HomeMy WebLinkAbout208070 04/10/2012 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1
ONE CIVIC SQUARE TRAVELERS
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $1,579.10
CHICAGO IL 60693
CHECK NUMBER: 208070
CHECK DATE: 4/10/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000406519 1,579.10 GENERAL INSURANCE
TRAVELERS PAGE 1
DEDUCTIBLE SELF INSURED INVOICE
i
GP09313908 5216X7087 03/30/2012 000406519 04/15/2012 1,579.10
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 WIQ l1R_GLi BLE TO TRAVELERS.
PLEASE WRITE THE P® CY COUNUVUM ON YOUR CHECK.
D. u
AW APR 09 2012
TRAVELERS.J PAGE
By
GP09313908 5216X7087 03/30/2012 000406519 04/15/2012 1,579.10
CURRENT
CLAIM CES6844 DATE OF LOSS: 06/13/2010
DESCRIPTION: C ROBERTS, MARY TORT NOTICE ALLEDGING BATTERY,
TRESPASS, FALSE ARR
CLAIMANT: BILLYJOE ROBERTS
EXPENSE 972.90
CLAIM TOTAL 972.90
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 140.90
R oN. vcA. CLAIM TOTAL 140.90
CLAIM ESA6198 DATE OF LOSS: 09/08/2009
DESCRIPTION: CLAIMANT ALLEGES HIS RIGHTS WERE VIOLATED BY MEMBERS
OF CARMEL POLICE
CLAIMANT: DENNIS W CARLYLE
EXPENSE 465.30
CLAIM TOTAL 465.30
CURRENT CHARGES $1,579.10
ACCOUNT SUMMARY
CURRENT CHARGES 1,579.10 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 1.579.10
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 1,579.10
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
39103
CITY OF CARMEL; CARMEL CLAY PARKS
ATTN: JIM SPELBRING
ONE CIVIC SQUARE
CARMEL IN 46032
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF
13607 Collections Center Drive
Chicage, IL 60693
$1,579.10
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1205 000406519 43- 475.00 $1,579.10 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
Monday, April 09, 2012
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))
03/30/12 000406519 $1,579.10
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