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Home My WebLink About214851 11/20/2012 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1 ONE CIVIC SQUARE TRAVELERS ~' CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $9,321.89 19y«ON 00? CHICAGO IL 60693 CHECK NUMBER: 214851 CHECK DATE: 11/20/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 423306 56 .40 GENERAL INSURANCE 1205 4347500 423402 7, 797 . 60 GENERAL INSURANCE 1205 4347500 423899 1, 467 . 89 GENERAL INSURANCE TRAVELERS JW PAGE , DEDUCTIBLE / SELF-INSURED INVOICE AGENT COPY illillwadmillil MEW gotill i 1 ill] 1 1 GPO9313908 521GX7087 10/31/2012 000423306 11/15/2012 . 56.40 MAIL PAYMENT TO: AGENT. TRAVELERS HYLANT GROUP INC 13607 COLLECTIONS CENTER DRIVE PO BOX 40925 CHICAGO, IL 60693 INDIANAPOLIS IN 46280-0925 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE WRITE THE POLICY & ACCOUNT NUMBER ON YOUR CHECK. TRAVELERS J , PAGE 1 i I Mubmilli 1 1 GPO9313908 5216X7087 10/31/2012 000423306 11/15/2012 56.40 CURRENT 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 56.40 CLAIM TOTAL 56.40 CURRENT.CHARGES �SS8.40 ACCOUNT SUMMARY CURRENT CHARGES 56.40 INSURED NAME: CITY OF CARMEL.CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC UNAPPLIEO PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 56.40 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 56.40 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 1-800-358-4098 EXT. 08900: ANTONIO CONTRERAS D NOV 1 9 2012 By TRAVELERS PAGE 1 DEDUCTIBLE / SELF-INSURED INVOICE AGENT COPY 1 1 I D 1 -mm"l I GPOS315757 521GX7087 10/31/2012 000423402 11/15/2012 10,858.47 MAIL PAYMENT TO: AGENT: TRAVELERS HYLANT GROUP INC 13607 COLLECTIONS CENTER DRIVE PO BOX 40925 CHICAGO, IL 60693 INDIANAPOLIS IN 46280-0925 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE WRITE THE POLICY A ACCOUNT NUMBER ON YOUR CHECK. TRAVELERS J� PAGE 1 1 1 I INJ J,1 1 4 0 imul 1 I GPO9315757 521GX7087 10/31/2012 000423402 1175/2012 10,858.47 CURRENT CL.AIM#: CES8015 OATE OF LOSS: 02/12/2011 DESCRIPTION: CLMT STEPPED' OUT OF HIS CAR IN A COVERED PARKING GARAGE AND SLIPPED AN CLAIMANT: ERIC BRODT LOSS 5,000.00 ' CLAIM TOTAL 5,000.00 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 ,XE-X 2,797:60 CLAIM TOTAL 2,797.60 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 37;_Q6�, 7` CLAIM TOTAL _3-i-060.87 CURRENT CHARGES $10,858.47 ACCOUNT SUMMARY CURRENT CHARGES 10,858.47 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) 617-5000 TOTAL DUE 10,858.47 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 10 858.47 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 NOV 1 9 2012 By TRAVELERS PAGE 1 DEDUCTIBLE / SELF-INSURED INVOICE AGENT COPY rill 41 wm ill 111TI N 4111111imill 17.111 ill l 1 3036P64A-810 521GX7087 10/31/2012 000423899 11/15/2012 2,949.25 MAIL PAYMENT TO: AGENT: TRAVELERS HYLANT GROUP INC 13607 COLLECTIONS CENTER DRIVE PO BOX 40925 CHICAGO, IL 60693 INDIANAPOLIS IN 46280-0925 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE WRITE THE POLICY 8 ACCOUNT NUMBER ON YOUR CHECK. TRAVELERS J� PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. . , , ,11, 1�llqqkl 11 _uNuumUlm 1 1 303GP64A-810 5216X7087 10/31/2012 000423899 11/15/2012 2,949.25 ( 1= CURRENT CLAIM#: EUY7509 , DATE OF LOSS: 09/12/2012 DESCRIPTION: AARON LEACH OFFICE AARON LEACH WAS BACKING OUT OF HIS GARAGE IN HIS PO CLAIMANT: AARON LEACH LOSS 112.07 �� ! j'•��tcQ CLAIM TOTAL 112.07 CLAIM#: EVU2839 DATE OF LOSS: 10/04/2012 DESCRIPTION: IV BACKED OUT OF PARKING SPACE AND STUCK PARKED AND UMOCCUPIED OV CLAIMANT: EDWARD DAHM LOSS 1,355.82 CLAIM TOTAL / 1,355.82 CURRENT CHARGES( =,487.89 ACCOUNT SUMMARY \\\ CURRENT CHARGES 1,467.89 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PAST DUE CHARGES 1,481.36 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 2,949.25 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 2,949.25 CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE. FOR BILLING QUESTIONS, PLEASE EMAIL DEDUCTIBLE-HELPDESKPTRAVELERS.COM OR CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT 1-800-358-4088 EXT. 08900: ANTONIO CONTRERAS D Q � Nov 19 2012 BY VOUCHER NO. WARRANT NO. ALLOWED 20 Travelers IN SUM OF $ 13607 Collections Center Drive Chicage, IL 60693 $9,321.89 ON ACCOUNT OF APPROPRIATION FOR Administration Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1205 000423306 43-475.00 $56.40 I hereby certify that the attached invoice(s), or bill(s) is (are)true and correct and that the 1205 000423402 43-475.00 $7,797.60 materials or services itemized thereon for 1205 1 000423899 1 43-475.00 1 $1,467.89 which charge is made were ordered and received except Monda November 19, 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)) 10/31/12 000423306 $56.40 10/31/12 000423402 $7,797.60 10/31/12 000423899 $1,467.89 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