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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// G.L.# Line-b L inebescr 7 � . w,F 1-M Purchaser JUL 1 012 Approval _ Date TV 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 P.O.#�j 6). �'n for F (q- j : J G.L.#7JUL Budae t 1 7 Line De scr �L&1�#�—!�?— ��—73� "Q i Purchaser ate BY Date'7 )? - Approval A http://dedbilling.prodlb.travp.net/WBDI_NONFUNDED/Vie\vBiIIdtiv4.aspx?billnum=41 1... 7/17/2012 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 0 m 0 m 0 N m V O O O N O a 0 N AVQk 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 0 0 m 0 o - N a O O O a 0 N 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