HomeMy WebLinkAbout218132 03/13/2013 CITY OF CARMEL, INDIANA VENDOR: 366179 Page 1 of 1
ONE CIVIC SQUARE LIBERTY MUTUAL INSURANCE CO
CARMEL, INDIANA 46032 25762 NETWORK PLACE CHECK AMOUNT: $100.00
?` CHICAGO IL 60673-1257 CHECK NUMBER: 218132
CHECK DATE: 3/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
801 4347500 100 . 00 GENERAL INSURANCE
Liberty Mutual Surety INVOICE
Invoice Summary MILLER, ADAM C
Balance overdue 0.00 US Dollars
Balance currently due 100.00 US Dollars
Less unapplied funds 0.00 US Dollars
Total due Liberty Mutual Surety by Mar 15,2013 100.00 US Dollars
_ Aging of Overdue Balances -
Receivable account for US Dollars transactions is current as of Mar 1, 2013
Please direct any questions regarding this invoice to the National Bond Center at 888-844-2663 or bonds @libertymutual.com.
Please direct any payment inquiries to our Customer Accounting Department at 877-751-2640 or suretyinvoice @libertymutual.com.
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Liberty 1 INVOICE DATE: March 1, 2013
Mutual. Bond Transaction Detail
J MILLER,ADAM C -355394121
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Indianapolis
Transactions in US Dollars
Premium Now Due
Surcharges
Transaction Dividends Other Net Premium
LMS Bond a Alt Bond N Bond Description I Bond Amount Obligee Period Premium Expenses Amount Cleared Balance
0
0 601001685 Police Pension Secretary Police 15,000.00USD Carmel Police 05118113-05118114 100.00 0.00 0.00 100.00
N Pension Secretary Department
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CA Total Premium Now Due in US Dollars 100.00 0.00 0.00 100.00
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A Member of the Liberty Mutual Group
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995)
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.
LA J11or I Terms
Date Due
Invoice Invoice Description Amount
Date Number (or rp to attached invoice(s) or bill(s))
On
Total
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.
ibALLOWED 20 IN SUM OF $
$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#!TITLE AMOUNT
DEPT.# I 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
20
SidAatu re
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund