166636 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 069001 Page 1 of 1
r ONE CIVIC SQUARE CRYSTAL FLASH
t
CARMEL, INDIANA 46032 PO Box 105080 CHECK AMOUNT: $237.43
8 ATLANTA GA 30348 -5080
CHECK NUMBER: 166636
CHECK DATE: 12/10/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4231400 BG1298100 237.43 GASOLINE
IC�Yl�4�rFASI�i►- Local Office: Crystal Flash Petroleum PL
PO BOX 105080 For billing questions call: (800) 903 -9368
ATLANTA, GA 30348 -5080
Account BG1298100
Please reference account on all payments
STATEMENT NP15132178
DATE 11103/2008
CITY OF CARMEL MAINTENANCE DUE DATE 1111712008
1 CIVIC SQ
I N 46032
CARMEL TOTAL BALANCE DUE $237.43
PAYMENT TERMS Net 14 days MN
Your account terms and conditions include late fee, finance charge, and statement fee provisions which have been waived.
These provisions will be applied going forward. For free online statements and payments, log onto www.fleetnet.net.
DESCRIPTION OF CURRENT ACTIVITIES
Services and Fees as reported 10/31/2008
Date Description Gallons Amount. Due
10/13/2008 CREDIT: Payment Without Remit Coupon $318.05 CR
10/2412008 CREDIT: Payment Without Remit Coupon $352.48 CR
11/03/2008 Fleet 1315492 Name: CITY OF CARMEL- MAINTENANCE 82.695 $237.43
Current Activity
Previous
Statement Prior Balance Payments and
Ad Adjustments
Gallons Charges Total Balance Due
Date f
1010112008 $670.53 $670.53 CR 82.695 $237.43 $237.43
FOR PROPER PAYMENT POSTING, PLEASE SUBMIT YOUR CHECK WITH ONLY THE REMITTANCE COPY BELOW.
J
PO BOX 105080 FLEET MANAGEMENT REPORT
ATLANTA, GA 30348 -5080 Account BG1298100
FLEET 1315492
Provided By. Name: CITY OF CARMEL MAINTENANCE
Crystal Flash Petroleum PL MATCHING STATEMENT NP15132178
(800)903 -9368
Page: 1 Of 1
CITY OF CARMEL MAINTENANCE
1 CIVIC SQ
CARMEL IN 46032
FLEET MANAGEMENT REPORT FOR 10/1/2008 1013112008
SUMMARY OF TRANSACTIONS THIS REPORTING PERIOD FOR ALL VEHICLES IN YOUR FLEET
PRODUCT QUANTITY BASE PRICE FEDERAL STATE OTHER TOTAL
UNL 82.695 $192.83 $15.33 $29.27 $0.00 $237.43
Total 82.695 $192:83 $15.33 $29.27' $0:00 $237.43
This report is for information only.
Please see remittance copy on the statement for the total payment amount.
TOTAL MILES: 0
EXCEPTION CODES:
11 Odometer entry is out of sequence.
Transaction betail for Customer NQ. 1315492;— CITY: OF CARMEL= MAINTENANCE; 10!1!2008 —'1013112008'
FUEL NET TOTAL EXCEPT
DATE TIME SITE DRIVER ODOMETER MPG TYPE QTY PRICE TAXES AMT CODE'*
581400 -GRASS 42
10106 11:47 882081 DRIVER 1 0 0.0 UNL 18.780 2.75990 0.56901 $62.52 11
10 /07 12:49 882081 DRIVER 1 0 0.0 UNL 12.910 2.76070 0.56884 $42.98 11
10/16 16:39 885419 DRIVER 1 0 0.0 UNL 15.173 2.31990 0.53864 $43.38 11
10/22 12:27 885419 DRIVER 1 0 0.0 UNL 18.147 2.11500 0.52397 $47.89 11
10/29 10:30 885419 DRIVER 1 0 0.0 UNL 17.685 1.79700 0.50185 $40.66 11
Miles: 82.695 $237.43
SITE LEGEND
SITE SITE NAME ADDRESS CITY STATE
882081 Circle K 2275 Shell -p @p 1230 S Range Line Rd Carmel IN
885419 Crystal Flash #67 -p @p 545 S Rangeline Rd Carmel IN
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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 1 Amount
Date Number (or note attached invoice(s) or bill(s))
Total �3
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. 0 9ARRANT NO.
r sa ALLOWED 20
P -C) IN SUM OF
Rfl Vt 6 n
c3 ").43
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1 -2-05 P isd 32f 314 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
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund