194885 02/22/2011 CITY OF CARMEL, INDIANA VENDOR: 00352984 Page 1 of 1
ONE CIVIC SQUARE FLEET SERVICES CHECK AMOUNT: $134.06
CARMEL, INDIANA 46032 0453 00-7946296
PO BOX 6293 CHECK NUMBER: 194885
CAROL STREAM IL 60197
CHECK DATE: 2122!2011
DEPARTMENT ACCOU PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231400 25107972 134.06 0496 -00- 138012 -0
Invoice Statement
INVOICE NUMBER: 25107972
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 -fl6- 136012 -0 3.400.00 31 JAN -31 -2011 FEB -25 -2011 154.06
DATE ACTIVITY DESCRIPTION CHARGES /DEBITS PAYMENTS /CREDITS
JAN-24-2011 PAYMENT THANK YOU 67.75
JAN -31 -2011 FUEL PURCHASES 134.06
REMINDER
BALANCE INCLUDES PAST DUE AMOUNT IF PAYMENT HAS
BEEN MADE, PLEASE DISREGARD THIS NOTICE. PAST DUE
ACCOUNTS ARE SUBJECT TO SERVICE INTERRUPTION
PURCHASES RETURNS AND PAYMENTS MADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT INVOICHSTATEMENT.
CURRENT PERIOD -ONE BILLING PERIOD PAST DUE1 TWO BILLING PERIODS PAST DUE THREE+ BILLING PERIODS PAST DUE I TOTAL DUE
144.06 10.00 0.00 0.00 154.06
PREVIOUS BALANCE PAYMENTS PURCHASES )DEBITS CREDITS LATE FEE NEW BALANCE
77.75 67.75 134.06 0.00 0.00 10.00 154.06
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
applving a monthly rate of RATE of fee for this p erfod which is
2.00 24.00 10.00
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 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.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 fans 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: /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.
PARENT ACCOUNT: REPORT FOR:
City of Carmel Fire City of Carmel Fire
0495 -00- 138012 -0
JAN -01 -2011 TO JAN -31 -2011
I
I
Purchase Activity Report I PAGE 1 OF 2
CARD NUMBER CARD EMBOSSING VEHICLE/ ASSET IDENTIFIER VEHICLE DESCRIPTION PLATES VIN
0002 Asst. Chief Hoffman 74957
DATE TIME SITE ADDRESS I PROMPT TRAN ODOM. PROD UNITS COST/ FUEL OTHER EXEMPT NET REPORTED EXC.
INFO CODE UNIT TAX TAX CODES
PREVIOUS ODOMETER 21,698
JAN -09 18:09 11601 Allisonville Fishers IN 1• driver OP 22,222 UNL 22.200 3.119 69.25 4.06- 65.19 8.00
JAN-19 08:07 9510E 126th St Fishers IN 1 driver OP 22,545 UNL 23.290 3.139 73.13 4.26- 68.87 8.42-
PERIOD TOTALS 847 45.490 142.38 8.32- 134.06 16.42
YTO TOTALS 847 L 45.490 ;,142.38 8.32- 134.06 16.42
PERIOD AVERAGES: MPG, PPG, CPN 18.62 3.130 0.17
YTD AVERAGES: MPG, PPG, CPM 18.62 3.130 0.17
TRANSACTION CODES:
OP Outdoor Payment Terminal
r.+
PARENT ACCOUNT: REPORT FOR:
City of Carmel Fire City of Carmel Fire
0496 -00- 138012 -0
JAN -01 -2011 TO JAN -31 -2011
Financial Summary PAGE 1 OF 2
DEPARTMENT DESCRIPTION FEES PURCHASES TOTAL FEES
QTY COST/FEE TOTAL FEES FUEL OTHER EXEMPTED TAX NET PURCHASES
I
ACCOUNT TOTALS Unleaded Regular 142.38 8.32- 134.06
PERIOD 0.00 142.38 0.00 8.32- 134.06 134.06
YT1) 0.00 —1 42 38 0.00 8.32- 134.06. 134.06
ACCOUNTS RECEIVABLE SUMMARY- Invoice 25107972
PREVIOUS BALANCE 77.75
PAYMENTS 67.75-
PURCHASES 134.06
DEBITS 0.00
CREDITS 0.00
LATE FEES 10.00
AMOUNT DUE 154.06
PARENT ACCOUNT: REPORT FOR:
City of Carmel Fire City of Carmel Fire
0496 -00- 138012 -0
JAN -01 -2011 TO JAN -31 -2011
Site Summary PAGE 1 OF 2
BRAND ADDRESS CITY STATE ZIP NO. FUEL UNITS FUELS OTHER EXEMPT NET
TRANS TAX
SHELL 11601 Allisonville R Fishers IN 46038 1 22.200 69.25 4.06- 65.19
9510 E 126th St Fishers IN 46038 1 23.290 73.13 4.26- 68.87
PERIOD TOTALS 2 45.490 142.38 0.00 8.32- 134.06
..do-:•
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PARENT ACCOUNT: REPORT FOR:
City of Carmel Fire City of Carmel Fire
0496 -00- 138012 -0
JAN -01 -2011 TO JAN -31 -2011
Tax Summary PAGE 1 OF 2
TAX JURISDICTION ID EXPIRATION EXEMPTED TAX REPORTED TAX TAX TYPE TAX PRODUCT CLASS UNITS GROSS TAX RATE
i
FEDERAL 356000972 JUN -18 -2012 -8.32 Federal Excise Gasoline Unblended 45.490 142.38 0.18300
FEDERAL TOTALS -8.32 45.490 142.38
IN 356000972 JUN -18 -2012 -823 State Sales Gasoline Unblended 45.490 142.38 0.07000
-8.19 State Excise Gasoline Unblended 45.490 142.38 0.18000
IN STATE TOTALS 9 16.42
ACCOUNT TOTALS -8.32 -16.42
I
VOUCHER NO, WARRANT NO.
ALLOWED 20
Fleet Services
IN SUM OF
P.O. Box 6293
Carol Stream, IL 60197
$134.06
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 I 25107972 I 42- 314.00 $134.06 I 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
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))
25107972 $134.06
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