217016 02/12/2013 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1
ONE CIVIC SQUARE TRAVELERS
` CARMEL, INDIANA 46032 CHECK AMOUNT: $13,886.68
��•+, 13607 COLLECTIONS CENTER DRIVE
CHICAGO IL 60693 CHECK NUMBER: 217016
CHECK DATE: 2/12/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 429949 205 . 80 GENERAL INSURANCE
1205 4347500 430039 2 , 194 . 00 GENERAL INSURANCE
1205 4347500 430554 11, 486 . 88 GENERAL INSURANCE
TRAVELERS PAGE 1
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GP09313908 �55221GX7087 01/31/2013 000429949 02/15/2013 205.80
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 205.80
CLAIM TOTAL 205.80
CURRENT CHARGES $205.80
ACCOUNT SUMMARY
CURRENT CHARGES 205.80 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 205.80
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 205.80
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
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9MN
HARTFORD, CT 06183
00808 39150
CITY OF CARMEL; CARMEL CLAY PARKS
ATTN: JIM SPELBRING
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS PAGE 1
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
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GP09315757 5216X7087 01/31/2013 000430039 02/15/2013 21,202.45
t )�.�1'�C� 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 2, 194.45
CLAIM TOTAL 2, 194.45
CURRENT CHARGES $2, 194.45
ACCOUNT SUMMARY
CURRENT CHARGES 2, 194.45 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 19,008.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 21 202.45
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 21 202.45
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
00809 39149
CITY OF CARMEL, CARMEL CLAY PARKS BUILD
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS'!' PAGE 1
low
303GP64A-810 5216X7087 01/31/2013 , 000430554 .
. 02/15/2013 11 ,486.88
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CURRENT
CLAIMN: ERY8377 DATE OF LOSS: 01/16/2013
DESCRIPTION: C - TIPTON, BRETT OFFICER LOVEALL WAS UNABLE TO STOP
IN TIME AND REAR
CLAIMANT: JUDITH E TIPTON
LOSS 1 ,080.31
� �� --�5�-- CLAIM TOTAL 1,080.31
CLAIM#: EVU5942 DATE OF LOSS: 11/07/2012
DESCRIPTION: IV WAS STOPPED AND STARTED TO REVERSE WHEN STRUCK OV
CLAIMANT: LARRY D HUGHEY
LOSS 406.57
CLAIMI#: EVU8632 DATE OF LOSS: 12/10/2012 CLAIM TOTAL 406.57
DESCRIPTION: IV ENTERING ROUNDABOUT. IVD DID NOT SEE OV ALREADY IN
ROUNDABOUT. IV
CLAIMANT: LEANNE SHAW
LOSS 10,000.00
CLAIM TOTAL 10,000.00
ACCOUNT SUMMARY CURRENT CHARGES $11,486.88
CURRENT CHARGES 11 ,486.88 INSURED NAME: CITY OF CARMEL,CARMEL CLAY
PAST DUE CHARGES
UNAPPLIED PAYMENTS 0.00 AGENT NAME: HYLANT GROUP INC
TOTAL DUE 0.00 AGENT PHONE: (317) 817-5000
11 486.88
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 11 486.88
CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE.
CONTACT THE FOLLOWING ACCOUNTING SPECIALIST AT
O T EMAIL D1D800I356-4098D EXT.T08900 ANTONIO CONTRERAS
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TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9MN
HARTFORD, CT 06183
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00811 39147
CITY OF CARMEL,CARMEL CLAY
ONE CIVIC SQUARE
CARMEL IN 46032
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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))
01/31/13 000429949 $205.80
01/31/13 000430039 $2,194.45
01/31/13 000430554 $11,486.88
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
$13,887.13
ON ACCOUNT OF APPROPRIATION FOR
i
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 000429949 43-475.00 $205.80 I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1205 000430039 43-475.00 $2,194.45;
materials or services itemized thereon for
1205 000430554 43-475.00 $11,486.88, which charge is made were ordered and
i
received except
Monday, February 11, 2013
Director, Lministration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund