HomeMy WebLinkAbout211973 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1
0 ONE CIVIC SQUARE TRAVELERS
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $8,414.05
'bq ioN i�,r' CHICAGO IL 60693 CHECK NUMBER: 211973
CHECK DATE: 8114/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 000416208 4, 749 .22 GENERAL INSURANCE
1125 R4358400 30307 409073 888 . 30 TORT CLAIM SETTLEMENT
1125 R4358400 30307 411449 465 . 30 TORT CLAIM SETTLEMENT
1125 R4358400 30307 415354 2, 311 . 23 TORT CLAIM SETTLEMENT
Non-Funded Deductible Collections & Billing System Page 1 of I
TRAVELERS,
DEDUCTIBLE / SELF-INSURED INVOICE (copy)
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE
GP09315757 5216X7087 4/30/2012 409073 5/15/2012 $3,581 40
MAIL PAYMENT TO: PAYER ADDRESS:
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.
TRAVELERS
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE
GP09315757 5216X7087 4/30/2012 409073 5/15/2012 $3,581.40
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 $1,353.60
CLAIM TOTAL $1,353.60
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 $888 30
CLAIM TOTAL $888.30
CURRENT CHARGES $2,241.90
ACCOUNT SUMMARY
CURRENT CHARGES $2,241.90 INSURED NAME CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES $1,339 50 AGENT NAME HYLANT GROUP INC
UNAPPLIED PAYMENTS $0 00 AGENT PHONE' (317)817-5000
TOTAL DUE $3,581.40
DISPUTED ITEMS $D.DD
ACCOUNT BALANCE $3,581.40
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
Purchase >d�sC�c.tLMLI DI-Z C LIV
Description
P.O.# 00307 ✓ (P)or F C. Vd//
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JUL 1 012 Approval _ Date
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BY:
http://dedbilling.prodlb.travp.net/WBDI_NONFUNDED/ViewBilldtiv4.aspx?billnum=409... 7/17/2012
Non-Funded Deductible Collections & Billing System Page 1 of 1
TRAVELERS]
DEDUCTIBLE / SELF-INSURED INVOICE (copy)
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE
GP09315757 5216X7087 5/31/2012 411449 6/15/2012 $3,251.50
MAIL PAYMENT TO: PAYER ADDRESS:
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.
Aft,
TRAVELERS!
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE
GP09315757 5216X7087 5/31/2012 411449 6/15/2012 $3,251.50
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 EXPENSE $784.00
CLAIM TOTAL $784.00
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 $1,113.90
CLAIM TOTAL $1,11190
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 $465 30
CLAIM TOTAL $465.30
CURRENT CHARGES $2,363 20
ACCOUNT SUMMARY
CURRENT CHARGES $2,363.20 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES $888.30 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS $0.00 AGENT PHONE (317)817-5000
TOTAL DUE $3,251.50
DISPUTED ITEMS $0.00
ACCOUNT BALANCE $3,251.50
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE,
FOR BILLING QUESTIONS,PLEASE EMAIL DEDUCT IBLE-HELPDESK @TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-800-356-4098 EXT 08900:ANTONIO CONTRERAS
Purchase zon
Description
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P Mf-V CLEK a J
DEDUCTIBLE / SELF - INSURED INVOICE
GPO9315757 521GX7087 06/29/2012 000415354 07/15/2012 4,491 . 13
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 C.qFCK,
TRAIVELERS J PAGE 1
THIS ACCOUNT IS SCHEDULED TO GO TO A COLLECTION AGENCY
IF PAYMENT IS NOT RECEIVED ON OR BEFORE THE DUE DATE.
04... WiL El 0 U111-V71,
GPO9315757 521GX7087 06/29/2012 000415354 07/15/2012 4,491 . 13
r
t
CURRENT
CLAIM#: EPS2377 DATE OF LOSS: 02/19/2011
DESCRIPTION: C-PARK,GREG VS CITY OF CARMEL POLICE MERIT BOARD.
COMPLAINT FILED AGAI
CLAIMANT:_-GPEG
------- 42.30
CLAIM TOTAL 42.30
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 2,311 .23
CLAIM TOTAL, 2,311 .23
CURRENT CHARGES $2,353.53
ACCOUNT SUMMARY
CURRENT CHARGES 2,353 53 INSURED WAME 7
. CITY OF CARMEL,CARMEL CLAY PARKS BUTLDTN
DAST DUE CHARGES' 2, 137 .60 AGENT NAME: HYLANT GROUP INC
,LqAPPI-TED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 4,491. 13
)ISPUIED ITEMS 0.00
C20-UN T-_qA-L-AN C 4,4 9-1 . 13
CONTACT YOUR AGENT LISTED ABOVE IF' YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE.
FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-HEL,POESK@TRAVELERS.COM OR
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-800-356-4098 EXT, 08900: ANTONIO CONTRERAS
Purchase -v9
Description
P.O.# _3 0 3
�,orF CT,011
G.L.#
Budget
Purchaser Date
Approval Date—T-Lib
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.
362876 Travelers Terms
13607 Collections Center Drive
Chicago, IL 60693
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
4/30/12 409073 Discrimination claim 30307 $ 888.30
5/31/12 411449 Discrimination claim 30307 $ 465.30
6/29/12 415354 Discrimination claim 30307 $ - 2,311-23
Total $ 3,664.83
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.
362876 Travelers Allowed 20
13607 Collections Center Drive
Chicago, IL 60693
In Sum of$
$ 3,664.83
ON ACCOUNT OF APPROPRIATION FOR
101 -General Fund
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
30307 409073 4358400 $ 888.30 1 hereby certify that the attached invoice(s), or
30307 411449 4358400 $ 465.30 bill(s) is (are) true and correct and that the
30307 415354 4358400 $ 2,311.23 materials or services itemized thereon for
which charge is made were ordered and
received except
9-Aug 2012
Signature
$ 3,664.83 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
AffSk
TRAVELERS J PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
e
GP09313908 521GX7087 07/31/2012 000416208 08/15/2012 8,040.59
F?Z, CURRENT
CLAIM#: CES6844 DATE OF LOSS: 06/13/2010
DESCRIPTION: C - ROBERTS, MARY TORT NOTICE ALLEDGING BATTERY,
TRESPASS, FALSE ARR
CLAIMANT: BILLYJOE ROBERTS
EXPENSE 2,303. 12
/ CLAIM TOTAL 2,303. 12
C�
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 676.80
CLAIM TOTAL 676.80
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 1 ,769.30
CLAIM TOTAL 1,769.30
CURRENT CHARGES
pAUG 13 2Qt2
By
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9MN
HARTFORD, CT 06183
00895 39051
CITY OF CARMEL; CARMEL CLAY PARKS
ATTN: JIM SPELBRING
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS J PAGE 2
DEDUCTIBLE / SELF- INSURED INVOICE
• �
GP09313908 5216X7087 07/31/2012 000416208 08/15/2012 8,040.59
ACCOUNT SUMMARY
CURRENT CHARGES 4,749.22 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 3,291 .37 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 8,040.59
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 8,040.59
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
00895 39050
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
$4,749.22
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
I hereby certify that the attached invoice(s), or
1205 000416208 43-475.00 $4,749.22
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, August 13, 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))
07/31/12 000416208 $4,749.22
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