216339 01/15/2013 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1
ONE CIVIC SQUARE TRAVELERS
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $13,535.58
` CHICAGO IL 60693 CHECK NUMBER: 216339
CHECK DATE: 1/1512013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4351000 421579 1, 481 . 36 AUTO REPAIR & MAINTEN
1205 4347500 427819 7, 607 . 60 GENERAL INSURANCE
1205 4347500 429266 4, 446 . 62 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.
303GP64A-810 5216X7087 12/31/2012 000429266 01/15/2013 5,927.98
CURRENT
CLAIM#: CER0592 DATE OF LOSS: 11/19/2012
DESCRIPTION: C - SMITH, CALVIN IV MADE A LEFT TURN ONTO RANGELINE
RD AND DID NOT SE
CLAIMANT: CALVIN R SMITH
LOSS 4,311 .82
�7 1, CLAIM TOTAL 4,311.82
CLAIM#: EVU5942 es� DATE OF LOSS: 11/07/2012
DESCRIPTION: IV WAS STOPPED AND STARTED TO REVERSE WHEN STRUCK OV
CLAIMANT: LARRY D HUGHEY
LOSS 134.80
CLAIM TOTAL 134.80
CURRENT CHARGES $4,446.62
ACCOUNT SUMMARY
CURRENT CHARGES 4,446.62 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 5,927.98
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 5,927.98
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
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JAN 1 4 2013 i
By
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9MN
HARTFORD, CT 06183
00827 39135
CITY OF CARMEL,CARMEL CLAY
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS J PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
GP09315757 521GX7087 12/31/2012 000427819 01/15/2013 26,615.60
�> C-/-�lc-_ 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 18,420.00
CLAIM TOTAL 18,420.00
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 7,607.60
CLAIM TOTAL 7,607.
CURRENT CHARGES $26,027.60
ACCOUNT SUMMARY
CURRENT CHARGES 26,027.60 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 588.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 26.615.60
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 26,615.60
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
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JAN 14 2013 5
By
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9MN
HARTFORD, CT 06183
00826 39136
CITY OF CARMEL, CARMEL CLAY PARKS BUILD
ONE CIVIC SQUARE
CARMEL IN 46032
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF $
13607 Collections Center Drive
Chicage, IL 60693
$12,054.22
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 000429266 43-475.00 $4,446.62 I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1205 000427819 43-475.00 $7,607.60
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, January 14, 2013
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))
12/31/12 000429266 $4,446.62
12/31/12 000427819 $7,607.60
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
Non-Funded Deductible Collections& Billing System Page 1 of 1
TRAVELERSI
DEDUCTIBLE / SELF-INSURED INVOICE (copy)
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE
3036P64A-810 5216X7087 9/28/2012 421579 10/15/2012 $1,780.94
MAIL PAYMENT TO: PAYER ADDRESS:
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)
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATEUT.
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE
3036P64A-810 5216X7087 9/28/2012 421579 10/15/2012 $1,780.94
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 $1,481.36
CLAIM TOTAL $1,481.36
CURRENT CHARGES $1,481.36
ACCOUNT SUMMARY
CURRENT CHARGES $1,481.36 INSURED NAME: CITY OF CARMEL,CARMEL CLAY
PAST DUE CHARGES $299.58 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS $0.00 AGENT PHONE: (317)817-5000
TOTAL DUE $1,780.94
DISPUTED ITEMS $0.00
ACCOUNT BALANCE $1,780.94
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
http://dedbilling.prodlb.travp.net/WBDI_NONFUNDED NiewBilldtiv4.aspx?bilinum=421... 12/5/2012
VOUCHER NO. WARRANT NO.
ALLOWED 20
Travelers
IN SUM OF $
13607 Collections Center Drive
Chicago, IL 60693
$1,481.36
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Prior Yenr I hereby certify that the attached invoice(s), or
1110 421579 I 43-510.00 $1,481.36
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
Monday, January 14, 2013
Chief of Police
V 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))
09/28/12 421579 deductible/car 26-Leach $1,481.36
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