193013 12/22/2010 CITY OF CARMEL, INDIANA VENDOR: 00352984 Page 1 of 1
ONE CIVIC SQUARE FLEET SERVICES
CHECK AMOUNT: $22.98
CARMEL, INDIANA 46032 0453- 00a946296
•1, oats PO BOX 6293 CHECK NUMBER: 193013
CAROL STREAM IL 60197
CHECK DATE: 12/22/2010
DEPARTMENT ACCOUNT P O NUMBER INVOICE NU AMOUNT DESCRIPTION
1120 4231400 24587603 22.98 0496 -00- 138012 -0
Invoice Statement
INVOICE NUMBER: 24587603
ACCOUNT NAME: City of Carmel Fire
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0496 -00- 138012 -0 3,400.00 30 NOV -30 -2010 DEC -23 -2010 22.98
DATE ACTIVITY DESCRIPTION CHARGES/DEBITS PAYMENTS /CREDITS
NOV -30 -2010' FUEL PURCHASES 22.98
REMINDER
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 JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTFL THE NEXT INVOICE/STATEMENT.
PREVIOUS BALANCE PAYMENTS PURCHASES )DEBITS CREDITS LATE FEE NEW BALANCE
0.00 0.00 22.98 0.00 0.00 0.00 22.98
CALL CUSTOMER SERVICE TO PAY BY PHONE
FEDERAL TAX ID: 841425616 The Late Fee is determined by Which is an EFFECTIVE ANNUAL To the balance subject to late
applying a m rthly rate of RATE of fee for this period which is
2.00 24.00 0.00
SEE REVERSE SIDE FOR IMPORTANT INFORMATION AND TERMS.
TO ENSURE PROPER CREDIT, TEAR AT PERFORATION AND INCLUDE BOTTOM PORTION WITH YOUR PAYMENT.
Balance Subject to Late Fee Payment Options
The late fee will be calculated by determining the total balance Mall
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.wextools.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 falls 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- 866 544 -1715 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 making a payment, you can
considered final and binding. also check your balance.
Card issuer Payments scheduled by 3:00 PM ET (on business days)
The Circle K Fleet 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:llwww.e- fleet.com
Call 1- 866 -544 -1715, or ACH payments made 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.
PARENT ACCOUNT: REPORT FOR:
City of Carmel Fire City of Carmel Fire
No 0496 -00- 138012 -0
NOV -01 -2010 TO NOV -30 -2010
Purchase Activity Report PAGE 1 OF 2
I
I
CARD NUMBER CARD EMBOSSING VEHICLEi/ ASSET IDENTIFIER VEHICLE DESCRIPTION PLATE'S VIN
0001 i 63225
u
DATE TIME SITE ADDRESS it PROMPT TRAN ODOM. PROD UNITS COST/ FUEL OTHER EXEMPT NET REPORTED EXC.
9 INFO CODE UNIT TAX TAX CODES
PREVIOUS ODOMETER 4
NOV -24 13:12 545 S Range Line R Carmel IN 1 driver OP 14,500 UNL 9.110 2.869 26.14 3.16- 22.98 1.64
PERIOD TOTALS y 9.110 26.14 3.16 22.98 1.64
YTD TOTALS 9.110 26.14 3,16- 22.98 1.64
PERIOD AVERAGE: PPG 2.669
YTDAVERAGE: PPG 2.669
TO ENSURE MORE ACCURATE MILEAGE REPORT] G, VEHICLE iv ILEAGE STA ISTICS ARE N T
CALCU -ATED WHEN KEY ODOMETER 3EADINGS RE NOJ WITHIN AN CCEPTABLE RANGE.
I
TRANSACTION CODES:
OP Outdoor Payment Terminal
PARENT ACCOUNT: REPORT FOR:
City of Carmel Fire City of Carmel Fire
0496 -00- 138012 -0
NOV -01 -2010 TO NOV -30 -2010
Financial Summary PAGE 1 OF 2
DEPARTMENT DESCRIPTION FEES PURCHASES TOTAL FEES
OTY COST/FEE TOTAL FEES FUELS OTHER EXEMPTED TAX NET PURCHASES
ACCOUNT TOTALS Unleaded Regular 26.14 3.16- 22.98
PERIOD 0.00 26.14. 0.00 3.16- 22.98 22.98
YTD'. 0.00 26.14 0.00 3.16- 22.98 22.98
ACCOUNTS RECEIVABLE SUMMARY- Invoice 24587603
PREVIOUS BALANCE 0.00
PAYMENTS 0.00
PURCHASES 22.98
DEBITS 0.00
CREDITS 0.00
AMOUNT DUE 22.98
PARENT ACCOUNT: REPORT FOR:
City of Carmel Fire City of Carmel Fire
LNG 0496 -00- 138012 -0
NOV -01 -2010 TO NOV -30 -2010
Site Summary i PAGE 1 OF 2
BRAND ADDRESS CITY STATE ZIP NO. FUEL UNITS FUEL OTHER EXEMPT NET
TRANS TAX
Dairy Mart 545 S Range Line Rd Carmel IN 46032 1 9.110 26.14 3.16- 22.98
PERIOD TOTALS 1 9.110 26.14 0.00 3.16- 22.98
PARENT ACCOUNT: REPORT FOR:
City of Carmel Fire City of Carmel Fire
0496 -00- 138012 -0
m
NOV -01 -2010 TO NOV -30 -2010
Tax Summary PAGE 1 OF 2
TAX JURISDICTION ID EXPIRATION EXEMPTED TAX REPORTED TAX TAX TYPE TAX PRODUCT CLASS UNITS GROSS TAX RATE
FEDERAL 356000972 JUN -18 -2012 -1.67 Federal Excise Gasoline Unblended 9.110 26.14 0.18300
FEDERAL TOTALS. -1.67 9.110_ 26.14_,
IN 356000972 JUN -18 -2012 -1.49 State Sales Gasoline Unblended 9.110 26.14 0.07000
-1.64 State Excise Gasoline Unblended 9.110 26.14 0.18000
IN STATE TOTALS -1.49 -1.64
ACCOUNT TOTALS -3.16 -1.64
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�i:
VO N O. WARRANT NO.
ALLOWED 20
Fleet Services
N SUM OF
P.O. Box 6293
Carol Stream, IL 60197
$22.98
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# l Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 24587603 42- 314.00 $22.98 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
DEC 2 0 M CI
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))
24587603 $22.98
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