHYSICAL, EMOTIONAL
PSYCHOLOGICAL INJURIES S
CLAIMANT: SENSITIVE CLAIM
LOSS 1,071.67
CLAIM TOTAL 1,071.67
CURRENT CHARGES $1,647.67
ACCOUNT SUMMARY
CURRENT CHARGES 1,647.67 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 1,647.67
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 1,647.67
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
TRAVELERS
NON- FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
39778
CITY OF CARMEL
ATTENTION: B COOK
1 CIVIC SQUARE
CARMEL IN 46032
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TRAVELERSAJ PAGE 1
DEDUCTIBLE INVOICE
1�.
GPO9313908 521GX7087 05/29/2009 000321094 06/15/2009 13,583.40
e.
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL; CARMEL CLAY PARKS
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.
TRAVELERS I PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
1 1 1 1 L ljfjqo llll
GPO9313908 521GX7087 05/29/2009 000321094 06/15/2009 13,583.40
CURRENT
CLAIM A5C7407 DATE OF LOSS: 12/23/2008
DESCRIPTION: C CELADON TRUCKING INSD FIRE TRUCK RESPONDING TO A
MEDICAL EMERGENCY
CLAIMANT: /CELADON TRUCKING SERVICE
LOSS 174.52
CLAIM TOTAL 174.52
CLAIM CAW5269 DATE OF LOSS: 06/22/2007 1� J�✓
DESCRIPTION: THE IV WAS ON AN EMERGENCY RUN, THE IV LOST CONTROL ON v
A WET ROAD HITT
CLAIMANT: PATRICK K DAVISON
LOSS 1,231.40
CLAIM TOTAL 1,231.40
CLAIM CES0074 DATE OF LOSS: 03/11/2008 C
DESCRIPTION: C BELL, LOGAN ALLEGATIONS THAT CPD TOOK UNREASONABLE
ACTIONS IN LIEU
CLAIMANT: LOGAN BELL
EXPENSE 1,054.10
CLAIM TOTAL 1,054.10
CLAIM CES0119 DATE OF LOSS: 01/06/2008
DESCRIPTION: C HUFF, MARGARET, CLMNT WAS FOUND UNRESPONSIVE 1 �SCJ
CARMEL FIRE DEPT RE VV
CLAIMANT: MARGARET C HOFF
EXPENSE 1,086.10
CLAIM TOTAL 1,086.10
TRAVELERS
NON- FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
38958
CITY OF CARMEL; CARMEL CLAY PARKS
ONE CIVIC SQUARE
CARMEL IN 46032
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TRH VELERSJ PAGE 2
DEDUCTIBLE INVOICE
GP09313908 521GX7087 05/29/2009 000321094 06/15/2009 13,583.40
CURRENT
CLAIM#: CES2627 DATE OF LOSS: 05/08/2009
DESCRIPTION: C DENNINO,_KEITH IV ROLLED INTO THE BACK OF A
MOTORCYCLE CAUSING THE
CLAIMANT: KEITH A DENINNO
LOSS 1,621.18
CLAIM TOTAL 1,621.18
CURRENT CHARGES $5; 157.30
ACCOUNT SUMMARY
CURRENT CHARGES 5,167.30 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 8,416.10 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 13,583.40
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 13,583.40
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
TRAVELERS
NON- FUNDED DEPARTMENT
ONE TOWER SQUARE -9CR
HARTFORD, CT 06183
38957
CITY OF CARMEL; CARMEL CLAY PARKS
ONE CIVIC SQUARE
CARMEL IN 46032
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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))
05/29/09 321094 DOL: 03/11/2008 $1054.10
Total $2
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 N8 6 I 08 0 9 WARRANT NO.
ALLOWED 20
n er rive IN SUM o f
C hicago, IL 60693
$2,701.77
ON ACCOUNtT
rAP PR, �A,T,I,ON FOR
1205 Administration
Board Members
PO# or
DEPT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
lzub 0922 475 $676,00) bill(s) is (are) true and correct and that the
1205 f materials or services itemized thereon for
which charge is made were ordered and
1205 321094 475 $1 or 0 received except
20
tj
I n tur
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
TRAVELERS J PAGE 1
DEDUCTIBLE INVOICE
GP09313908 5215X7067 04/30/2009 00031SG76 05/15/2009 12,616,36
MAIL PAYMENT TO: PAYER:
TRAVELERS CITY OF CARMEL; CARMEL CLAY PARKS
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 3 ACCOUNT NU61BER ON YOUR CHECK.
RA ff ELER.J J PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
GPO9313908 521GX7087 04/30/2009 000318676 05/15/2009 12,816.36
CURRENT
CLAIM#!: CES0074 DATE OF LOSS: 03/11/2006
DESCRIPTION: C BELL, LOGAN ALLEGATIONS THAT CPD TOOK UNREASONABLE
ACTIONS IN LIEU
CLAIMANT: LOGAN BELL EXPENSE 660.40
CLAIM TOTAL 660.40
CLAIMN: CES0119 DATE OF LOSS: 01/06/2006
DESCRIPTION: C HOFF, MARGARET. CLMNT WAS FOUND UNRESPONSIVE
CARMEL FIRE DEPT RE
CLAIMANT: MARGARET C HOFF EXPENSE 38.10
CLAIM TOTAL 3B.10
CLAIM##: CES1746 DATE OF LOSS: 01/21/2004
DESCRIPTION: OV SLOWING DOWN FOR ROUND ABOUT AND IV WAS BEHIND, DID
NOT SLOW DOWN I
CLAIMANT: LAURA GALYAN LOSS 3,416.10
CLAIM TOTAL 3,416.10
CURRENT CHARGES $4,114.60
RAVELE S J PAGE 2
DEDUCTIBLE INVOICE
GPO9313908 5216X7087 04/30/2009 000316676 05/15/2009 12.816.36
ACCOUNT SUMMARY
CURRENT CHARGES 4.114.60 INSURED NAME: CITY OF CARMEL,CARh1EL CLAY PARKS BUILDIN
PAST DUE CHARGES 8,701.75 AGENT NAME: HYLANT GROUP INC
UNAPPLIEO PAYMENTS 0.00 AGENT PHONE: (317) 817 -5000
TOTAL DUE 12.816.36
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 12,816.36
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR DEDUCTIBLE COVERAGE,
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-HELPt1ESK@TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1 -800- 356 -4098 EXT. 08900: ANTONIO CONTRERAS
I
J
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
354565 Travelers Terms
13607 Collections Center Drive
Chicago, IL 60693
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
413/09 318676 Claim CES1 746 1 1121109 Galyan 3,416.10
Total 3,416.10
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.
354565 Travelers Allowed 20
13607 Collections Center Drive
Chicago, 1L 60693
In Sum of
3,416.10
ON ACCOUNT OF APPROPRIATION FOR
101 -Genera! Fund
PO# or INVOICE N0. ACCT #fTITLE AMOUNT Board Members
Dept
1125 318676 4358400- 3,416.10 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
4 -Jun 2009
Signature
3,416.10 Accounts Payable Coordinator
Cost distribuUon Ledger classification if Title
claim paid motor vehicle highway fund