HomeMy WebLinkAbout228034 1 /14/2014 CITY OF CARMEL, INDIANA VENDOR: 00352999 Page 1 of 1
ONE CIVIC SQUARE HYLANT GROUP
CARMEL, INDIANA 46032 301 PENNSYLVANIA PKWY,SUITE 201 CHECK AMOUNT: $168,040.45
INDIANAPOLIS IN 46280 CHECK NUMBER: 228034
CHECK DATE: 1/14/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
302 5023990 010314 95, 830 . 45 OTHER EXPENSES
1091 4347500 34752 55, 648 . 00 GENERAL INSURANCE
1125 4347500 34752 16, 562 . 00 GENERAL INSURANCE
OHYLANT
GROUP �7
301 Pennsylvania Parkway,Suite 201 )AI'll 0 9 L(}(0,. INVOICE
Indianapolis,IN 46280-0925
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Phone:317-817-5000
LBY.___ CARME�80 79 1/3/20146.
W.Michael Wells
To: City of Carmel :
Attn:Steve Engelking 1/1/2014 1/1/2015 1/1/2014
One Civic Square _ �- On 0e
Carmel,IN 46032 $72,210.00
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Invoice# Trans Policy# Description Company Amount
34752 Renb H630561M4076TIL Property/IM Travelers $26,934.00
34754 Renb ZLP14T62033 Genf Liab Travelers $24,403.00
34748 Renb H8103036P64ACOF Auto Travelers $9,327.00
32366 Renb XC00000115 Umbrella National Casualty Co. $11,546.00
Amount Due $72,210.00
Prop/IM Genl Liab Auto Umb Total
Monon $ 23,294 $ 21,963 $ 10,391 $ .55 648
School,
All Other :$ .3,640 $ 2,440 $ 9,327 $ 1,165 $ 16,662
TOTALS 1 $ 26,934 $ 24,403 1 $ 9,3271 $ 11,6461 $ 72,2101
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L) -- `1341 S o v [;ascription
P.O.# P or F
l i_ GCJ�wt tn���o-c_,
Linenene Descr
Purchaser Date
"Y1 Li-bLi -15b a Approval Date I
C114 z
301 Pennsylvania Parkway,Suite 201,Indianapolis,IN 46280
Toll Free:800-678-0361 Local: 317-817-5000 Fax:317-817-5151
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
00352999 Hylant Group Terms
301 Pennsylvania Parkway, Suite 201 Date Due
Indianapolis, IN 46280-0925
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
1/3/14 34752 Annual insurance premium $ 16,562.00
1/3/14 34752 Annual insurance premium $ 55,648.00
Total $ 72,210.00
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
120
Clerk-Treasurer
i
Voucher No. Warrant No.
00352999 Hylant Group Allowed 20
301 Pennsylvania Parkway, Suite 201
Indianapolis, IN 46280-0925
In Sum of$
$ 72,210.00
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund / 109 -Monon Center
PO#or Board Members
Dept#
INVOICE NO. CCT#/TITL AMOUNT
1125 34752 4347500 $ 16,562.00 1 hereby certify that the attached invoice(s), or
1091 34752 4347500 $ 55,648.00 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
9-Jan 2014
Signature
$ 72,210.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
J''HYLANT
A GROUP
301 Pennsylvania Parkway,Suite 201 INVOICE
Indianapolis, IN 46280-0925
Phone:317-817-5000 CARME80 79 1/3/2014
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W.Michael Wells
To: City of CarmelEFFECT�V E fi?1RA'«iB�LA11±i �LiE'Ai�
it=_-• . _.
Attn: Steve Engelking 111/201L4 b1/1/2015
One Civic Square
Carmel, IN 46032 72855,45
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Invoice# Trans Policy# Description Company Amount
34747 Renb EWC008873 Excess WC Midwest Employers Casualty Co. $45,740.00
34746 Renb WC Risk Mgt Fee Risk Mgt Fee Hylant $10,000.00
34799 Newb BL04659054 Excess Occupational Great American E&S Insurance Co $16,698.00
Accident Buffer Layer
34799 GTAX BL04659054 IN Surplus Lines Tax Great American E&S Insurance Co $417.45
Amount Due $72,855.45
Submitted T®
JAN 13 2014
L_SC�IerkTreasurer
301 Pennsylvania Parkway,Suite 201,Indianapolis, IN 46280
Toll Free: 800-678-0361 Local: 317-817-5000 Fax:317-817-5151
1MYLANT
GROUP
301 Pennsylvania Parkway,Suite 201 INVOICE Page 1
Indianapolis, IN 46280-0925 ACCOL�Nl Cts` DATA
Phone:317-817-5000 CARME80 79 1/3/2014
W. Michael Wells
o' City of Carmel ECI IVE EXPIi A_;BNLAKE Q1 E 0th=
Attn: Steve Engelking 1/1/2014 1/1/2015 1/1/2014
One Civic Square
Carmel, IN 46032 $22,975.00
Ii1/t10E F.ORt... _
r.
:t.
Invoice#Trans Policy# Description Company Amount
Renb 0385 TPA Service Fee CMI-York $22,975.00
1 st of 2 Installments
Amount Due $22,975.00
I
S Submitted To
JAN 1 32014 To
srt ' Sub�6"
301 Pennsylvania Parkway, Suite 201, Indianapolis, IN 46280
Toll Free: 800-678-0361 Local: 317-817-5000 Fax: 317-817-5151
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
HYLANT GROUP Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
0
0
1103/ 11 03 14-
Total $95'
830. 5
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
20Clerk-Treasurer
VOUCHER NC06/03/13 WARRANT NO.
ALLOWED 20
HYLANT GROUP
IN SUM OF $
301 Pennsylvania Parkway, Suite 201
Indianapolis, IN 46280
$ $95,830.45
ON ACCOUNT OF APPROPRIATION FOR
302 WORK COMP FUND
Board Members
PO#or DEPT.# INVOICE NO. ACCT#/TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
01.03.14 302 $72,855.45 materials or services itemized thereon for
01.03.14 302 $22,975.00 which charge is made were ordered and
received except
20
y
-Sig at e
!
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund