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HomeMy WebLinkAbout208492 04/25/2012 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1 ONE CIVIC SQUARE TRAVELERS i f i CHECK AMOUNT: $3,945.17 CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 CHECK NUMBER: 208492 CHECK DATE: 4/25/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 000406620 1,339.50 GENERAL INSURANCE 1205 4347500 000407162 504.77 GENERAL INSURANCE 1205 4347500 0004706932 2,100.90 GENERAL INSURANCE TRAVELERS PAGE 1 DEDUCTIBLE SELF INSURED INVOICE 14N99887 -ZPP 521GX7087 03/30/2012 000406932 04/15/2012 2,100.90 MAIL PAYMENT TO: PAYER: TRAVELERS CITY OF CARMEL, CARMEL CLAY PARKS BUIL 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 PAGE 14N99887 -ZPP 5216X7087 03/30/2012 000406932 04/15/2012 2,100.90 CURRENT CLAIM ESM3927 DATE OF LOSS: 02/08/2012 DESCRIPTION: C KIRBY, KURT EEOC COMPLAINT ALLEGING DISCRIMINATION DUETO A DIS.A.BIL CLAIMANT: KURT J KIRBY EXPENSE 2,100.90 CLAIM TOTAL 2,100.90 CURRENT CHARGES $2,100.90 ACCOUNT SUMMARY CURRENT CHARGES 2,100.90 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 2.100.90 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 2,100.90 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 D Q APR 23 2012 By TRAVELERS J PAGE 1 DEDUCTIBLE SELF INSURED INVOICE all i GP09315757 5216X7087 03/30/2012 000406620 04/15/2012 1,339.50 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 TRAVIIgTS. PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YT C APR 2 3 2012 TRAVELERS J By PAGE 1 121141WAil i GP09315757 521GX7087 03/30/2012 000406620 04/15/2012 1,339.50 CURRENT 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 451.20 CLAIM TOTAL 451.20 CLAIM EQG5061 DATE OF LOSS: 05/12/2011 DESCRIPTION: KNONSARI, RANA; CLAIMANT ALLEGES DISCRIMINATION DUE TO MERDISABILITY C CLAIMANT: RANA KHONSARI EXPENSE 28.20 CLAIM TOTAL 28.20 CLAIM EQR4757 DATE OF LOSS: 06/13/2011 DESCRIPTION: C MYERS, TERRY ALLEGATION OF DISCRIMINATION DUE TO AGE. EEOC COMPLAI CLAIMANT: TERRY 0 MYERS EXPENSE 860.10 CLAIM TOTAL 860.10 CURRENT CHARGES $1,339.50 ACCOUNT SUMMARY CURRENT CHARGES 1,339.50 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 1,339.50 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 1,339.50 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 i� PAGE DEDUCTIBLE SELF INSURED INVOICE 303GP64A -810 521GX7087 03/30/2012 000407162 04/15/2012 504.77 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 TRAVEL S. APR 2 3 2012 PLEASE WRITE THE POLICY ACCOUNT NUMBER ON YOUR CHECK By TRAVELERSJ� PAGE 1 303GP64A -810 521GX7087 03/30/2012 000407162 04/15/2012 504.77 CURRENT CLAIM#: ENV7990 DATE OF LOSS: 03/05/2012 DESCRIPTION: IV WAS SEARCHING FOR HER DOG, DOG RAN IN FRONT OF CAR, SWERVED TO MISS CLAIMANT: SKYE DONALDSON LOSS 447.96 CLAIM TOTAL 447.96 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#: ESP9678 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 858.64 CLAIM TOTAL 858.64 CURRENT CHARGES $504.77 ACCOUNT SUMMARY CURRENT CHARGES 504.77 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 504.77 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 504.77 CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE. FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE HELPOESK @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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 03/30/12 000406932 $2,100.90 03/30/12 000406620 $1,339.50 03/30/12 000407162 $504.77 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. ALLOWED 20 Travelers IN SUM OF 13607 Collections Center Drive Chicage, IL 60693 $3,945.17 ON ACCOUNT OF APPROPRIATION FOR Administration Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1205 000406932 43- 475.00 $2,100.90 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1205 000406620 43- 475.00 $1,339.50 materials or services itemized thereon for 1205 1 000407162 1 43- 475.00 1 $504.77 which charge is made were ordered and received except Monday, April 23, 2012 Director, Xdministratiln Title Cost distribution ledger classification if claim paid motor vehicle highway fund