193012 12/22/2010 CITY OF CARMEL, INDIANA VENDOR: 00352984 Page 1 of 1
ONE CIVIC SQUARE FLEET SERVICES
CARMEL, INDIANA 46032 0453 -00- 7946296 CHECK AMOUNT: $91.99
PO BOX 6293 CHECK NUMBER: 193012
CAROL STREAM IL 60197
CHECK DATE: 12/22/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4231400 24601072 91.99 0496 -00- 138002 -1
Invoice Statement
so INVOICE NUMBER: 24601072
ACCOUNT NAME: City of Carmel Admin.
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0496 -00- 136002 -1 550.00 30 NOV -30 -2010 DEC -23 -2010 91.99
DATE ACTIVITY DESCRIPTION CHARGES /DEBITS PAYMENTS /CREDITS
NOV -30 -2010 FUEL PURCHASES 91.99
REMINDER
REMINDER PLEASE BE SURE TO INCLUDE REMITTANCE STUB
WITH PAYMENT. MAIL TO THE ADDRESS SHOWN IN THE
RIGHT PORTION OF THE REMITTANCE STUB.
D
DEC 2 0 2010
By
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
0.00 0.00 91.99 0.00 0.00 0.00 91.99
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 monthly 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 anon- business day, payment is
due on the business day before the payment due date. Delinquent are credited to your account on the same day. There is no fee for
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: //www.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.
No
Welcome to the Circle K Fleet Card Program!
We are pleased to enclose your first reporting package and invoice. These reports are produced at
the end of each billing cycle and are available by mail and online in PDF format.
Like many of our customers, you may find the convenience of online access to invoice and reports
eliminates the need to receive them by mail. To shut off mailing of reports, schedule payments,
download purchase information and more, log in to www.circleKfieetcards.com /login
Don't forget to emphasize to your drivers the importance of entering accurate odometer readings. If
the analysis of a vehicle's odometer readings indicates that the readings are not within an
acceptable range, the current period's mileage calculations will not be reported, and that_ vehicle's
data will be excluded from the department mileage calculations....
In order to help you meet the standardriet 26 =day payment terms and especially terms,
we encourage you to take advantage of online payment or'pay -by -phone services. Either way, payments
scheduled by 3:00 PM ET'on a business day are posted to your account the same day. To select the
automated pay -by -phone services, call Customer Service and select the Billing Inquiries menu.
If you have any questions or need help using our online features, please call Customer Service at
866- 544 -1715 We're available to assist you any time, 24 hours a day, 7 days a week. We
appreciate your business and look forward to working with you.
Sincerely,
Your Customer Service Team
0
Custom Exception Request
Use this form to change exception settings.
1. Complete parts A and B.
2. Be sure to sign and date the form.
3. Fax completed form to: 1-800- 395 -0809 or mail to Fleet Services, PO Box 639, Portland ME 04104
Account Name: Account Number:
Authorized Fleet Contact: Phone No.:
Fleet Contact email: Fax No.:
EXCEPTION
We have set up your exceptions with the default settings indicated below. You may use this form to deselect the exceptions you do
NOT want reported and to change the defaults.
EXCEPTION CODE DO NOT DEFAULT CUSTOMIZED
REPORT
Fuel cost per transaction FC $75 per ransaction per transaction.
Regular Unleaded Only Check One:
Allowed product class PR 11 (including Diesel Only
(including alcohol blends)
Diesel and Unleaded, incl. Alcohol blends
Fuel transactions per day FD 1 transaction per day transactions per day
Fuel units per billing cycle BU 150 gallons per vehicle gallons per vehicle
Fuel units per transaction TU 20 gallons gallons per transaction
Purchase start time and end time STET 5:30 a.m. 7:00 p.m. start time to end time
Service transactions per day SD N/A transactions per day
Service cost per transactions Sc N/A per transaction
Check all that apply
Days not allowed DY Holidays Saturdays Sundays Holidays'
'New Years Day, Memorial Day, Independence Day,
Labor Day, Thanksgiving, Christmas
Max price per unit CU N/A per gallon
List a maximum of 3 states where fueling is allowed:
Allowed state or province SP N/A
Manual transactions MT N/A N/A
AUTHORIZED SIGNATURE DATE
(Required to authorize any of the above changes)
PARENT ACCOUNT: REPORT FOR:
City of Carmel Admin. City of Carmel Admin.
0496 -00- 138002 -1
NOV -01 -2010 TO NOV -30 -2010
Purchase Activity Report PAGE 1 OF 2
CARD NUMBER CARD EMBOSSING VEHICLE! ASSET IDENTIFIER VEHICLE DESCRIPTION PLATE ST VIN
0001 Mercury mariner
DATE TIME SITE ADDRESS PROMPT TRAIN ODOM. PROD UNITS COST/ FUEL OTHER EXEMPT NET REPORTED EXC.
INFO CODE UNIT TAX TAX CODES
PREVIOUS ODOMETER
NOV -04 12:31 545 S Range Line R Carmel IN 1 Driver OP 2,340 UNL 17.057 2.889 49.28 3.12 46.16 5.89
NOV-24 11:00 545 S Range Line R Carmel IN 1 .Driver OP 2,340 UNL 17.062 2.869 48.95 3.12- 45.83 5.87
PERIOD TOTALS 34 -119 98.23 6.24- 91.99 11.76
YTD TOTALS 34.119 98.23 6.24- 91.99 11.76
PERIOD AVERAGE: PPG 2.879
YTD AVERAGE: PPG 2.879
TO ENSURE MORE ACCURATE MILEAGE FEPORTING, VEHICLE NILEAGE STA ISTICS ARE N T
CALCU ATED WHEN KEY ODOMETER EADINGS RE N07 WITHIN AN CCEPTABLE RANGE.
TRANSACTION CODES:
OP Outdoor Payment Terminal
R
I
I
i
PARENT ACCOUNT: REPORT FOR:
City of Carmel Admin. City of Carmel Admin.
0496 -00- 138002 -1
LNO
NOV -01 -2010 TO NOV -30 -2010
Financial Summary 11 ary PAGE 1 OF 2
DEPARTMENT DESCRIPTION FEES PURCHASES TOTAL FEES
QTY COSTYFEE 'TOTAL FEES FUEL OTHER S EXEMPTED TAX NET PURCHASES
ACCOUNT TOTALS Unleaded Regular 98.23 6.24- 91.99
PERIOD 0.00 98.23 0.00 6,24- 91.99 91.99
YTD 0.00 98.23 0.00 6.24- 91.99, 91.99
ACCOUNTS RECEIVABLE SUMMARY Invoice 24601072
PREVIOUS BALANCE 0.00
PAYMENTS 0.00
PURCHASES 91.99
DEBITS 0.00
CREDITS 0.00
AMOUNT DUE 91.99
k
PARENT ACCOUNT: REPORT FOR:
City of Carmel Admin. City of Carmel Admin.
0496 -00- 138002 -1
m
NOV -01 -2010 TO NOV -30 -2010
Site Summary y 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 2 34.119 9823 6.24- 91.99
PERIOD TOTALS 2 34.119 98.23 0.00 6.24- 91.99
W
VAAA PARENT ACCOUNT: REPORT FOR:
City of Carmel Admin. City of Carmel Admin.
0496 -00- 138002 -1
LN O
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 -6.24 Federal Excise Gasoline_ Unblended 34.120 98.23 0.18300
FEDERAL TOTALS -6.24 34.120 98.23
IN 356000972 JUN -18 -2012 -5.62 State Sales Gasoline Unblended 34.120 98.23 0.07000
-6.14 State Excise Gasoline Unblended 34.120 98.23 0.18000
IN STATE TOTALS -11.76
ACCOUNT TOTALS -6.24 -11.76
o
pM�d:
VOUCHER NO. WARRANT NO.
ALLOWED 20
Fleet Services
IN SUM OF
PO Box 6293
Carol Stream, IL 60197 -6293
$91.99
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
D
PO# Dept. INVOICE NO. ACCT #rrITLE AMOUNT Board Members
1205 I 24601072 42- 314.00 I $91.99 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
Monday, December 20, 2010
Director, Xdministratign
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 Num or not attac in o r b ill(s))
11/30/10 24601072 $91.99
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
20
Clerk- Treasurer