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Home My WebLink About214107 10/23/2012 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1 ONE CIVIC SQUARE TRAVELERS ` CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $3,590.55 "+ ? CHICAGO IL 60693 CHECK NUMBER: 214107 CHECK DATE: 10/23/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1125 4358400 421075 878 . 23 REFUNDS AWARDS & INDE 1205 4347500 421075 1, 602 .45 GENERAL INSURANCE 1125 R4358400 30307 421075 1, 011 . 17 TORT CLAIM SETTLEMENT 1205 4347500 421363 98 . 70 GENERAL INSURANCE T A VELERS J PAGE 1 4.iVED DEDUCTIBLE / SELF- INSURED INVOICE OCT 10 2012 BY: GPO9315757 5216X7087 09/28/2012 000421075 10/15/2012 5,434.95 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. T ff AVELE;'S J PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. GP093i5757 521GX7087 09/28/2012 000421075 10/15/2012 5,434.95 r�.�1 i.�� 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 1,602.45 CLAIM TOTAL 1,602.45 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 1,889.40 CLAIM TOTAL 1,889.40 _ CURRENT CHARGES $3,491.85 ACCOUNT SUMMARY CURRENT CHARGES 3,491 .85 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 1 ,943. 10 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 5,434.95 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 5,434095 CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE, FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-HELPDESK @TRAVELERS.COM OR CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-800-356-4098 EXT. 08900: ANTONIO CONTRERAS Purchase Description b lSCP�YYI��PrRL�'� NmS t1u11 .,1 1 P.o.# = P or CZ- I- S_2.`_A3 G.L.# 1 5-1 — Q j - C$� 5O Budget Line Descr Purchas Date Approva Date/Z 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 9/28/12 421075 Discrimination claim 30307 $ 1,011.17 9/28/12 421075 Discrimination claim $ 878.23 Total $ 1,889.40 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$ $ 1,889.40 ON ACCOUNT OF APPROPRIATION FOR 101 -General Fund PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 30307 F 421075 4358400 $ 1,011.17 1 hereby certify that the attached invoice(s), or 1125 421075 4358400 $ 878.23 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 18-Oct 2012 Signature $ 1,889.40 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund AIM TRAVELERS J PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. I GP09315757 5216X7087 09/28/2012 000421075 10/15/2012 5,434.95 o�"Lt� 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 602.45\ �sl� CLAIM TOTAL �5 - 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 1.889.40 CLAIM TOTAL 1,889.40 CURRENT CHARGES $3,491.85 ACCOUNT SUMMARY CURRENT CHARGES 3,491 .85 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 1 ,943. 10 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 5.434.95 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 5,434.95 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 � OCT 2 2 2012 By i TRAVELERS NON-FUNDED DEPARTMENT ONE TOWER SQUARE -9MN HARTFORD, CT 06183 00875 39078 CITY OF CARMEL, CARMEL CLAY PARKS BUILD ONE CIVIC SQUARE CARMEL IN 46032 m 0 0 0 N O O O O O Q O N TRAVELERS PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. milli 14N99887-ZPP 521GX7087 09/28/2012 000421363 10/15/2012 312.80 '-'p .�� CURRENT CLAIM#: ESM3927 DATE OF LOSS: 02/08/2012 DESCRIPTION: C - KIRBY, KURT EEOC COMPLAINT ALLEGING DISCRIMINATION DUETO A DISABIL CLAIMANT: KURT J KIRBY EXPENSE 28.20 CLAIM TOTAL 28.20 CLAIM#: ETH9758 DATE OF LOSS: 02/11/2012 DESCRIPTION: C- WAKLEY, VICTO V CITY OF CARMEL (COUNTER CLAIM DEFENDANT) CLMT IS AS CLAIMANT: VICTOR D WAKLEY EXPENSE 70.50 CLAIM TOTAL 70.50 CURRENT CHARGES $98.70 ACCOUNT SUMMARY CURRENT CHARGES 98.70 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 214. 10 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 312.80 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 312.80 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 � OCT 222012 gy TRAVELERS NON-FUNDED DEPARTMENT ONE TOWER SQUARE -9MN HARTFORD, CT o6183 00876 39077 CITY OF CARMEL, CARMEL CLAY PARKS BUIL ONE CIVIC SQUARE CARMEL IN 46032 o _ m 0 m a 0 0 0 0 a 0 0 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)) 09/28/12 000421075 $1,602.45 09/28/12 000421363 $98.70 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Travelers IN SUM OF $ 13607 Collections Center Drive Chicage, IL 60693 $1,701.15 ON ACCOUNT OF APPROPRIATION FOR Administration Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1205 000421075 43-475.00 $1,602.45 1 hereby certify that the attached invoice(s), or bill(s) is (are)true and correct and that the 1205 000421363 1 43-475.00 $98.70 materials or services itemized thereon for which charge is made were ordered and received except Monday, October 22, 2012 Director, Administration Title Cost distribution ledger classification if claim paid motor vehicle highway fund