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Home My WebLink About215545 12/18/2012 "*R CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1 0 ONE CIVIC SQUARE TRAVELERS CARMEL,INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $19,395.86 ? CHICAGO IL 60693 „o �o CHECK NUMBER: 215545 CHECK DATE: 12/1812012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4347500 425568 5, 642 . 00 GENERAL INSURANCE 1125 4358400 425663 6, 500 . 00 REFUNDS AWARDS & INDE 1205 4347500 425663 2, 627 . 94 GENERAL INSURANCE 1205 4347500 427049 4 , 625 . 92 GENERAL INSURANCE TRAVELERS J PAGE 1 THIS ACCOUNT IS SCHEDULED TO GO TO A COLLECTION AGENCY IF PAYMENT IS NOT RECEIVED ON OR BEFORE THE DUE DATE. o 1 3036P64A-810 5216X7087 11/30/2012 000427049 12/15/2012 7,575. 17 CURRENT CLAIM#: EVU4354 DATE OF LOSS: 10/23/2012 DESCRIPTION: C - CARMEL CLAY SCHOOLS IV WENT TO PASS A PARKED BUS THE PALLADIUM CLAIMANT: /CARMEL CLAY SCHOOLS LOSS 238.75 CLAIM TOTAL 238.75 CLAIM#: EVU4927 DATE OF LOSS: 11/06/2012 DESCRIPTION: IV, WHICH WASN'T IN PARK AFTER THE DRIVER GOT OUT, ROLLED INTO OV WHIC CLAIMANT: MARILYN J HARBISON LOSS 3,003.76 CLAIM TOTAL 3,003.76 CLAIM#: EVU5942 DATE OF LOSS: 11/07/2012 DESCRIPTION: IV WAS STOPPED AND STARTED TO REVERSE WHEN STRUCK OV CLAIMANT: LARRY D HUGHEY LOSS 1 ,383.41 CLAIM TOTAL 1,383.41 CURRENT CHARGES (' $4,625.92 D Q � DEC 17 2012 By TRAVELERS NON-FUNDED DEPARTMENT ONE TOWER SQUARE -9MN HARTFORD, CT 06183 00832 39122 CITY OF CARMEL,CARMEL CLAY ONE CIVIC SQUARE CARMEL IN 46032 N N m 0 0 0 r N a 0 0 0 N O Q O O AM TRAVELERS J PAGE 2 DEDUCTIBLE / SELF- INSURED INVOICE 303GP64A-810 5216X7087 11/30/2012 000427049 12/15/2012 7,575. 17 ACCOUNT SUMMARY CURRENT CHARGES 4,625.92 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PAST DUE CHARGES 2,949.25 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 7,575. 17 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 7,575. 17 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 00832 39121 CITY OF CARMEL,CARMEL CLAY ONE CIVIC SQUARE CARMEL IN 46032 0 m a 0 r v 0 0 0 N Q O O TRAVELERS J PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. GPO9315757 5216X7087 11/30/2012 000425663 12/15/2012 20,574.41 C--/�Q- 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 588.00 CLAIM TOTAL 588.00 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 E2,62 4 ��ss CLAIM TOTAL 4 CLAIM#: EQR4757 DATE OF LOSS: 06/13/2011 DESCRIPTION: C - MYERS, TERRY ALLEGATION OF DISCRIMINATION DUE TO AGE. EEOC COMPLAI CLAIMANT: TERRY D MYERS LOSS 6,500.00 CLAIM TOTAL 6,500.00 D CURRENT CHARGES $9,715.94 I DEC 1 7 2012 By TRAVELERS NON-FUNDED DEPARTMENT ONE TOWER SQUARE -9MN HARTFORD, CT 06183 00830 39125 CITY OF CARMEL, CARMEL CLAY PARKS BUILD ONE CIVIC SQUARE CARMEL IN 46032 0 a 0 0 0 N O a 0 0 ------ ------ .. . - --- ----------. . . ...........-. - - - AM TRAVELERS J PAGE 2 DEDUCTIBLE / SELF- INSURED INVOICE i I GP09315757 5216X7087 11/30/2012 000425663 12/15/2012 20,574.41 ACCOUNT SUMMARY CURRENT CHARGES 9,715.94 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 10,858.47 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 20,574.41 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 20,574.41 --- 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 00830 39124 CITY OF CARMEL, CARMEL CLAY PARKS BUILD ONE CIVIC SQUARE CARMEL IN 46032 a 0 m a 0 0 0 N Q O O AdW TVALE S I PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. GPO9313908 5216X7087 11/30/2012 000425568 12/15/2012 5,698.40 CURRENT CLAIM#: A3V2186 DATE OF LOSS: 08/01/2009 DESCRIPTION: C- TRANCIK, THOMAS TORT NOTICE ALLEGEING CITY WILL NOT INVESTIGATE A P CLAIMANT: THOMAS TRANCIK EXPENSE 5,642.00 CLAIM TOTAL 5,642.00 CURRENT CHARGES $5,642.00 ACCOUNT SUMMARY CURRENT CHARGES 5,642.00 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 56.40 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 5,698.40 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 5,G98.40 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 D Q DEC 17 2012 By TRAVELERS NON-FUNDED DEPARTMENT ONE TOWER SQUARE -9MN HARTFORD, CT 06183 00829 39126 CITY OF CARMEL; CARMEL CLAY PARKS ATTN: JIM SPELBRING ONE CIVIC SQUARE -CARMEL IN 46032 0 m m a 0 0 0 0 a 0 N VOUCHER NO. WARRANT NO. ALLOWED 20 Travelers IN SUM OF $ 13607 Collections Center Drive Chicage, IL 60693 $17,895.86 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 9265 000425941——43-475..-00-=$5;000:00 bill(s) is (are)true and correct and that the 1205 000425568 43-475.00 $5,642.00 materials or services itemized thereon for 1205 000425663 43-475.00 $2,627.94 which charge is made were ordered and 1205 000427049 43-475.00 $4,625.92 received except Mon y, December 17, 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)) 11/30/12 000425941 $5,000.00 11/30/12 000425568 $5,642.00 11/30/12 000425663 $2,627.94 11/30/12 000427049 $4,625.92 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 TRAVELERS T ' PAGE 1 DEDUCTIBLE / SELF- INSURED INVOICE a a a i a i GP09315757 5216X7087 11/30/2012 000425663 12/15/2012 20,574.41 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. TA IV/ Lt�SI il PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. GP09315757 5216X7087 11/30/2012 000425663 12/15/2012 20,574.41 C-3_' 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 588.00 CLAIM TOTAL 588.00 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 2,627.94 CLAIM TOTAL 2,627.94 CLAIM#: EQR4757 DATE OF LOSS: 06/13/2011 DESCRIPTION: C - MYERS, TERRY ALLEGATION OF DISCRIMINATION DUE TO AGE. EEOC COMPLAI CLAIMANT: TERRY D MYERS LOSS 6,500.00 CLAIM TOTAL 6,500.00 CURRENT CHARGES $9,715.94 Purchase pi$GYI YY 111� 0Y1 P Description D. F a P.O.# 11 RFCElV1F__,D G.L.# eueut DEC 10 2012 Line escr Date—_.— Purchaser Date L ► Z $Y; Approval TRAVELERS I PAGE 2 DEDUCTIBLE / SELF- INSURED INVOICE GP09315757 5216X7087 11/30/2012 000425663 12/15/2012 20,574.41 ACCOUNT SUMMARY CURRENT CHARGES 9,715.94 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN PAST DUE CHARGES 10,858.47 AGENT NAME: HYLANT GROUP INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000 TOTAL DUE 20 574.41 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 20,574.41 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 11/30/12 425663 Discrimination claim $ 6,500.00 Total $ 6,500.00 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 Voucher No. Warrant No. 362876 Travelers Allowed 20 13607 Collections Center Drive Chicago, IL 60693 In Sum of$ $ 6,500.00 ON ACCOUNT OF APPROPRIATION FOR 101 -General Fund PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1125 425663 4358400 $ 6,500.00 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 13-Dec 2012 2 01 Signature $ 6,500.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund