HomeMy WebLinkAbout212887 09/25/2012 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1
ONE CIVIC SQUARE TRAVELERS
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $2,313.75
CHICAGO IL 60693 CHECK NUMBER: 212887
CHECK DATE: 9125/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 418589 1, 200 . 97 GENERAL INSURANCE
1205 4347500 418700 514 . 50 GENERAL INSURANCE
1125 R4358400 30307 418700 84 . 60 TORT CLAIM SETTLEMENT
2201 4237000 419008 214 . 10 REPAIR PARTS
601 5023990 419228 299 . 58 OTHER EXPENSES
TRAVELERS .1 PAGE 1
DEDUCTIBLE / SELF- INSURED INVOICE
GPO9315757 5216X7087 08/31/2012 000418700 09/15/2012 2,506.70
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 CHECK.
TR LE SJ PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
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I I I I I
GPO9315757 5216X7087 08/31/2012 000418700 09/15/2012 2,506.70
7 C L 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 1 ,344.00
CLAIM TOTAL 1,344.00
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 514.50
CLAIM TOTAL 514.50
CLAIM#: EQR4757 DATE OF LOSS: 06/13/2011 n
DESCRIPTION: C - MYERS, TERRY ALLEGATION OF DISCRIMINATION DUE TO
AGE. EEDC COMPLAI Y VJ
CLAIMANT: TERRY D MYERS
EXPENSE 84 O
CLAIM TOTAL
CURRENT CHARGES $1,943. 10
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'urchaser Date
oval
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
8131/12 418700 Discrimination claim 30307 $ 84.60
Total $ 84.60
1 hereby certify that the attached invoice(s),or biff(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$
$ 84.60
ON ACCOUNT OF APPROPRIATION FOR
101 -General Fund .
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
30307 418700 4358400 $ 84.60 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
20-Sep 2012
Signature
$ 84.60 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
TRA f/ ELEfI S J PAGE 1
DEDUCTIBLE / SELF- INSURED INVOICE
i
303GP64A-810 521GX7087 08/31/2012 000419228 09/15/2012 299.58
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 TRAVELERS.
PLEASE WRITE THE POLICY & ACCOUNT NUMBER ON YOUR CHECK.
TRAVELERS J PAGE 1
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303GP64A-810 521GX7087 08/31/2012 000419228 09/15/2012 299.58
CURRENT
CLAIM#: EUY5094 DATE OF LOSS: 07/12/2012
DESCRIPTION: C - ROBERTSON, DAVID UNIDENTIFIED CITY TRUCK ALLEGEDLY
LEAKED BLUE PAI
CLAIMANT: DAVID ROBERTSON
LOSS 299.58
CLAIM TOTAL 299.58
CURRENT CHARGES $299.58
ACCOUNT SUMMARY
CURRENT CHARGES 299.58 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 299.58
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 299.58
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
00926 39015
CITY OF CARMEL,CARMEL CLAY
ONE CIVIC SQUARE
CARMEL IN 46032
0
0
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VOUCHER # 122239 WARRANT # ALLOWED
T2291 IN SUM OF $
TRAVELERS
13607 COLLECTIONS CENTER DRIVE
CHICAGO, IL 60693
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
419228 01-6330-08 $299.58
Voucher Total $299.58
Cost distribution ledger classification if
claim paid under 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
T2291
TRAVELERS Purchase Order No.
13607 COLLECTIONS CENTER DRIVE Terms
CHICAGO, IL 60693 Due Date 9/19/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/19/2012 419228 $299.58
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
Date Officer
AMk
TRAI LERS J PAGE 1
GP09313908 521GX7087 08/31/2012 000418589 09/15/2012 1 ,200.97
f- ' kk u- CURRENT
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 945.20
CLAIM TOTAL 945.20
CLAIM#: ENZ9527 DATE OF LOSS: 09/13/2010
DESCRIPTION: TORT CLAIM - CLMT ALLEGES SHE VIOLOATION OF PROTECTED
RIGHTS, EMBARRAS
CLAIMANT: JUSTINE ALLEN
EXPENSE 28.20
CLAIM TOTAL 28.20
CLAIM#: ESA6198 DATE OF LOSS: 09/08/200
DESCRIPTION: CLAIMANT ALLEGES HIS RIGHTS WERE VIOLATED Ey t_I
OF CARMEL POLICE
CLAIMANT: DENNIS W CA RLYLE EXPENSE 227.57
J�i CLAIM TOTAL 227.57
L. CURRENT CHARGES $1,200.97
ACCOUNT SUMMARY
CURRENT CHARGES 1 ,200.97 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 1,200.97
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 1 ,200.97
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
00923 39019
CITY OF CARME-E;- L CLAY PARKS
ATTN: JIM SPELBRING
ONE CIVIC SQUARE
CARMEL IN 46032
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0
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0
0
0
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AlDk
TRAVELERS J PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
GP09315757 5216X7087 08/31/2012 000418700 09/15/2012 2,506.70
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 1,344.00
CLAIM TOTAL 1,344.00
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 L514.50
CLAIM TOTAL .50
CLAIM#: EQR4757 DATE OF LOSS: 06/13/2011
DESCRIPTION: C - MYERS, TERRY ALLEGATION OF DISCRIMINATION DUE TO
AGE. EEOC COMPLAI
CLAIMANT: TERRY D MYERS
j EXPENSE 84.60
D IJ CLAIM TOTAL 84.60
n;
SEI' 2 hUi1 CURRENT CHARGES $1,943. 10
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9MN
HARTFORD, CT 06183
00924 39018
CITY OF CARMEL, CARMEL CLAY PARKS BUILD
ONE CIVIC SQUARE
CARMEL IN 46032
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0
0
0
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0
0
0
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TRAVELERS J PAGE 2
DEDUCTIBLE / SELF-INSURED INVOICE
i
GPO9315757 521GX7087 08/31/2012 000418700 09/15/2012 2,506.70
ACCOUNT SUMMARY
CURRENT CHARGES 1 ,943. 10 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 563.60 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 2,506.70
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 2,506.70
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
00924 39017
CITY OF CARMEL, CARMEL CLAY PARKS BUILD
ONE CIVIC SQUARE
CARMEL IN 46032
0
0
0
0
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0
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF $
13607 Collections Center Drive
Chicage, IL 60693
$1,715.47
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
1205 000418589 43-475.00 $1,200.97 1 hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1205 000418700 43-475.00 $514.50
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, September 24, 2012
Director, Ad inistration
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))
08/31/12 000418589 $1,200.97
08/31/12 000418700 $514.50
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
I n/4 V G1_Gn.7 J
DEDUCTIBLE / SELF-INSURED INVOICE
1 1 1 1 1 I
14N99887-ZPP 521GX7087 08/31/2012 000419008 09/15/2012 214. 10
i
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 I PAGE 1
14N99887-ZPP 521GX7087 08/31/2012 000419008 09/15/2012 214. 10
CURRENT
CLAIM#: ETU7185 DATE OF LOSS: 08/01/2012
DESCRIPTION: C - ZUREK, MOLLY TORT NOTICE ALLEGING CLMT WAS DRIVING
FROMTHE PARKING
CLAIMANT: MOLLY ZUREK
LOSS 214. 10
CLAIM TOTAL 214. 10
CURRENT CHARGES $214. 10
ACCOUNT SUMMARY
CURRENT CHARGES 214. 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 214. 10
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 214. 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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF $
13607 Collections Center Drive
Chicago, IL 60693
$214.10
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 I 000419008 I 42-370.001 $214.10 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
Friday, September 21, 2012
)OLLr4 ,.
Street Commissidner
Street Conflelissioner
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))
08/31/12 000419008 $214.10
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