217925 03/12/2013 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1
' ONE CIVIC SQUARE TRAVELERS
CARMEL, INDIANA 46032 CHECK AMOUNT: $2,719.47
13607 COLLECTIONS CENTER DRIVE
CHICAGO IL 60693 CHECK NUMBER: 217925
CHECK DATE: 3/1212013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 432692 58 . 80 GENERAL INSURANCE
1205 4347500 432693 1, 161.30 GENERAL INSURANCE
1205 4347500 432694 1, 499 .37 GENERAL INSURANCE
TRAVELERS PAGE 1
GPO9313908 5216X7087 02/28/2013 03/15/2013 13,385. 16
CURRENT
CLAIM#: A3V2186 I DATE OF LOSS: 08/01/2009
DESCRIPTION: C- TRANCIK, THOMAS TORT NOTICE ALLEGEING CITY WILL NOT
INVESTIGATE A P
CLAIMANT: THOMAS TRANCIK
EXPENSE 13,326.36
CLAIM TOTAL 13,326.36
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 58.80
CLAIM TOTAL -8
CURRENT CHARGES 113,385. 16
ACCOUNT SUMMARY
CURRENT CHARGES 13,385. 16 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 13,385. 16
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 13 385. 16
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
E MAR 1 2013
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9MN
HARTFORD, CT 06183
00798 39159
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.
14N99887-ZPP 5216X7087 02/28/2013 000432693 03/15/2013 1 ,484.70
'-r Cc� CURRENT
CLAIM#: EWP1036 r DATE OF LOSS: 04/26/2012
DESCRIPTION: C - LANNAN, REBECCA EEOC CHARGE OF RETALIATION AND
DISABILITY DISCRIMI
CLAIMANT: REBECCA LANNAN
EXPENSE 1 , 161 .30
CLAIM TOTAL 1, 161.30
CURRENT CHARGES =, 161.30
ACCOUNT SUMMARY
CURRENT CHARGES 1 , 161 .30 INSURED NAME: CITY OF CARMEL,CARMEL CLAY PARKS BUILDIN
PAST DUE CHARGES 323.40 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 1,484.70
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 1 ,484.70
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 zj
OR 1 1 2013
By
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9MN
HARTFORD, CT 06183
00800 39157
CITY OF CARMEL, CARMEL CLAY PARKS BUIL
ONE CIVIC SQUARE
CARMEL IN 46032
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TRAVELERS JW PAGE 1
3036P64A-810 5216X7087 02/28/2013 000432694 03/15/2013 1,499.37
CURRENT
�7 0\1CS2_
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 865.00-
�� 'l,l. CLAIM TOTAL 865.00-
CLAIM#: ERY9279 11� DATE OF LOSS: 02/13/2013
DESCRIPTION: IV REAR ENDED OV THAT WAS EDGING FORWARD TO TURNRIGHT
ONTO 31 FROM 116
CLAIMANT: RUTH BASS
LOSS 2,364.37
CLAIM TOTAL 2,364.37
CURRENT CHARGES $1,499.3
ACCOUNT SUMMARY
CURRENT CHARGES 1 ,499.37 INSURED NAME: CITY OF CARMEL,CARMEL CLAY
PAST DUE CHARGES 0.00 AGENT NAME: HYLANT GROUP INC
UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (317) 817-5000
TOTAL DUE 1,499.37
DISPUTED ITEMS 0.00
ACCOUNT BALANCE 1 ,499.37
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
MAR 1 1 2013 ;
By
TRAVELERS
NON-FUNDED DEPARTMENT
ONE TOWER SQUARE -9MN
HARTFORD, CT 06183
00801 39156
CITY OF CARMEL,CARMEL CLAY
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
$2,719.47
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 000432692 43-475.00 $58.80 hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1205 000432693 43-475.00 $1,161.30
materials or services itemized thereon for
1205 000432694 1 43-475.00 $1,499.37_ which charge is made were ordered and
received except
Monday March 11, 2013
7
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))
02/28/13 000432692 $58.80
02/28/13 000432693 $1,161.30
02/28/13 000432694 $1,499.37
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