HomeMy WebLinkAbout187673 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 069001 Page 1 of 1
ONE CIVIC SQUARE CRYSTAL FLASH PETROLEUM
CHECK AMOUNT: $1,157.63
CARMEL, INDIANA 46032 PO BOX 105080
ATLANTA GA 30348 -5080 CHECK NUMBER: 187673
pion o
CHECK DATE: 7/21/2010
DEPARTMENT ACCO PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231400 BG1297998 .-752.88 GASOLINE
1205 4231400 NP25552233 X210.24 GASOLINE
1110 4231400 NP25552234 _,194.51 GASOLINE
26]3M1Ot.]O idO]OifiSflllt,fg115
Local Office: Crystal Flash Petroleum PL
PO BOX 105080 For billing questions call: (800) 903 -9368
ATLANTA, GA 30348 -5080
Account BG1298138
Please reference account on all payments
I�I I II1 II II IIII) II� II �li 111 STATEMENT NP25552234
I i DATE 07/02/2010
CITY OF CARMEL POLICE DUE DATE 08/01/2010
1 CIVIC SQ TOTAL BALANCE DUE $194.51
CARMEL IN 46032 -2584
PAYMENT TERMS Net 30 MN
For online statements and simple, automated payment setup, contact customer service at cardservices @fleetcor.com.
DESCRIPTION OF CURRENT ACTIVITIES
Services and Fees as reported 6/30/2010
Date Description Gallons Amount Due
06/25/2010 PAYMENT: Lockbox Payment Thank You
$407.13 CR
07/02/2010 Fleet 1315510 Name: CITY OF CARMEL POLICE 68.703 $194.51
Current Activity
Previous
Statement Prior Balance Payments and Gallons Charges Total Balance Due
Date Adjustments
06/01/2010 $407.13 $407.13 CR 68.703 $194.51 $194.51
FOR PROPER PAYMENT POSTING, PLEASE SUBMIT YOUR CHECK WITH ONLY THE RFMITTANCF C,0Pv ?ELOw_
2673 w1.20lW70t65841. W i l l
CRY P.FL.��sl�il.
PO BOX 105080 FLEET MANAGEMENT REPORT
ATLANTA, GA 30348 -5080 Account BG1298138
FLEET 1315510
Provided By: Name: CITY OF CARMEL POLICE
Crystal Flash Petroleum PL
(800) 903 -9368 MATCHING STATEMENT NP25552234
Page: 1 of 1
CITY OF CARMEL POLICE
1 CIVIC SQ
CARMEL IN 46032
FLEET MANAGEMENT REPORT FOR 6!112010 6!3012010
SUMMARY OF TRANSACTIONS THIS REPORTING PERIOD FOR ALL VEHICLES IN YOUR FLEET
PRODUCT QUANTITY BASE PRICE FEDERAL STATE OTHER TOTAL
UNL 22.127 $48.45 $4.11 $7.62 $0.00 $60.18
PREM 46.576 $109.17 $8.64 $16.52 $0.00 $134.33
r� rZa p
TOtdI N 3 iC •.t a¢s M ai a n% z�ti S m a
68 70.3 $157 62 pE 7, 14y,I$U:00� ,$194 €51E
This report is for information only.
Please see remittance copy on the statement for the total payment amount.
TOTAL MILES: 1,372
EXCEPTION CODES:
11 Odometer entry is out of sequence.
Transactton` "Detail r Customer,N0; 1315510= {CIT OF CARM'EL POL C %112010 `613Q12010
fo s
,vHuar.�.:u >�tkdtrW?$
FUEL NET TOTAL EXCEPT
DATE TIME SITE DRIVER ODOMETER MPG TYPE QTY PRICE TAXES AMT CODE
Fi c �,f`i rxa E
144 CAR 144, P
0 2 21 a "rte r x IX �s¢�` y w
06121 14.13 885419 DRIVER 10 13733 0.0 UNL 17.562 2.17060 0.52850 $47.40
Miles: 17.562 $47.40
r�gIc �5? L g; 1a ie 1e§i'g" i i� rm' c1 p 4
t A ,1 sE''".:,�� y
K k h t Y,¢, a Y 9 s 4 E
r, uu, M.r,"z 3 ,.a�11E -(`ei� .Ips
06/11 09:38 885419 DRIVER 10 1669 0.0 PREM 4.176 2.32280 0.53874 $11.94
06/17 08:00 885419 DRIVER 10 1793 32.5 PREM 3.819 2.32000 0.53825 $10.92
06125 09:13 885419 DRIVER 10 1920 32.3 PREM 3.929 2.50700 0.55152 $12.02
Miles: 251 32.4 11.924 $34.88
5 T1 -"-a y"•° ��t `ka
567168 -CAR 1;19 a i
t -;t. 3 vxi.,s #L.Y�'..�___.. „wM.
06/02 G8:31 885419 DRIVER 10 1333 30.6 PREM 3.105 2.23510 0.53371 $8.60
06/02 14:35 885419 DRIVER 10 1482 41.7 PREM 3.575 2.23780 0.53254 $9.90'
06107 13:39 885419 DRIVER 10 1613 34.2 PREM 3.828 2.35890 0.54048 $11.1v
06/14 09:48 885419 DRIVER 10 1730 28.3 PREM 4.127 2.32130 0.53825 $11.80
06/16 08:56 885419 DRIVER 10 1840 34.6 PREM 3.182 2.32240 0.53932 $9.10
06/23 09:17 885419 DRIVER 10 1957 35.1 PREM 3.334 2.50750 0.55286 $10.20
06/29 11:04 885419 DRIVER 10 2085 33.9 PREM 3.776 2.46820 0.55069 $11.40
Miles: 847 34.1 24.927 $72.10
e,?+'�kP E' �3 GPFF pm s
a�; f w
u�
06102 08:32 885419 DRIVER 10 1413 0.0 PREM 1.390 2.24460 0.53417 $3.85 11
06102 14:35 885419 DRIVER 10 1562 40.3 PREM 3.701 2.23450 0.53261 $10.25
06109 10:34 885412 DRIVER 10 6399 0.0 UNL 4.565 2.26290 0.53581 $12.78
06119 14:16 885419 DRIVER 10 6524 27.0 PREM 4.634 2.31980 0.53991 $13.25
Miles: 274 33.7 14.290 $40.13
SITE LEGEND
SITE SITE NAME ADDRESS CITY STATE
885412 Crystal Flash 441 10598 N College Ave Indianapolis IN
885419 Crystal Flash #67 545 S Rangeline Rd Carmel IN
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
Crystal Flash Petroleum Purchase Order No.
P.O. Box 105080 Terms
Atlanta, GA 30348 -=5080 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
7/2/10 monthl a ent 194.51
Total
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
C ry.gtal Flash Petroleum IN SUM OF
P.O. BOX 105080
Atlanta, GA 30348-5080
194.51
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
PO# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 314 194.51 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
July 13 20 10
1
Signature 1 7
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
2673101 e1nQ? ,,M01. pIMJ,]
Local Office: Crystal Flash Petroleum PL
PO BOX 105080 For billing questions call: (800) 903 -9368
ATLANTA, GA 30348 -5080
Account BG1298100
Please reference account on all payments
1111 1 1 1 II 1 967 STATEMENT NP25552233
DATE 07102/2010
CITY OF CARMEL- MAINTENANCE DUE DATE 08/01/2010
1 CIVIC SQ TOTAL BALANCE DUE $21 0.24
CARMEL IN 46032 -2584
PAYMENT TERMS Net 30 MN
For vn ii ne statements and simple, automated payment sentup contact customer c 2r� ;ce at rnrcicura��r"Sufi°°tcnr nn�
DESCRIPTION OF CURRENT ACTIVITIES
Services and Fees as reported 6/30/2010
Date Description Gallons Amount Due
07/02/2010 Fleet 1315492 Name: CITY OF CARMEL- MAINTENANCE 78.348 $210.24
P Q
"I'll",
By
Current Activity
Previous
Statement Prior Balance Payments and Gallons Charges Total Balance Due
Date Adjustments
0610112010 $0.00 $0.00 78.348 $210.24 $210.24
FOR PROPER PAYMENT POSTING, PLEASE SUBMIT YOUR CHECK WITH ONLY THE REMITTANCE COPY BELOW.
267.1101 2010070165801 M%7
C/4YST.4L7-j=LASh/.
PO BOX 105080 FLEET MANAGEMENT REPORT
ATLANTA, GA 30348 -5080 Account BG1298100
FLEET 1315492
Provided By Name: CITY OF CARMEL- MAINTENANCE
Crystal Flash Petroleum PL MATCHING STATEMENT NP25552233
(800) 903 -9368
Page: 1 of 2
CITY OF CARMEL MAINTENANCE
1 CIVIC SQ
CARMEL IN 46032
FLEET MANAGEMENT REPORT FOR 6/1/2010 6/30/2010
SUMMARY OF TRANSACTIONS THIS REPORTING PERIOD FOR ALL VEHICLES IN YOUR FLEET
PRODUCT QUANTITY BASE PRICE FEDERAL STATE OTHER TOTAL
UNL 16.534 $37.73 $3.08 $5.80 $0.00 $46.61
PREM 38.418 $89.11 $7.15 $13.58 $0.00 $109.84
E85 23.396 $49.45 $4.34 $0.00 $0.00 $53.79
1
13r�: a:��'1
0 14 57 b x$19 38� w .$0 00$210
�t
This report is for information only.
Please see remittance copy on the statement for the total payment amount.
TOTAL MILES: 386
DEPARTMENTAL SUMMARIES
DEPT !BASE .FED k STAI E�, LOCAL
RI MAINTfOTH EXTENDED EXCEP f
DEPARTMENT�NAME� IQTY' r'
PCE TAXES i TAXES T�AXES� (No'n Fuel) 1 TOTAL COUNT?
MAYOR 809016 78.348 176.29 14.57 19.38 0.00 5 0.00 210.24 1
EXCEPTION CODES:
11 Odometer entry is out of sequence.
FLEET MANAGEMENT REPORT
Account BG1298100
FLEET 1315492
PO BOX 105080
ATLANTA, GA 30348 -5080 Name: CITY OF CARMEL- MAINTENANCE
MATCHING STATEMENT NP25552233
Page: 2 of 2
Transaction Detail�for NO 1315492,�� CITY OFCARMEL MAINT�N,�4�NCE, fi11i201D, 6/3012090 a tr
Department: MAYOR
FUEL NET TOTAL EXCEPT
DATE TIME SITE DRIVER ODOMETER MPG TYPE QTY PRICE TAXES AMT CODE`*
rb"`r a 7"Y'� a"�.
T1 x,3 f 8i s s a.. '�iia r"
�0�s �a�a.
z �u4iz£n uzs,3w:.k .arm. puv�. .:a �,"r;wr ..n, �n e s�
06101 1125 885419 MAYOR 1954 0.0 E85 10.878 2.11340 0.18590 $25.01 11
06108 12:59 885419 MAYOR 1954 0.0 E85 12.518 2.11380 0.18590 $28.78
06110 12:27 885419 MAYOR 2340 20.6 PREM 18.695 2.31930 0.53905 $53.45
06118 09:22 885419 MAYOR 2340 0.0 PREM 19.723 2.31960 0.53916 $56.39
06129 09:24 885419 MAYOR 2340 0.0 UNL 16.534 2.28200 0.53618 $46.61
Miles: 386 20.6 78.348 $210.24
Department: MAYOR UNL 16.534 $46.61
PREM 38.418 $109.84
E85 23.396 $53.79
Department Totals 78.348 $210.24
SITE LEGEND
SITE SITE NAME ADDRESS CITY STATE
885419 Crystal Flash #67 545 S Rangeline Rd Carmel IN
VOUCHER NO. WARRANT NO.
ALLOWED 20
Crystal Flash
IN SUM OF
PO Box 105080
Atlanta, GA 30348 -5080
$210.24
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
PO# 1 Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1205 I NP25552233 I 42- 314.00 I $210.24 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
Friday, July 16, 2010
Director, Administratio
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
Da te Number (o r n ote a invo or bill(s))
07101/10 NP25552233 $210.24
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
1 20
Clerk- Treasurer
07/02/2010 3;31;13 PM —0500 FLEETDETAILS PAGE 2 OF 4
L.
gRVS P
Local Office: Crystal Flash Petroleum PL
PO BOX 105080 For billing questions call: (800) 903 -9368
ATLANTA. GA 30348 -5080
Account BG1297998
Please reference account on all payments
STATEMENT NP25552232
DATE 07/02/2010
CITY OF CARMEL -FIRE DUE DATE 08101/2010
1 civic so
CARMEL IN 46032 TOTAL BALANCE DUE $752.88
PAYMENT TERMS Net 30 MN
For online statements and simple, automated payment setup, contact customer service at
cardservices @fleetcor.com.
DESCRIPTION OF CURRENT ACTIVITIES
Services and Fees as reported 6/30/2010
Date Description Gallons Amount Due
06/1212010 PAYMENT: Lockbox Payment Thank You $747.65 CR
071U2/201 0 Fleet 1315390 Name: CITY OF CARMEL -FIRE 321380 $752.88
Current Activity
Previous
Statement Prior Balance Payments and Gallons Charges Total Balance Due
Date Adjustments
06/01/2010 $747.65 $747.65 CR 323.380 $752.88 $752.88
FOR PROPER PAYMENT POSTING, PLEASE SUBM EMITTANCE COPY BELOW.
07/02/2010 3:31:13 PM -0500 FLEETDETAILS PAGE 3 OF 4
PO BOX 105080
FLEET MANAGEMENT REPORT
ATLANTA, GA 30348 -5080 Account BG1297998
FLEET 1315390
Provided By, Name: CITY OF CARMEL FIRE
Crystal Flash Petroleum PL MATCHING STATEMENT NP25552232
(800) 903 -9368
Page: 1 of 2
CITY OF CARMEL -FIRE
1 CIVIC SQ
CARMEL IN 46032
FLEET MANAGEMENT REPORT FOR 61112010 6/30/2010
SUMMARY OF TRANSACTIONS THIS REPORTING PERIOD FOR ALL VEHICLES IN YOUR FLEET
PRODUCT QUANTITY BASE PRICE FEDERAL STATE OTHER TOTAL
UNL 45.293 $100.41 $8.41 $15.66 $0.00 $124,48
E85 278.087 $576.71 $51.69 $0.00 $0.00 $628 40
:;r.:r..,::r:;ca•:r.:r':r. ^.r .x•,a:r'::.•::ra x r: �;:;.•:r::r:cr. z:; :;r.sr. ;r. :;:cr.•;e. ^:';r.•;;:.x z:•ss, ;;r: x: �:�;r:r.':z: ;r. cr:, a; a: ;z. r. s•�: z: s: ;;:cz: �'r:.'�r;[.'•xmr.':r:':r.
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.ro;s��l,s(.ah�il.srr,s rt��a,t;,ft,f�. xr•f;r l,4,,,ss! ,,s�,s.\!a'�," ,s ,;c:rr, ,,F4�u( ,r :{;:;.,�,,s�Y,�:r.Ch: >t: .c.,i,t <,r s"'yt s�.
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This report is for information only.
Please see remittance copy on the statement for the total payment amount.
TOTAL MILES: 2,605
EXCEPTION CODES:
11 Odometer entry Is out of sequence.
t L't• ^l c t q t..i,, t.,,,:¢tt•Ln. V,LCC.. ,..mc,'Flw:.•S:.R r ye c,t:c••1._t'.'c,.,:,'r .t...., {r'•l ^•t.. l •,i G r
5 s 5 r >+s su a�;5:, ,s;�::..�:� 2 j r. Sr t •F•� �s� u�, 'a�;_�`�`�����: 5 5 S:�
sa'� �'f�fl�Drr�� s. i. �,c R o 1 f`' �r��t��. y� �h t�,< �;fey g ^�ii�yl k f` 5 G i ,��g
r ar�:4�rYa�C,iks''•�k'.c:; >7 „a lro�avata��s: Stns;= r:`;: i_ yyvbu��, SY�r r.-. r f;, a�� _�ri;,:a\"tifi -.7 �vu:.rlrf?: Y r. r, ��i, i��: s 1:: ��4 .,Ft,n^'�1'F§Ivi- Sys,t ',fps >':`i 1.t.Y�t Tit.+ Ata
FUEL NET TOTAL EXCEPT
DATE TIME SITE DRIVER ODOMETER MPG TYPE QTY PRICE TAXES AMT CODE"
a >r. ;,;.y;,,;,.;,..amr :rw ^:n�. ;n.;v r rr r r; v ..q... �.,;r ^.y ,,;,.,;v, :r r•,;r•;r a,'.n..;.
q�: f�r 7c4c:.. _Fj' cc�� chi.. k5; 2 a: 2:! i; �c' r ca'; v c. a•. c S., r�. 2 .k. r,.c, c.r�.c,.a v' c.fhc, .c.F_�•F„5 tu'' 'r�r.?r.r „�sk.�,8 r „a.c. .�,�.c.k.�".'c�. �e
.�7�,�61�',rs '±��593Sx`§K 1F>t,e a v.;,.r 1vkc�fv,�,.)r c 1� �;r 7 1t-1 r; 't fv .e'� y �a 5 Er^ 1k Y{ a r 1 Y}� 1� i p)4 T rr,F`?Crs�•E`N r F 1 ei��G li
a. ,,.:ar a��. �?r`, a_r�;t:���i,k,�,�,�Y�A<„i� s ��fi�i?: >f „�,x,, ,,��'axsn�,� :'�`,z�,;4� r�� z.. rt�.: ��?r':; i?� „h�:?��,�;eh��ai�z{i�.>&'�,�'r� i�:e,� 4 fib`, {is;..,'! �a.��,,1,���'�;afr�, +h't�•�� r:,��:,af�r,��,;,>��u>ti ��I
06121 11:30 885419 DRIVER 1 26934 0.0 E85 18.672 2.01260 0.18590 $41.06
Miles: 18.672 $41.06
,x,,.A. r••; -r c _...:;.z. r .':r::x z•x a: 'r.:r:. o• "aa,. r:. ns.r. ::z:.r. r.:r.r z :..x
,,7): )`?i.•.i. rr.'[.. T.fra�r r.r {xf s iY rir,tr [ir, i F t P.. S. h.f. E s,.,,. -t 3st s -f s...f '3ifi ,t. d. ,G {.i ^•..f i z:.
3 ..fit, 'rt 4. r. 3� h'••h N ,S1iEs3.'r cc l..sf.c+t!•." M, rl. {1... S, !t a .r J, r r, r i rj'$:ir N(f-. f i •t �t r:'
t. ...4. h C <t 6,5 i, t•�; ttr�'L lt1 h #•:N•. ,.x,. l� l �1N'{i11 i�, {�t. r r).. 1 .•yl i, \!C\.�, r I�l trL y3. L h�'f;�L i fr.l j�5 vr;
°�"�gci�tc�v�rr�dil,�`: ski,={ c, 3. t: �J<. �?f, �xS, z���„ vG:,'. f ,t<,E:.Err.,Z�t�ct�x,��}3x�irl; Diu. a!; �1rya l�. s. t. tl�,. f�U.',<: �E; t�ilrc�' t? Ir„ v` i �n r!✓, �rk�. ��v�>,. �A;. ruhrs�' ic<, ��1 .�,a�cG�a���i,:G�x ��Yr. >.�x�..,
06101 08:37 885419 DRIVER 1 14500 0.0 E85 23.057 2.11350 0.18590 $53,01
06104 08 :40 885419 DRIVER 1 14500 0.0 L85 17.899 211300 0.18590 $41.15
06107 08:43 885419 DRIVER 1 14500 0.0 E85 15,432 2.11310 0.18590 $35.48
06114 08 :07 885419 DRIVER 1 14500 0.0 UNL 23.174 2.13340 0.52607 $61.62
06{18 08:25 885419 DRIVER 1 145000 0.0 E85 16.280 2.11300 0.18590 $37.43
06121 08.37 885419 DRIVER 1 14500 00 E85 13.762 2.11310 0.18590 $31.64 11
06123 08:35 885419 DRIVER 1 14500 0.0 UNL 12.623 2.32040 0.53909 $36.09
06125 10:34 885419 DRIVER 1 14500 00 E85 11.255 2.01330 0.18590 $24.75
06128 12:50 865419 DRIVER 1 14500 OA E85 14.497 2.01350 0.18590 $31.88
06130 12.52 885419 DRIVER 1 14500 0.0 UNL 9.496 2.28310 0 -53597 $26.77
Miles: 157.475 $379.82
+w t :......::'ec:..: ,.wi::.'
s Y I ,Y 7 S Y Z' r r z Y' f Y Y f Y K.Y Y F'. w •f-".. x X •'xis' i'Y':Y. Yj "P &:S' "i;Z' ":x a". i
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06/04 08:28 885419 DRIVER 1 68251 0.0 E85 13.484 2.11290 0.18590 $31.00
06108 13:2 -1 885419 DRIVER 1 68706 36.1- -E85 12.614 2.11350 0.18590 $29.00
Miles: 455 36.1 26.098 $60.00
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06102 15:29 885419 DRIVER 1 93167 10.8 E85 12.370 2.11400 0.18590 $28.44
06104 16:10 885419 DRIVER 1 93331 11.3 E85 14.462 2.11310 0 -18590 $33.25
06107 16:38 885419 DRIVER 1 93508 12.0 E85 14.810 2.11340 0.18590 $34.05
06110 16:58 885419 DRIVER 1 93682 12.0 E85 14.475 211330 0 -18590 $33.28
06122 03:38 885419 DRIVER 1 94701 47.1 E85 21.641 2.01330 0.18590 $47.59
06122 1623 685419 DRIVER 1 94738 6.3 E85 5 -866 2.01330 0.18590 $12.90
06/24 16:12 885419 DRIVER 1 94940 12.0 E85 16.766 2.01300 0.18590 $36.87
06/28 0828 885419 DRIVER 1 95184 11.8 E85 20.745 2.01300 0- 18590 $45 -62
Miles: 2150 15.4 121.135 $272.00
07/02/2010 3:31:13 PM -0500 FLEETDETAILS PAGE 4 OF 4
FLEET MANAGEMENT REPORT
Account BG1297998
Po Box 105080 FLEET 1315390
ATLANTA, GA 30348 -5080
Name: CITY OF CARMEL -FIRE
MATCHING STATEMENT NP25552232
Page: 2 of 2
SITE LEGEND
S ITE S ITE NAME ADDRESS C ITY S TATE
885419 Crystal Flash #67 545 S Rangellne Rd Carmel IN
VOUCHER NO, WARRANT NO.
ALLOWED 20
Crystal Flash
IN SUM OF
P.O. Box 684
Indianapolis, IN 46206
$752.88
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 BG1297998 42- 314.00 $752.88 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
UL 19 2010
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))
BG1297998 $752.88
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