191955 11/22/2010 CITY OF CARMEL, INDIANA VENDOR: 00351794 Page 1 of 1
ONE CIVIC SQUARE SHELL CREDIT CARD CENTER
0 CHECK AMOUNT: $743.43
CARMEL, INDIANA 46032 PO BOX 183019
a ��o COLUMBUS OH 43218 -3019 CHECK NUMBER: 191955
CHECK DATE: 11/22/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4231400 065127193011 743.43 065 127 -193
www.shelitleetcard .accountonline.com
ACCOUNT NUMBER TOTAL TRANSACTIONS INVOICE NUMBER SEND INQUIRIES TO:
065 127 -193 21 065127193011 SHELL CARD CENTER
P.O. BOX 689001
CLOSING DATE DUE DATE CYCLE DAYS DES MOINES, IA 50368 -9081
11 -05 -2010 11 -30 -2010 30 1 0 TELEPHONE: 1- 800377 -5150
FAX: 1.515- 226 -4045
NEW CHARGES FLEET FEE PREVIOUS BALANCE PAYMENTS /ADJUSTMENTS LATE FEE NEW BALANCE
L 795.21 .00 .1,193 33 51.78 CR .00 1,936.76
PAYMENT OF NEW BALANCE MUST BE RECEIVED BY 11 -30 -2010
Please see the enclosed notice of change in terms for
important information.
CARD TRANSACTION TRANS MSG PROD EXEMPT TRANSACTION
NUMBER DATE TIME ID TRANSACTION LOCATION /DESCRIPTION QUANTITY CD CD TAX AMOUNT
0002 10 -10 1309 0798975 9599 N MERIDIAN ST INDIANAPOLIS IN 14.720 8 UNL 2.69 42.10
14.720 GAL UNLEADED S42.10
0002 10 -23 1802 0371260 1821 E 151ST ST CARMEL IN 14.804 8 UNL 2.71 41.75
14.804 GAL UNLEADED $41.75
0002 10 -27 10:24 0914226 1230 S RANGELINE RD CARMEL IN 14.290 8 UNL 2.62 40.30
14.290 GAL UNLEADED S40.30
0002 10 -31 14:22 0716019 8598 N MIGHIGAN RD INDIANAPOLIS IN 13.713 8 UNL 2.51 37.85
13.713 GAL UNLEADED S37.85
0002 11 -04 12.06 0449397 8190 ALLISONVILLE RD INDIANAPOLIS IN 13.884 8 UNL 2.54 4025
13.884 GAL UNLEADED 540.25
TOTAL CARD 0002 71.411 13.07 202.25
0004 10 -13 14:38 0818666 1230 S RANGELINE RD CARMEL IN 2.800 8 UNL 0.51 8.01
2.800 GAL UNLEADED 58.01
0004 11 -02 07:32 0387639 9510 E 126TH ST FISHERS IN 14.734 8 UNL 2.70 40.49
14.734 GAL UNLEADED 46.49
TOTAL CARD 0004 17.534 3.21 48.56
Message Codes: 1 Electronic Sale with Authorization 4 Electronic Sale without Authorization 8- Electronic Sale at Pump
2 Keyed Sale with Authorization 5 Keyed Sale without Authorization 9 Manual Sale
SCHEDULE OF LATE FEE
PERIODIC RATE ANNUAL MONTHLY MINIMUM BALANCE SUBJECT TO LATE FEE
(MONTHLY) PERCENTAGE RATE SEE REVERSE SIDE
0.000% 0.00% 0.00 .00
6057 0021 GUG 1 7 2 101105 D 9366 8015 SH26 7622
NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION PLEASE KEEP THIS PORTION FOR YOUR RECORDS
0007622 Page 1 of 3 FLET26ya
Information About Your Account
Report a Lost or Stolen Card Immediately: Our Customer Service Representatives are available by phone 24 hours a day, 7
days a week.
Payment Instructions: We must receive your payment in proper form at our processing facility by 5 p.m. local time there. If we
do, it will be credited as of that day. A payment received at the processing facility in proper form after that time will be credited as
of the nett day. Allow 5 t 7 days for payments by regular mail to reach us. There may be a delay of Up to 5 days in crediting a
payment we receive that is not in proper form or is not sent to the correct address. The correct address fog a payment sent by
regular mail is the address listed on the return envelope or on the front of the payment coupon. If you wish to send a payment by
express courier, you must call us for the correct address at the Customer Service number shown on the front of this statement.
Proper Form. For a payment sent by mail or courier to be in proper form, you must:
Enclose a valid check or money order. No cash or foreign currency please.
Include your name and account number on the front of your check or money order.
If you send an eligible check with the payment coupon, you authorize us to complete your payment by electronic debit. If
we do, the checking account will be debited in the amount on the check. We may do this as soon as the day we receive
the check. Also, the check will be destroyed.
Optional Pay by Phone Service. You may use this optional service any time to make a payment by phone. You will be charged
$14.95 to use this service. Call by 5 p.m. Eastern time to have your payment credited as of that day. If you call after that time,
your payment will be credited as of the next day. We may process your payment electronically after we verify your identity.
Note: Your account is owned and serviced by Citibank (South Dakota), N.A.
PLOCOMM Rev 06 /08
www. shelifleetcard .accountonline.com
ACCOUNT NUMBER TOTAL TRANSACTIONS INVOICE NUMBER SEND INQUIRIES TO:
065 -127 -193 21 065127193011 SHELL CARD CENTER
P.O. BOX 609081
CLOSING DATE DUE DATE CYCLE DAYS DES MOINES, IA 50368 -9081
11.05 -2010 11- 30.2010 30 TELEPHONE: 1.800 377-5150
FAX: 1 -515- 226 -4045
CARD TRANS kCTION TRANS TRANSACTION LOCATION I DESCRIPTION QUANTITY MSG PROD EXEMPT TRANSACTION
NUMBER DATE TIME ID CD CD TAX AMOUNT
0007 10 -20 19:46 0872135 1230 S RANGELINE RD CARMEL IN 12.280 8 UNL 2.25 35.00
12.280 GAL UNLEADED $35.00
TOTAL CARD 0007 12.280 2.25 35.00
0009 10 -27 1358 0289959 4333 STATE RD 26 E LAFAYETTE IN 18.714 8 UNL 3.42 52.57
18.714 GAL UNLEADED SS2.S7
TOTAL CARD 0009 18.714 3.42 52.57
0011 10 -24 1707 0545269 555 SR 67 MOORESVILLE IN 11231 8 UNL 2.06 32.01
11.231 GAL UNLEADED $32.01
TOTAL CARD 0011 11.231 2.06 32.01 f•
0016 10.11 17:39 0799890 8924 E 116TH ST FISHERS IN 15.920 8 UNL 2.91 45.04
15.920 GAL UNLEADED S4S.04
0016 10 -20 1010 0866962 1230 S RANGELINE RD CARMEL. IN 16.322 8 UNL 2.99 46.52
16.322 GAL UNLEADED $46.52
0016 10 -22 12:12 0215277 9611 ALLISONVILLE RD INDIANAPOLIS IN 9.470 8 UNL 1.73 26.82
9.470 GAL UNLEADED S26.82
0016 10 -24 18:32 0726901 2658E THIRD ST BLOOMINGTON IN 13.512 8 UNL 2.47 37.70
13.512 GAL UNLEADED S37.70
TOTAL CARD 0016 55.224 10.10 156.08
0018 10 -14 09:06 0823971 1230 S RANGELINE RD CARMEL IN 5.000 8 UNL 0.92 14.15
5.000 GAL UNLEADED S14.15
TOTAL CARD 0018 5.000 0.92 14.15
0021 11 -01 10:11 0578112 2400 JONATHON MOORE PIKE COLUMBUS IN 14.652 8 UNL 2.68 40.00
14.652 GAL UNLEADED 540.00
rr
TOTAL CARD 0021 14.652 2.68 40.00
0022 10 -08 14:49 0781088 1230 S RANGELINE RD CARMEL IN 17.445 8 UNL 3.19 49.86✓
17.445 GAL UNLEADED S49.86
0022 10 -19 10:16 0859181 1230 S RANGELINE RD CARMEL IN 12.471 8 UNL 2.28 34.42
12.471 GAL UNLEADED S34.42
0022 10 -31 17:45 0374645 9510 E 126TH ST FISHERS IN 17.951 8 UNL 3.29 49.35
17.951 GAL UNLEADED S49.3S
TOTAL CARD 0022 47.867 8.76 133.63
0028 10 -16 1701 0295022 1821 E 15151'STCARMEL IN 15.212 8 UNL 2.78 41.97
15.212 GAL UNLEADED S41.97
0028 10 -22 07:39 0352807 1821 E 151ST ST CARMEL IN 11803 8 UNL 2.53 39.05
Message Codes: 1 Electronic Sale with Authorization 4 Electronic Sale without Authorization 8 Electronic Sale at Pump
2 Keyed Sale with Authorization 5 Keyed Sale without Authorization 9 Manual Sale
6057 0021 GUG 1 7 2 101105 D 9366 801S SH26 7622
NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION PLEASE KEEP THIS PORTION FOR YOUR RECORDS
Page 2 of 3 FLEI'2GUG
Information About Your Account
Report a Lost or Stolen Card Immediately: Our Customer Service Representatives are available by phone 24 hours a day, 7
days a week.
Payment Instructions: We must receive your payment in proper form at our processing facility by 5 p.m. local time there. If we
do, it will be credited as of that day. A payment received at the processing facility in proper form after that time will be credited as
of the next day. Allow 5 to 7 days for payments by regular mail to reach us. There may be a delay of up to 5 days in crediting a
payment we receive that is not in proper form or is not sent to the correct address. The correct address for a payment sent by
regular mail is the address listed on the return envelope or on the front of the payment coupon. If you wish to send a payment by
express courier, you must call us for the correct address at the Customer Service number shown on the front of this statement.
Proper Form. For a payment sent by mail or courier to be in proper form, you must:
Enclose a valid check or money order. No cash or foreign currency please.
Include your name and account number on the front of your check or money order.
If you send an eligible check with the payment coupon, you authorize us to complete your payment by electronic debit. If
we do, the checking account will be debited in the amount on the check. We may do this as soon as the day we receive
the check. Also, the check will be destroyed.
Optional Pay by Phone Service. You may use this optional service any time to make a payment by phone. You will be charged
S14 95 to use this service. Call by 5 p.m. Eastern time to have your payment credited as of that day. If you call after that time,
yc.;r payment will be credited as of the next day. We may process your payment electronically after we verify your identity.
Note: Your account is owned and serviced by Citibank (South Dakota), N.A.
r. PLOCOMM Rev 06/08
www. shelitleetcard .accountonline.com
ACCOUNT NUMBER TOTAL TRANSACTIONS INVOICE NUMBER SEND INQUIRIES TO:
SHELL CARD CENTER
065 -127 -193 21 065127193011 P.O. BOX 689081
CLOSING DATE DUE DATE CYCLE DAYS DES MOINES, IA 50368 -9081
11 -05 -2010 11 -30 -2010 30 TELEPHONE: 1- 800.377.5150
FAX: 1 -515- 226 -4045
CARD TRANS TRANSACTION LOCATION DESCRIPTION QUANTITY MSG PROD EXEMPT TRANSACTION
NUMBER DATE TIME ID CID CD TAX AMOUNT
13.803 GAL UNLEADED $39.05
R*
TOTAL CARD 0028 29.015 5.31 81.02
GRAND TOTAL 282.928 51.78 795.21
FEDERAL EXCISE TAX
282.9 GALLONS GASOLINE 51.78 CR
OVERSIGHT IN PUTTING YOUR PAYMENT IN THE MAIL?
CALL 1-888- 304 -5075 TO PAY BY CHECK OVER THE
PHONE 24 HOURS A DAY. HAVE YOUR CHECKBOOK
READY WHEN YOU CALL.
Need help to bring your account up to date?
If you call us today, we may be able to help you
bring your account current before the end of the
year. We have payment solutions you may not
be aware of that can help you get back on track.
Call us today at 1- 866 -532 -9505, we can help!
Message Codes: 1 Electronic Sale with Authorization 4 Electronic Sale without Authorization 8 Electronic Sale at Pump
2 Keyed Sale with Authorization 5 Keyed Sale without Authorization 9 Manual Sale
6057 0021 GUG 1 7 2 101105 D 9366 8015 SH26 7622
NO PLEASE KEEP THIS PORTION FOR YOUR RECORDS
Information About Your Account
Report a Lost or Stolen Card Immediately: Our Customer Service Representatives are available by phone 24 hours a day, 7
days a week.
Payment Instructions: We must receive your payment in proper form at our processing facility by 5 p.m, local time there. If we
do, it will be credited as of that day. A payment received at the processing facility in proper form after that time will be credited as
of the next day. Allow 5 to 7 days for payments by regular mail to reach us. There may be a delay of up to 5 days in crediting a
payment we receive that is not in proper form or is not sent to the correct address. The correct address for a payment sent by
regular mail is the address listed on the return envelope or on the front of the payment coupon. If you wish to send a payment by
express courier, you must call us for the correct address at the Customer Service number shown on the front of this statement.
Proper Form. For a payment sent by mail or courier to be in proper form, you must:
Enclose a valid check or money order. No cash or foreign currency please.
Include your name and account number on the front of your check or money order.
If you send an eligible check with the payment coupon, you authorize us to complete your payment by electronic debit. If
we do, the checking account will be debited in the amount on the check. We may do this as soon as the day we receive
the check. Also, the check will be destroyed.
Optional Pay by Phone Service. You may use this optional service any time to make a payment by phone. You will be charged
$14.95 to use this service. Call by 5 p.m. Eastern time to have your payment credited as of that day. If you call after that time,
your payment will be credited as of the next day. We may process your payment electronically after we verify your identity.
Note: Your account is owned and serviced by Citibank (South Dakota), N.A.
Prescribed �y 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
Shell Fleet Plus Purchase Order No.
Processing Center Terms
P.O. Box 183019
Columbus, OH 43218 -3019 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
11/16/1 65127193011 monthly payment 743.43
O1
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
She6l Fleet Plus IN SUM OF
Processing Center
P.O. BOX 18301.9
Columbus, OH 43218 -3019
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 65127.193011.:. _314 743.43 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
November 16 20 10
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund