181090 01/13/2010 CITY OF CARMEL, INDIANA VENDOR: 00352984 Page 1 of 1
ONE CIVIC SQUARE FLEET SERVICES
1,, CARMEL, INDIANA 46032 0453 -00- 7946296
Po sox 6293 CHECK AMOUNT: $753.57
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CHECK NUMBER: 181090
CAROL STREAM IL 60197
CHECK DATE: 1/13/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231400 21750489 753.57 GASOLINE
FLEET SERVICES INVOICE /STATEMENT
INVOICE NUMBER: 21750489
ACCOUNT NAME: CARMEL FIRE DEPARTMENT
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0453 00 794629 6 6,000.00, 31 12 31 2009 01 26 2010 753.57
I DATE ACTIVITY DESCRIPTION CHA /DEBITS• PAYMENTS /CREDITS
3k
'12:1 72009 P, PAYMENT RECEIVED THANK YOU '-f'.',. 492.34
RETAIL FUEL PURCHASES e s 739.57
12 3.12009', MONTHLY CARD CMG 14.00
REMINDER
r w PLEASE BE SURE TO INCLUDE REMITTANCE STUB WITH
PAYMENT. MAIL TO THE ADDRESS SHOWN IN THE RIGHT
rt .a .h 1l r PORTION OF THE REMITTANCE STUB.
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PURCHASES. RETURNS AND PAYMENTS MADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT INVOICE /STATEMENT
PREVIOUS BALANCE )PAYMENTS (+)PURCHASES +)DEBITS )CREDITS +)LATE FEE =)NEW BALANCE
492.34 492.34 739.57 14.00 0.00 0.00 753.57
$10.00 MINIMUM LATE FEE
PAY ONLINE AT:www.wexonline.com
FEDERAL TAX ID: 84- 1425616 The Late Fee is determined by 1 Which is an ANNUAL To the Balance subject to late
applying a monthly periodic rate of PERCENTAGE RATE of fee for this period which is
2.00 24.00 0.00\
SEE REVERSE SIDE FOR MORE INFORMATION AND TERMS.
TO ENSURE PROPER CREDIT, TEAR AT PERFORATION AND INCLUDE BOTTOM PORTION WITH YOUR PAYMENT
ACCOUNT CARMEL FIRE DEPARTMENT CLOSING DATE: 12-31-2009
FLEET SERVICES ACCOUNT NO: 0453-00-794629-6
DELIVER TO:
DENISE SNYDER
CARMEL FIRE DEPARTMENT
2 CIVIC SO
CARMEL. IN 46032-2584
Tax Summary
TAX JURISDICTION ID EXPIRATION EXEMPTED TAX REPORTED TAX TAX TYPE TAX PRODUCT CLASS GALLONS GROSS COST TAX RATE
FEDERAL 356000972 '-5316 0.00 FEDERAL E85 290 470 714 20 0.18300
-10.42
FkrikRA 1
4d iY00 000 .7„ 6 9 40 41° 140.02
IN 356000972 0.00 10.25 STATE EXCISE GASOLINE 56.940 140,02 0 18000
-43.27 0.00 STATE SALES E85 290.470 714.20 0.07000
IN STATE TOTALS: :1; 121.: 9A!°,1NsE, 530 149 92 9 97999
ACCOUNT TOTALS 11465 10.25
(c) WRIGHT EXPRESS CORPORATION 2009 PAGE 1
FLEET SERVICES STANDARD REPORT
INVOICE NUMBER: 21750489
ACCOUNT NAME: CARMEL FIRE DEPARTMENT
PAGE 1 OF 2
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
L 0453 -00- 794629 -6 6,000.00 31 12 -31 -2009 01 -26- 2010 753.57
CARD LOCATION DATE TIME DRIVER ODOMETER PRODUCT UNITS COST! ITEM TOTAL
NO. NO. UNIT TOTAL AMOUNT
0001 MH 001 078 12 -16 -2009 17:46 SMITH, KEITH 14,500 [85 14.320 2.458 35.20 35.20
MH 001 074 12 -18 -2009 12:56 SMITH, KEITH 14,500 E85 11.800 2.458 29.01 29.01
MR 001 074 12- 23-2009 12:43 SMITH, KEITH 14,500 E85 10.840 2.459 26.66 26.66
MH 001 078 12 -29 -2009 17:07 SMITH, KEITH 14,500 E85 14.780 2458 36.33 36.33
CARD SUBTOTALS 51.740 127.20
0002 MH 001 078 11 -30 -2009 15:17 HULETT, MARK 58,489 E85 12.450 2.458 30.60 30.60
MH 001 078 12 -03 -2009 06:44 HULETT, MARK 58,704 E85 13.010 2.460 32.00 32.00
MH 001 074 12 -07 -2009 08:41 HULETT, MARK 58,915 E85 12.260 2.459 30.15 30.15
MI-1 001 074 12 -09 -2009 10:14 HULETT, MARK 59,079 E85 10.250 2.459 25.20 25.20
MH 001 078 12 -11- -2009 22:42 HULETT, MARK 59,272 E85 11.940 2.458 29.35 29.35
MH 001 074 12 -16 -2009 08:33 HULETT, MARK 59,473 E85 12.539 2.458 30.80 30.80
MH 001 078 12 -18 -2009 1 2:52 HULETT, MARK 59,650 E85 10.990 2.458 27.01 27.01
MH 001 078 12 -22 -2009 12:20 HULETF, MARK 59,882 E85 13.560 2.459 33.35 33.35
CARD SUBTOTALS 96.990 238.46
0003 MH 001 074 12 -02 -2009 09:02 STEELE, JEFF 8,843 E85 20.400 2.458 50.15 50.15
.G1001 065 12 -10 -2009 16:28 STEELE, JEFF 8,964 SUP 17.962 2.459 4417 44.17
Gl 001 065 12 -22 -2009 13:43 STEELE, JEFF 9,122 SUP 20.668 2.459 50.80 50.80
GI 001 065 12 -27 -2009 08:42 STEELE, JEFF 9,312 SUP 18.320 2.459 45.05 45.05
CARD SUBTOTALS 77.340 190.17
0004 MH 001 074 12 -07 -2009 07:38 HABOUSH, DAVE 20,390 E85 21.560 2.459 53.01 53.01
MH 001 074 12 -12 -2009 05:49 HABOUSH, DAVE 20,559 E85 17.590 2.459 43.26 43.26
MH 001 074 12 -17 -2009 07 :44 HABOUSH, DAVE 20,775 E85 22.340 2.459 54.94 54.94
MH 001 074 12 -20 -2009 17:48 HABOUSH, DAVE 20,968 [85 17.680 2.459 43.48 43.48
Mil 001 074 12- -24- -2000 10:4? Ht.80USI DAVE 21,10:3 E >15 19.W ;/€5° 4x -4819
MH 001 074 12 -29 -2009 21:03 HABOUSH, DAVE 21,390 [85 22.570 2459 55.51 55.51
CARD SUBTOTALS 121.340 298.39
TOTAL PURCHASES 347.410 854.22
Y -T -D PURCHASES 2,241183 5,085.09
SITES USED THIS MONTH NO. PURCHASES TOTAL AMOUNT
Location No. Brand Street City State Zip
MH 001 074 MEIJER 1426 W CARMEL DR CARMEL IN 46032 12 490.36
MH 001 078 MEIJER 5303 E SOUTHPORT RD INDIANAPOLIS IN 46237 7 223.84
GI 001 065 CRYSTAL FLAS 545 SOUTH RANGELINE CARMEL IN 46032 3 140.02
PRODUCTS: E85 ETH ANL 85 SUP= SUPER ON
VOUCHER NO. WARRANT NO.
ALLOWED 20
Fleet Services
IN SUM OF$
P.O. Box 6293
Carol Stream, IL 60197
$753.57
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 21750489 42- 314.00 $753.57 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
JAN 1 1 L010
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
21750489 $753.57
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