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Home My WebLink About228615 1/28/2014 �.F CITY OF CARMEL, INDIANA VENDOR: 366179 Page 1 of 1 ONE CIVIC SQUARE LIBERTY MUTUAL INSURANCE CO CARMEL, INDIANA 46032 25761 NETWORK PLACE CHECK AMOUNT: $100.00 CHICAGO IL 60673-1257 CHECK NUMBER: 228615 CHECK DATE: 1/28/2014 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 802 4340000 601004590 100 . 00 LEGAL FEES Someday is Today,LLC Libo-I'v Abilual 71161 71STST INDL\NAP0IJS,IN 46256-1997 Liberty Mutual Surety Bond Invoice 2974 1 MB 0.402 ****AUTO**MIXED AADC 290 Statement Date: 12/04/2013 111„1.1111111'111'11111111111111111111111111��l�lilll'111 "�' Premium: 100.00 KNOTT BRUCE A 002974 Applicable'Taxes: 0.00 2 CIVic SQ 2974 Applicable Fees: 0.00 CARMEL IN 46032-2584 15 PP Amount Due: 100.00 Payment Due Date: 1/18/2-014 Ntake checks payable to: Liberty AftutuA Bond Number: 601004590 Your Liberty Mutual Surety Bond Activity Summary Effective Date: 3/01/2014 Bond Description: Renewal -New Bond Official Pension Board Secretary Fire Department Obligee: City of Carmel Fire Department Headquarters Issuing Company: Ohio Casualty Insurance Company Billing is automatic until the bond is cancelled. If your bond is no longer needed or required, please notify your agent for cancellation.Thank you! For billing questions or to pay by credit card,please call the Liberty il4utual Surety Billing Center at 1-800-773-3312 PLEASE DO NOT SEND ANY CORRESPONDENCE WITH YOUR PAYMENT; I7'T71rC' AIf AXr Tri Acr STT ir' TT��rnniwr� �r�ri-.r rr� .�♦�r�rr�.r.. Help Us To Sen e You Better: Please remember to include the bottom portion of this invoice wdli your payment. This will assist us in properly crediting your account. Please clo not send any corresponclence witli your reniitt:ulce;this nlay delay the processing of your payment. in aciclition,please assist us by inclicating your boncl number on your check,making check payable to Liberty A4utual,and using the return envelope provicled for your convenience. Premium: Total amount clue after applying all payments, credits, or additional charges since the last billing. Applicable Taxes \\%Here applicable, these fees are assessed by your state and local g(-wen relent and & Fees: are sent from 1_,11)crty !\,luteal to the appropriate government agency. A\"here applicable, these fees are assessed by your agent and sent from Liberty 1\4uttilal to your agent of record. Mailing Instructions: Please mail :it least fifteen days prior to the pavnnent due date. Pavnlents not recelved ill a tunely manner are sub;ect to cancelLltion Credit Card Payments: YOU Call p:1y 11-IIS 111y0ICe by USlllg yOUr A'ISa(R�, !\4astercard(R), or Anierlcau 1'xpress(R) Card. To pay I)y credit carol, please call our billing center at 1-800-773-3313. Billing Questions or Issues: Liberty 1\luteal 1333 t\-lain Street,Suite 600 Columbia,SC 29201 1-800-773-3312 Ytcase Note: To clispute the premium amount owed, please send a written notification to the address shown above. "this written notification must be receivecl prior to the paynneot clue date. `the following iifomlation should be included: 1) Name appearing on bond 2) Bond number 3) Any supporting documentation which may offer further explanation of the sunoallt in dispute Upon receipt of the vyntten notification vve will suspend billuig of the :unount it question until a resolution to your clispute can he made. However, you «1111 still he requirecl to pay in full the undisputed amount by the payment clue date shovvn on this billing notice. Bond Questions or Issues: Contact your local agent. (See activity sunnnlary for agent Contact ilformation.) VOUCHER NO. WARRANT NO. ALLOWED 20 Liberty Mutual Insurance Company IN SUM OF $ 25761 Network Place Chicago, IL 60673 $100.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 601004590 I $100.00 1 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 JAN 2 7 9 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund 'rescribed by State Board of Accounts City Form No.201 (Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL kn invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by vhom, 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)) 601004590 Pension Secretray Bond $100.00 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