195254 03/09/2011 CITY OF CARMEL, INDIANA VENDOR: 00352984 Page 1 of 1
ONE CIVIC SQUARE FLEET SERVICES
\'4z CARMEL, INDIANA 46032 PO BOX 6293 CHECK AMOUNT: $200.67
CAROL STREAM IL 60197 CHECK NUMBER: 195254
CHECK DATE: 3!912011
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231400 25375100 200.67 0496--00- 138012 -0
I nvoi ce Statement
LN INVOICE NUMBER: 25315100
�t ACCOUNT NAME: City of Carmel Fire
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0496-00- 138012-0 3400.00 28 FEB- 28-2011 MAR 25-2011 230.67
DATE ACTIVITY DESCRIPTION CHARGESIDEBITS PAYMENTSICREDITS
FEB -28 -2011 PAYMENT THANK YOU 134.06
FEB -28 -2011 FUEL PURCHASES 200.67
REMINDER
BALANCE INCLUDES PAST DUE AMOUNT IF PAYMENT HAS
BEEN MADE, PLEASE DISREGARD THIS NOTICE. PAST DUE
ACCOUNTS ARE SUBJECT TO SERVICE INTERRUPTION
PURCHASE$ RETURNS AND PAYMENTS MADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT I NVOI CEISTATEM ENT.
CURRENT PERIO ONE BILLING PERIOD PAST DU TWO BILLING PERIODS PAST DUE I THREE- BILLING PERIODS PAST DUEJ TOTAL DUE
210.67 20.00 0.00 0.00 230.67
PREVIOUS BALANCE PAYMENTS )PURCHASES (,)DEBITS CREDITS LATE FE NEW BALANCE
I
154.06 134.06 200.67 0.00 0.00 10.00 230.67
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 24.00 354.73
SEE REVERSE SIDE FOR IMPORTANT INFORMATION AND TERMS.
TQ ENSURE PROPER CREDI T—TEAR AT PERFORATIQN AND I NCLUDE BOTTQM_i°ORTIQN W1T� 1 YOI�1R P AYMENT.
Federal
Account Prompt 2 Transaction Transaction Posted Site Street Exempted
Number Card Vehicle ID Value Date Time Date Site Site Name Address Product Units Discount Unit Cost Gross Cost Tax Net Cost
0496001380: 2 Asst. Chief Hoffman 22994 2/1/2011 15 :49:00 2/3/2011 Shell /Equiv Circle K Sto 545 S Rang FUL 17.19 $0.00 $2.90 $49.84 $0.00 $49.84
0496001380: 8 Chris Ellison 3956 2/24/2 12:45:00 2/28/2011 Shell /Equiv Circle K Sta 545 5 Rang UNL 20.56F $0.00 $2.76 $56.73 ($3,7 $52.97
0496001380: 9 keith Freer 130112 1/31/2011 14:35:00 2/2/2011 Shell /Equiv Circle K Sto 545 S Rang FUL 13.3 $0.00 $2.90 $38.58 $0.00 $38.58
0496001380: 9 keith Freer 130187 2/1/2011 9:47:00 2/3/2011 Shell /Equiv Circle K Stal545 S Rang FUL 6.9 $0.00 $2.90 $20.03 $0.00 $20.03
0496001380: 91keithFreer 1 130267 2/8/2011 14:35:00 2/10/2011 Shell /Equiv Circle KSto5455 Rang UNL 14.44 $0.00 $2.90 1 $41.89 ($2.64)1 $39.25
$200.67
VOUCHER NO. WARRANT NO.
ALLOWED 20
Fleet Services
IN SUM OF
P.O. Box 6293
Carol Stream, IL 60197
$200.67
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. I ACCT #TTITLE AMOUNT Board Members
1120 I 25375100 I 42- 314.00 I $200.67 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
f
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))
25375100 $200.67
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