HomeMy WebLinkAbout215203 12/04/2012 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1
` ONE CIVIC SQUARE TRAVELERS CHECK AMOUNT: $3,060.87
�• ? CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE
<.oa CHICAGO IL 60693 CHECK NUMBER: 215203
CHECK DATE: 12/4/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4358400 423402 3 , 060 . 87 REFUNDS AWARDS & INDE
TRAVELERS ) PAGE 1
DEDUCTIBLE / SELF- INSURED INVOICE � i
r
NOV 14 2012 t
BY--
GPO9315757 521GX7087 10/31/2012 000423402 11/15/2012 10,858.47
MAIL PAYMENT TO: PAYER: _ _
TRAVELERS Ci^TYY,OF,:;CARMEaC. _ CARINELdCL'AY^r.F?ARKS``BUI;LDu r'
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.
Aw
TRAVELERS JJ PAGE 1
GP09315757 521GX7087 10/31/2012 000423402 11/15/2012 10,858.47
Purchase C_LAIM.S CURRENT
CLAIM#: CES8015 DATE OF LOSS: 02/12/2011 Descriptio l ANA 110N
DESCRIPTION: CLMT STEPPED OUT OF HIS CAR IN A COVERED PARKIPI@,� # P or
GARAGE AND SLIPPED AN
G.L.# 43 5g4:=
CLAIMANT: ERIC BRODT Budaet n,-'
Line Descr awA44 0.00
Da C�AIM TOTAL 5,000.00
Purchaser e
CLAIM#: EPS2377 DATE OF LOSS: 02/19/2011 A proval Date Z-
DESCRIPTION: C-PARK,GREG VS CITY OF CARMEL POLICE MERIT BOAR.
COMPLAINT FILED AGAI
CLAIMANT: GREG PARK
EXPENSE 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: T;ERRY,!�M�YERS
EXPENSE 3,060.87
CLAIM TOTAL 3,060.87
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) 817-5000
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
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
10/31/12 423402 Discrimination claim $ 3,060.87
Total $ 3,060.87
1 hereby certify that the attached invoice(s), or bill(s)is(are)true and correct and I have audited same in accordance
"1
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$
$ 3,060.87
ON ACCOUNT OF APPROPRIATION FOR
101 -General Fund
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1125 423402 4358400 $ 3,060.87 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
29-Nov 2012
Signature
$ 3,060.87 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund