190158 09/29/2010 CITY OF CARMEL, INDIANA VENDOR: 00352984 Page 1 of 1
ONE CIVIC SQUARE FLEET SERVICES CHECK AMOUNT: $723.55
�4S CARMEL, INDIANA 46032 0453 -00- 7946296
PO BOX 6293 CHECK NUMBER: 190158
CAROL STREAM IL 60197
CHECK DATE: 9/2912010
DEPARTMENT ACCOUNT P N UMB ER INVOICE NUMBE AMOUNT DESCRIPTION
1120 4231400 23797406 723.55 0453 -00- 794629 -6
FLEET SERVICES INVOICE/STATEMENT
INVOICE NUMBER: 23797406
ACCOUNT NAME: CARMEL FIRE DEPARTMENT
PAGE 1 OF 1
ACCOUNT NUMBER
LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0453 DO 794629 6 6 000.00 31 08 31 2010 49 24 2010 723.55
DATE ACTIVITY DESCRIPTION CHARGES /DEBITS PAYMENTS /CREDITS
08 -23 -2010 PAYMENT RECEIVED THANK YOU 733.40
08 -31 -2010 RETAIL FUEL PURCHASES 709.55
08 -31 -20.10 MONTHLY CARD CHG 14.00
REMINDER
PLEASE BE SURE TO INCLUDE REMITTANCE STUB WITH
PAYMENT. MAIL TO THE ADDRESS SHOWN IN THE RIGHT
PORTION OF THE REMITTANCE STUB,
PURCHASES, RETURNS AND PAYMENTS MADE ,LUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT {NVOICE /STATEMENT
PREVIOUS BALANCE )PAYMENTS PURCHASES I +)DEBITS )CREDITS +)LATE FEE —)NEW BALANCE
733.40 733 -40 709.55 14.00 0.00 0.40 723.55
$10.00 MINIMUM LATE FEE
PAY ONLINE AT: www.wexonline.com
CALL CUSTOMER SERVICE TO PAY BY PHONE The Late Fee is determined by which is an ANNUAL To the Balance subject to late
FEDERAL TAX 0 84 1425616 applyiDg 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 C REDIT TEAR AT PERF ORATION AND INCLUDE RnT'__
Balance Subject to Late Fee Payment Options
The late fee will be calculated by determining the total balance Mail
due on the date your account becomes delinquent, as follows: Be sure to include bottom portion of invoice with your payment.
adding the total amount due on your account on the payment due Write your account number or invoice number on the check to help
date together with any purchases posted to your account from avoid delays in payment processing if the check and remit stub
the end of the last billing cycle through the payment due date and become separated.
subtracting from that amount any payments and /or credits entered
during that period. The total balance due will then be multiplied Allow 10 business days prior to the due date for mailing to help
by the applicable periodic rate to determine your late fee. In the avoid late fees. Mail payments to:
event that the calculated late fee is less than ten dollars ($10.00), Fleet Services
a minimum late fee of ten dollars ($10.00) will be charged. PO Box 6293
Your account will be delinquent if you do not pay it in full within Carol Stream, IL 60197 -6293
26 calendar days of the billing date appearing on your invoice. Online
Certain customers, based upon our credit review, may be required Authorized users can elect to receive an email notification when an
to make payment in less than 26 calendar days on a cycle that we invoice is ready for online viewing and payment. Log in or register to
may establish for you. In addition, certain customers may elect a set up an online account at www.wexonline.com,
shorter billing or payment cycle as offered by us.
Online payments scheduled by 3:00 PM ET (on business days)
If your payment due date fails on a non business day, payment is are credited to your account on the same day. There is no fee for
due on the business day before the payment due date. Delinquent online payments,
accounts will be subject to late fees, suspension, or termination
of credit privileges, without notice. All charges must be paid in Phone
full regardless of disputes. Charges must be disputed in writing Call Customer Service at 1 -888- 387 -5665 and select the menu
no later than sixty (60) days from the billing date or they will be option for Billing Inquiries. In addition to scheduling a payment, you
considered final and binding. can also check your balance.
Card issuer Payments scheduled by 3:00 PM ET (on business days)
The Fleet Services Card is issued by, and all card transactions are credited to your account on the same day.
are funded by and payable to, Wright Express Financial Services Be prepared with your fleet card account number and a sample
Corporation, under a Business Charge Account Agreement with check to enter your bank account number and routing number.
the cardholder named on the reverse. There is no fee for phone payments.
Customer Service Automated Clearing House (ACH)
For account Inquiries and correspondence in regard to account To make a one -time electronic payment go to:
service or billing: http:l /www.e- fleet.com
Call 1 -888- 387 -5665, or ACH payments scheduled by 2:30 PM ET (on business days) are
credited to your account on the same day. There is a fee for each
Fax to 1 -800- 395 -0809, or ACH payment.
Mail to P.O. Box 639, Portland, ME 04104
Be sure to include your account number on all correspondence.
ACCOUNT: CARMEL FIRE DEPARTMENT CLOSING DATE: 08 -31 -2010
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 62.94 0.00 FEDERAL E85 343.930 776.49 0.18300
-3.50 0.00 FEDERAL GASOLINE 19.120 48.92 0.18300
FEDERAL TOTALS -66.44 0.00 363.050 825.41
IN 356000972 0.00 3.44 STATE EXCISE GASOLINE 19.120 48.92 0.18000
-46.67 0.00 STATE SALES E85 343.930 776.49 0.07000
-2.75 0.00 STATE SALES GASOLINE 19.120 48.92 0.07000
IN STATE TOTALS -49.42 3.44
ACCOUNT TOTALS 115.86 3.44
(c) WRIGHT EXPRESS CORPORATION 2010 PAGE 1
FLEET SERVICES STANDARD REPORT
INVOICE NUMBER: 23797406
ACCOUNT NAME: CARMEL FIRE DEPARTMENT
PAGE 1 OF 2
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0453 -00- 794629 -6 6,000.00 31 0 S -31 -2010 09 -24 -2010 723.55
CARD LOCATION DATE TIME DRIVER ODOMETER PRODUCT UNITS COST/ ITEM TOTAL
NO. NO. UNIT TOTAL AMOUNT
0001 MH 001 078 08 -01 -2010 11:38 SMITH, KEITH 14,500 E85 10.400 2.199 22.87 22.87
MH 001 078 08 -29 -2010 11:33 SMITH, KEITH 14,500 E85 22.890 2.299 52.62 52.62
CARD SUBTOTALS 33.290 75.49
0002 MH 001 078 08 -04 -2010 17:54 HULETT, MARK 71,895 E85 11.440 2.198 25.15 25.15
MH 001 078 08 -19 -2010 18:04 HULETT, MARK 72,453 E85 14.550 2.299 33.45 33.45
MH 001 074 08 -24 -2010 09:52 HULETT, MARK 72,632 E85 11.740 2.300 27.00 27.00
CARD SUBTOTALS 37.730 85.60
0003 MH 001 074 08 -05 -2010 12:43 STEELE, JEFF 15,230 E85 24.130 2.199 53.07 53.07
MH 001 074 08 -12 -2010 07:53 STEELE, JEFF 15,469 E85 24.680 2.199 54.27 54.27
MH 001 074 08 -16 -2010 17:03 STEELE, JEFF 15,725 E85 23.500 2.299 54.03 54.03
MH 001 074 08 -20 -2010 11:56 STEELE, JEFF 15,930 E85 21.430 2.299 49.27 49.27
MH 001 095 08 -24 -2010 08:12 STEELE, JEFF 16,166 UNL 19.120 2.559 48.92 48.92
MH 001 074 08 -27 -2010 11:02 STEELE, JEFF 16,716 E85 18.200 2.299 41.84 41.84
CARD SUBTOTALS 131.060 301.40
0004 MH 001 074 07 -30 -2010 17:16 HABOUSH, DAVE 28,878 E85 22.620 2.199 49.74 49.74
MH 001 074 08 -02 -2010 18:55 HABOUSH, DAVE 29,158 E85 25.120 2.199 55.25 55.25
MH 001 074 08 -08 -2010 14:12 HABOUSH, DAVE 29,407 E85 24.000 2.199 52.78 52.78
MH 001 074 08 -13 -2010 18:25 HABOUSH, DAVE 29,629 E85 23.130 2.300 53.19 53.19
MH 001 074 08 -18 -2010 16:33 HABOUSH, DAVE 29,835 E85 20.750 2.299 47.71 47.71
MH 001 074 08- 23.2010 15:36 HABOUSH, DAVE 30,105 E85 23.560 2.299 54.16 54.16
CARD SUBTOTALS 139.180 312.83
0007 MH 001 154 08 -24 -2010 16:33 SMITH, KEITH 98,463 E85 21.790 2.299 50.09 50.09
CARD SUBTOTALS 21.790 50.09
TOTAL PURCHASES 363.050 825.41
Y -T -D PURCHASES 2,555.773 5,901.04
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 12 592.31
MH 001 078 MEIJER 5303 E SOUTHPORT RD INDIANAPOLIS IN 46237 4 134.09
MH 001 154 MEIJER 17000 MERCANTILE RD NOBLESVILLE IN 46060 1 50.09
MH 001 095 MEIJER 8225 E 96TH ST INDIANAPOLIS IN 46256 1 48.92
PRODUCTS: E85= ETHANL85 UNL UNLEADED
FLEET SERVICES
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VOUCHER NO. WARRANT N
ALLOWED 20
Fleet Services
IN SUM OF
P.O. Box 6293
Carol Stream, IL 60197
$723.55
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO Dept. INVOICE No. ACCT #!TITLE AMOUNT Board Members
1120 23797406 42- 314 -00 $723.55 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
SEP 8 7 2010
l
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))
23797406 $723.55
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
2a
Clerk- Treasurer