HomeMy WebLinkAbout219120 04/11/2013 CITY OF CARMEL, INDIANA VENDOR: 366179 Page 1 of 1
ONE CIVIC SQUARE LIBERTY MUTUAL INSURANCE CO CHECK AMOUNT: $100.00
CARMEL, INDIANA 46032 25762 NETWORK PLACE
CHICAGO IL 60673-1257 CHECK NUMBER: 219120
CHECK DATE: 4/11/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
802 4347500 KNOTT 100 . 00 BOND-KNOTT
Liberty Mutual Surety INVOICE
Invoice Summary KNOTT, BRUCE A
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 Apr 15,2013 100.00 US Dollars
Aging of Overdue Balances
Receivable account for US Dollars transactions is current as of Apr 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.
Please detach and return with check
Li
Mutual. ;
Payment Due By: Apr 15, 2013 Invoice Date: Apr 1, 2013
Total Due: 100.00 US Dollars Amount Paid:
Please include advice if paying less than total due.
KNOTT, BRUCE A LIBERTY MUTUAL INSURANCE CO.
2 CIVIC SQUARE 25762 NETWORK PLACE
CARMEL IN 46032 CHICAGO IL 60673-1257
Entity Number: 085401521
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Liberty DATE: April 1, 2013
Mutu'- Bond Transaction Detail
KNOTT, BRUCE A-085401521
Indianapolis
Transactions in US Dollars
Premium Now Due
Surcharges
Transaction Dividends Other Net Premium
LMS Bond✓< Alt Bond a Bond Description Bond Amount Obligee Period Premium Expenses Amount Cleared Balance
0
0 601004590 Pension Board Secretary Fire 15,000.00USD City of Carmel Fire 03101113.03101114 100.00 0.00 0.00 100.00
Department Department H
0
00 Total Premium Now Due in US Dollars 100.00 0.00 0.00 100.00
0
N Balance due Liberty Mutual Surety in US Dollars 100.00
0
0
0
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=Overdue
A Member of the Liberty Mutual Group
CITY OF CARIMEL
(Name of Governmental Unit)
FIRE Pension Fund
To Disbursing Officer:
The following is a schedule of Pension and Disability payments due members, or their dependents, for which it is requested
individual warrants be issued,payable from the above named fund.
Payment due April 2013
WARRANT NAME GROSS TAX AMOUNT OF
NUMBER PAYMENT WITHHELD WARRANT
Liberty Mutual Insurance Co. $100.00 $100.00
Pension Board Secretary Surety Bond
n
CERTIFICATE
I hereby certify that the foregoing amounts are just and correct d that n p e has been paid.
ecretary, Pension Fund
Claim No, Warrant No.
In Favor Of
Pensioners Scheduled Herein
Gross Payments: $100.00
Tax/Ins. Withheld: 0
Amount of Warrants: $ 100.00
On Account of Appropriation
For FIRE PENSION BOARD
I have examined the within claim and
hereby certify that same is in proper fonn and correct
and I hereby authorize payment of same.
Secretary FIRE Pension Fund
Afi4Boar,d ved for Payment by the
of rustees
Pre,de e Board
A.C.ROYCE CO.,MUNCIE,IND.89