218647 03/25/2013 CITY OF CARMEL, INDIANA VENDOR: 362876 Page 1 of 1
` ONE CIVIC SQUARE TRAVELERS
CARMEL, INDIANA 46032 13607 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $19,008.00
CHICAGO IL 60693 CHECK NUMBER: 218647
«ON�
CHECK DATE: 3/25/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 425663 588 . 00 PERFORMING ARTS CENTE
902 4460807 427819 18, 420 . 00 PERFORMING ARTS CENTE
Non-Funded Deductible Collections & Billing System Page 1 of 1
TRAVELERS J,
DEDUCTIBLE / SELF-INSURED INVOICE (copy)
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE
GP09315757 5216X7087 12/31/2012 427819 1/15/2013 $26,615.60
MAIL PAYMENT TO' PAYER ADDRESS:
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.
AM
TRAVELERSJ
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE
GP09315757 5216X7087 12/31/2012 427819 1/15/2013 $26,615.60
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 $7,607.60
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 1-800-3S6-4098 EXT.08900:ANTONIO CONTRERAS
// illin rodlb.travD.net/WBDl NONFUNDED/ViewBilldtiv4.aspx?blllnum=427... 2/15/2013
Non-Funded Deductible Collections & Billing System Page 1 of 1
A
TRAVELERS)
DEDUCTIBLE / SELF-INSURED INVOICE (copy)
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE
GP09315757 5216X7087 11/30/2012 425663 12/15/2012 $20,574.41
MAIL PAYMENT TO: PAYER ADDRESS:
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.
TRAVELERSJ�
THE TOTAL DUE INCLUDES PAST DUE CHARGES.
PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY.
POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE
GP09315757 5216X7087 11/30/2012 425663 12/15/2012 $20,574.41
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
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
http://dedbilling.pi,odlb.travp.net/WBDI_NONFUNDED NiewBilldtiv4.aspx?billnum=425... 2/15/2013
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
Tn ye lerS Purchase Order No.
13 607 to I le(�w 5 64e j- Pr, Terms'
I L 666 `) Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
ri er .rider rw < < dolt) Jg z o0
� �r s do
A 06
Total A
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor-
dance with IC 5-11-10-1.6.
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
V'e`ers IN SUM OF $
13 �a7 �o I lec+tons Center dr. '
C�►��a90�T � 6063__- -
$ Igloos",
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or DEPT# INVOICE NO. ACCT#/TITLE AMOUNT I hereby certify that the attached invoice(s),
V- or bill(s) is (are) true and correct and that
42 5 6 67 S the materials or services itemized thereon
for which charge is made were ordered and
received except
.20 t3
'Signature
Executive Director
Title
Cost distribution ledger classification if Carmel Redevelopment Commission
claim paid motor vehicle highway fund