194571 02/16/2011 CITY OF CARMEL, INDIANA VENDOR: 354030 Page 1 of 1
0 ONE CIVIC SQUARE FLEET FUELING
CARMEL, INDIANA 46032 PO BOX 6293 CHECK AMOUNT: $1,128.74
CAROL STREAM IL 60197-6293
a CHECK NUMBER: 194571
CHECK DATE: 2/16/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231400 25147625 1,128.74 GASOLINE
FLEET SERVICES INVOICE /STATEMENT
INVOICE NUMBER: 25147625
ACCOUNT NAME: CARMEL FIRE DEPARTMENT
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0453 -00- 794629 -6 6,000.00 31 01 -31 -2011 02 -25 -2011 1128.74
DATE ACTIVITY DESCRIPTION CHARGES /DEBITS PAYMENTS /CREDITS
01-24-2011 PAYMENT RECEIVED THANK YOU 1,068.43
01 -31-2011 RETAIL FUEL PURCHASES 1,114.74
01 -31- 2011. MONTHLY CARD CHG 1.4.00
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 JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT INVOICE /STATEMENT
PREVIOUS BALANCE PAYMENTS PURCHASES DEBITS CREDITS LATE FEE NEW BALANCE
1068.43 1068.43 1114.74 14.00 0.00 0.00 1128.74
$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 ID: 84- 1425616 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 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 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 prier 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 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, 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: /lwww.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.
i
ACCOUNT: CARMEL FIRE DEPARTMENT CLOSING DATE: 01 -31 -2011
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 -61.15 0.00 FEDERAL E85 334.140 916.03 0.18300
-21.31 0.00 FEDERAL GASOLINE 116,460 357.69 0.18300
FEDERAL TOTALS 82.46. 0.00 450.600 1,273.72
IN 356000972 0.00 20.96 STATE EXCISE GASOLINE 116.460 357.69 0.18000
-55.92 0.00 STATE SALES E85 334.140 916.03 0.07000
-20.64 0.00 STATE SALES GASOLINE 116.460 357.69 0.07000
IN STATE TOTALS 76.56. 20.96
ACCOUNT TOTALS 159.02 20.96
(c) WRIGHT EXPRESS CORPORATION 2011 PAGE 1
FLEET SERVICES STANDARD REPORT
INVOICE NUMBER: 25147625
ACCOUNT NAME: CARMEL FIRE DEPARTMENT
PAGE 1 OF 2
ACCOUNT NUMBER CREDIT LIMIT I DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0453 -00- 794629 -6 6,000.00 31 01.31 -2011 02 -25 -2011 1,128.74
CARD LOCATION DATE TIME DRIVER ODOMETER PRODUCT UNITS COST/ ITEM TOTAL
NO. NO. UNIT TOTAL AMOUNT
0001 MH 001 078 12 -31 -2010 16:24 SMITH, KEITH 14,500 E85 13.880 2.699 37.46 37.46
MH 001 074 01 -03 -2011 12:54 SMITH, KEITH 14,500 E85 21.640 2.699 58.40 58.40
MH 001 078 01 -05 -2011 19:55 SMITH, KEITH 14,500 E85 18.650 2.699 50.33 50.33
MH 001 074 01 -07 -2011 13:02 SMITH, KEITH 14,500 E85 11.880 2.759 32.78 32.78
MH 001 074 01 -10 -2011 08:17 SMITH, KEITH 14,500 UNL 13.710 3.158 43.30 43.30
MH 001 075 01.13 -2011 17:19 SMITH, KEITH 14,500 E85 18.140 2.759 50.04 50.04
MH 001 078 01 -15 -2011 12:45 SMITH, KEITH 14,500 E85 10.440 2.760 28.81 28.81
MH 001 074 01 -18 -2011 08:48 SMITH, KEITH 14,500 E85 20.040 2.759 55.29 55.29
MH 001 078 01 -20 -2011 07:19 SMITH, KEITH 14,500 E85 11.040 2.758 30.45 30.45
MH 001 078 01 -21 -2011 16:06 SMITH, KEITH 14,500 E85 11.660 2.759 32.17 32.17
MH 001 078 01- 22.2011 13:07 SMITH, KEITH 14,500 E85 5.990 2.756 16.51 16.51
MH 001 074 01 -25 -2011 13:12 SMITH, KEITH 14,500 E85 0.020 2.000 0.04 0.04
MH 001 074 01.25 -2011 13:15 SMITH, KEITH 14,500 E85 11.830 2,760 32.65 32.65
MH 001 074 01 -27 -2011 15:11 SMITH, KEITH 14,500 UNL 19.080 1198 61.02 61.02
MH 001 078 01 -30 -2011 11:44 SMITH, KEITH 14,500 E85 14.010 2.759 38.65 38.65
CARD SUBTOTALS 202.010 567.90
0002 MH 001 078 01 -04 -2011 12:39 HULETT, MARK 78,783 E85 14.270 2.698 38.60 38.50
MH 001 074 01- 07.2011 07:23 HULETT, MARK 78,957 E85 10.750 2.698 29.00 29.00
MH 001 078 01 -08 -2011 17:24 HULETT, MARK 79,152 E85 11,450 2.760 31.60 31.60
MH 001 078 01 -12 -2011 15:56 HULETT, MARK 79,371 E85 14.320 1760 39.52 39.52
MH 001 078 01 -18 -2011 15:35 HULETT, MARK 79,606 E85 13.410 2.760 37.01 37.01
MH 001 078 01.21 -2011 14:15 HULETT, MARK 79,805 E85 11.750 2.757 32.40 32.40
MH 001 078 01 -25 -2011 16:17 HULETT, MARK 79,959 E85 9.320 2.758 25.70 25.70
MH 001 078 01 -28 -2011 16:24 HULETT, MARK 80,178 E85 13.050 2.759 36.00 36.00
CARD SUBTOTALS 98.320 26933
0003 MH 001 095 01 -01 -2011 17:57 STEELS, JEFF 21,978 E85 17.460 2.699 47.12 47.12
MH 001 074 01 -25 -2011 10:28 STEELE, JEFF 22,856 E85 24.040 2.759 66.33 66.33
CARD SUBTOTALS 41.500 113.45
0004 MH 001 074 01.01 -2011 12:48 HABOUSH, DAVE 35,663 UNL 21.380 3.149 67.32 67.32
MH 001 074 01 -10 -2011 20:26 HABOUSH, DAVE 35,965 UNL 24.800 3.099 76.85 76.85
MH 001 074 01 -16 -2011 20:50 HABOUSH, DAVE 36,118 UNL 15.030 2.949 44.32 44.32
MH 001 074 01 -29 -2011 20:15 HABOUSH, DAVE 36,435 E85 25.120 2.759 69.31 69.31
CARD SUBTOTALS 86.330 257.80
0007 MH 001 154 01 -16 -2011 16:29 SMITH, KEITH 108,770 UNL 22.460 2.889 64.88 64.88
CARD SUBTOTALS 22.460 64.88
TOTAL PURCHASES 450.620 1,273.76
Y -T -D PURCHASES 450.620 1,273.76
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 13 636.61
MH 001 078 MEIJER 5303 E SOUTHPORT RD INDIANAPOLIS IN 46237 14 475.11
PRODUCTS: E85= ETHANL85 UNL= UNLEADED
FLEET SERVICES STANDARD REPORT
INVOICE NUMBER: 25147625
ACCOUNT NAME: CARMEL FIRE DEPARTMENT
PAGE 2 OF 2
CARD LOCATION DATE TIME DRIVER ODOMETER PRODUCT UNITS COST/ ITEM TOTAL
NO. NO, UNIT TOTAL AMOUNT
SITES USED THIS MONTH cunt. NO. PURCHASES TOTAL AMOUNT
Location No. Brand Street City State Zip
MH 001 154 MEIJER 17000 MERCANTILE RD NOBLESVILLE IN 46060 1 64.88
MH 001 075 MEIJER 11349 E WASHINGTON INDIANAPOLIS IN 46229 1 50.04
MH 001 095 MEIJER 8225 E 96TH ST INDIANAPOLIS IN 46256 1 47.12
PRODUCTS: E85= ETHANL85 UNL- UNLEADED
VOUCHER NO. WARRANT NO.
ALLOWED 20
Fleet Services
IN SUM OF
P.O. Box 6293
Carol Stream, IL 60197
$1,128.74
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. I ACCT #!TITLE I AMOUNT Board Members
1120 I 25147625 I 42- 314.00 I $1,128.74 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
FEB 14 2no
OLP'- FEre G
I
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))
25147625 $1,128.74
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
217
Clerk- Treasurer