198334 06/15/2011 CITY OF CARMEL, INDIANA VENDOR: 354030 Page 1 of 1
ONE CIVIC SQUARE FLEET FUELING
CHECK AMOUNT: $1,139.61
CARMEL, INDIANA 46032 PO BOX 6293
CAROL STREAM IL 60197 -6293 CHECK NUMBER: 198334
CHECK DATE: 6/15/2011
DEPARTMENT ACCOUNT PO NU MBER INVOICE N AMOUNT DESCRIPTION
1205 4231400 26196271 190.98 GASOLINE
1120 4231400 26231410 948.63 GASOLINE
FLEET SERVICES INVOICE /STATEMENT
INVOICE NUMBER: 26231410
ACCOUNT NAME: CARMEL FIRE DEPARTMENT
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
8,100.00 31 05 -31 -2011 06 -24 -2011 948.63
DATE ACTIVITY DESCRIPTION CHARGES /DEBITS PAYMENTS /CREDITS
05 -16 -2011 PAYMENT RECEIVED THANK YOU 1,018.52
05 -31 -2011 RETAIL FUEL PURCHASES 926.63
05 -31 -2011 MONTHLY CARD CHG 22.00
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
1018.52 1018.52 926.63 22.00 0.00 0.00 948.63
$10.00 MINIMUM LATE FEE
PAY ONLINE AT: www.wexon line. 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 aP2lYinq a monthly eeriodic rate of PERCENTAGE RATE of fee for this period which is
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.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, 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- 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: /www.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.
ACCOUNT: CARMEL FIRE DEPARTMENT CLOSING DATE: 05 -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 -50.94 0.00 FEDERAL E85 278.410 942.86 0.18300
-5.21 0.00 FEDERAL GASOLINE 28.490 104.44 0.18300
FEDERAL TOTALS -56.15 1 0.00 306.900 1,047.30
IN 356000972 0.00 5.12 STATE EXCISE GASOLINE 28.490 104.44 0.18000
-58.37 0.00 STATE SALES E85 278.410 942.86 0.07000
6.15 GOO STATE SALES GASOLINE 28.490 104.44 0.07000
IN STATE TOTALS -64.52 5.12
ACCOUNT TOTALS 120.67 5.12
(c) WRIGHT EXPRESS CORPORATION 2011 PAGE 1
FLEET SERVICES STANDARD REPORT
INVOICE NUMBER: 26231410
ACCOUNT NAME: CARMEL FIRE DEPARTMENT
PAGE 1 OF 2
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0453 -00- 794629 -6 8,100.00 31 05 -31 -2011 06 -24 -2011 948.63
CARD LOCATION DATE TIME DRIVER ODOMETER PRODUCT UNITS COST/ ITEM TOTAL
NO. NO. UNIT TOTAL AMOUNT
0001 MH 001 074 05 -03 -2011 12:40 SMITH, KEITH 14,500 E85 20.910 3.399 71.07 71.07
MH 001 074 05 -05 -2011 08:43 SMITH, KEITH 14,500 E85 18.790 3.399 63.86 63.86
MH 001 074 05 -10 -2011 11:27 SMITH, KEITH 14,500 E85 17.420 3.400 59.22 59.22
MH 001 078 05 -25 -2011 08:57 SMITH, KEITH 14,500 UNL 21.970 3.579 78.64 78.64
MH 001 074 05 -26 -2011 12:37 SMITH, KEITH 14,500 UNL 6.520 3.957 25.80 25.80
CARD SUBTOTALS 85.610 298.59
0002 MH 001 074 04 -29 -2011 09:22 HULETT, MARK 85,304 E85 8.590 3.300 28.35 28.35
MH 001 074 05 -04 -2011 13:50 HULETT, MARK 85,496 E85 11.770 3.398 40.00 40.00
MH 001 074 05 -11 -2011 13:08 HULETT, MARK 85,861 E85 10.010 3.399 34.02 34.02
MH 001 078 05 -14 -2011 01:30 HULETT, MARK 86,071 E85 13.240 3.399 45.00 45.00
MH 001 078 05 -18 -2011 13:42 HULETT, MARK 86,292 E85 14.420 3.398 49.00 49.00
MH 001 074 05 -24 -2011 07:09 HULETT, MARK 86,502 E85 12.150 3.399 41.30 41.30
MH 001 078 05 -26 -2011 18:18 HULETT, MARK 86,690 E85 11.190 3.400 38.05 38.05
CARD SUBTOTALS 81.370 275.72
0003 MH 001 095 05 -03 -2011 20:46 STEELE, JEFF 1,739 E85 24.390 3.399 82.91 82.91
CARD SUBTOTALS 24.390 82.91
0004 MH 001 074 04 -29 -2011 17:12 HABOUSH, DAVE 1,253 E85 26.050 3.299 85.93 85.93
MH 001 074 05 -05 -2011 07:58 HABOUSH, DAVE 1,525 E85 24.940 3.399 84.78 84.78
MH 001 074 05 -09 -2011 17:23 HABOUSH, DAVE 1,747 E85 20.700 3.400 70.37 70.37
MH 001 074 05 -16 -2011 19:44 HABOUSH, DAVE 1,957 E85 21.690 3.398 73.71 73.71
MH 001 074 05 -22 -2011 19:27 HABOUSH, DAVE 2,191 E85 22.150 3.399 75.29 75.29
CARD SUBTOTALS 115.530 390.08
TOTAL PURCHASES 306.900 1,047.30
Y -T -D PURCHASES 1,923.300 5,872.16
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 13 753.70
MH 001 078 MEIJER 5303 E SOUTHPORT RD INDIANAPOLIS IN 46237 4 210.69
-MH 001 095 MEIJER 8225-E 96TH ST INDIANAPOLIS IN 46256 1 82.91-
Iga
PRODUCTS: E85= ETHANL85 UNL= UNLEADED
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))
26231410 $948.63
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
20
Clerk- Treasurer
VOUCHER NO. WAR NO.
ALLOWED 20
Fleet Services
IN SUM OF
P.O. Box 6293
Carol Stream, IL 60197
$948.63
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT
Board Members
1120 I 26231410 I 42- 314.00 I $948.63 1 her 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
�nvouce Statement
INVOICE NUMBER: 26196271
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
550.00 31 MAY 31 2011 JUN 24 2011 200.98
DATE ACTIVITY DESCRIPTION CHARGES /DEBITS PAYMENTS /CREDITS
MAY -16 -2011 PAYMENT THANK YOU 112.76
MAY -31 -2011 FUEL PURCHASES 165.98
MAY -11 -2011 GOODWILL LATE FEE WRITE OFF 25.00
REMINDER
BALANCE INCLUDES PAST DUE AMOUNT IF PAYMENT HAS
BEEN MADE, PLEASE DISREGARD THIS NOTICE. PAST DUE
ACCOUNTS ARE SUBJECT TO SERVICE INTERRUPTION
D Z/A
JUN 10 2011
By
PURCHASES RETURNS AND PAYMENTS MADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT INVOICE/STATEMENT.
CURRENT PERIODI ONE BILLING PERIOD PAST DUE1 TWO BILLING PERIODS PAST DUE THREE+ BILLING PERIODS PAST DUE I TOTAL DUE
175.98 25.00 0.00 0.00 200.98
PREVIOUS BALANCE PAYMENTS )PURCHASES )DEBITS CREDITS )LATE FEE )NEW BALANCE
162.76 112.76 165.98 0.00 25.00 10.00 200.98
CALL CUSTOMER SERVICE TO PAY BY PHONE
FEDERAL TAX ID: 841425616 The Late Fee is determined by I Which is an EFFECTIVE ANNUAL To the balance subject to late
Balance Subject to Late Fee Payment Options
4
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 falls on anon- 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: /Avww.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 Admin. City of Carmel Admin.
NO 0496 -00- 138002 -1
MAY -01 -2011 TO MAY -31 -2011
Purchase Activity Report PAGE 1 OF 2
CARD NUMBER CARD EMBOSSING VEHICLElASSET IDENTIFIER VEHICLE DESCRIPTION PLATE ST VIN DEPARTMENT
000 Mercur mariner UNASSIGNED
DATE TIME SITE ADDRESS PROMPT TRAN ODOM. PROD UNITS COST/ FUELS OTHER EXEMPT NET REPORTED EXC.
INFO CODE UNIT TAX TAX CODES
PREVIOUS ODOMETER 1,955
MAY -02 12:28 545 S Range Line R Carmel IN 1 Driver OP 2,340 UNL 16.750 4.119 69.01 3.07- 65.94 7.14
MAY-24 10:51 545 S Range Line R Carmel IN 1 Driver OP 1,955 UNL 10.500 3.399 35.70 1.92- 33.78 3.98
MAY-25 12:29 545 S Range Line R Carmel IN 1 Driver OP 2,340 UNL 17.540 3.959 69.47 3.21- 66.26 7.29
PERIOD TOTALS 385 44.790 174.18 8.20- 165.98 18.41
YTD TOTALS 246.138 834.17 45.05- 789.12 93.06
PERIOD AVERAGES: MPG, PPG, CPIV 8.60 3.889 0.45
YTD AVERAGE: PPG 3.389
TO ENSURE MORE ACCURATE MILEAGE FEPORTING, VEHICLE MILEAGE STATISTICS ARE N T
CALCU -ATED WHEN KEY ODOMETER 1EADINGS kRE NOT WITHIN AN CCEPTABLE RANGE.
TRANSACTION CODES:
OF Outdoor Payment Terminal
PARENT ACCOUNT: REPORT FOR:
City of Carmel Admin. City of Carmel Admin.
NO 0496 -00- 138002 -1
MAY -01 -2011 TO MAY -31 -2011
Financial Summary PAGE 1 OF 2
DEPARTMENT DESCRIPTION FEES PURCHASES TOTAL FEES
OTY COS T/ FEE TOTAL FEES FUELS OTHERS EXEMPTED TAX NET PURCHASES
ACCOUNT TOTALS Unleaded Regular 174.18 8.20- 165.98
PERIOD 0.00 174.18 0.00 8.20- 165.98 165.98
YTD 0.00 834.17 0.00 45.05- 789.12 789.12
ACCOUNTS RECEIVABLE SUMMARY Invoice 26196271
PREVIOUS BALANCE 162.76
PAYMENTS 112.76
PURCHASES 165.98
DEBITS 0.00
CREDITS 25.00
LATE FEES 10.00
AMOUNT DUE ti 200.98
PARENT ACCOUNT: REPORT FOR:
City of Carmel Admin. City of Carmel Admin.
so 0496 -00- 138002 -1
MAY-01-2011 TO MAY-31-2011
Site Summary PAGE 1 OF 2
BRAND ADDRESS CITY STATE ZIP NO. FUEL UNITS FUEL OTHER EXEMPT NET
TRANS TAX
SHELL 545 S Range Line Rd Carmel IN 46032 3 44.790 174.18 8.20- 165.98
PERIOD TOTALS 3 44.790 174.18 0.00 8.20- 165.98
PARENT ACCOUNT: REPORT FOR:
LKJ City of Carmel Admin. City of Carmel Admin.
0496 -00- 138002 -1
MAY -01 -2011 TO MAY -31 -2011
Tax Summary Ima y PAGE i OF 2
TAX JURISDICTION ID EXPIRATION EXEMPTED TAX REPORTED TAX TAX TYPE TAX PRODUCT CLASS UNITS GROSS TAX RATE
FEDERAL 356000972 JUN -18 -2012 -8.20 Federal Excise Gasoline Unblended 44.790 174.18 0.18300
FEDERAL TOTALS -8.20 44.790 174.18
IN 356000972 JUN -18 -2012 -10.34 State Sales Gasoline Unblended 44.790 174.18 0.07000
-8.07 State Excise Gasoline Unblended 44.790 174.18 0.18000
IN STATE TOTALS 18.41
ACCOUNT TOTALS -8.20 -18.41
I
1
l
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))
06/14/11 10496 -00- 138002 -11 I $190.98
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
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Fleet Services
IN SUM OF
PO Box 6293
Carol Stream, IL 60197 -6293
$190.98
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
PO# Dept. INVOICE NO. I ACCT #/TITLE AMOUNT Board Members
1205 1 0496 00 42- 314.00 I $190.98 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
Tuesday, June 14, 2011
Director, Administrati n
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund