201120 09/13/2011 CITY OF CARMEL, INDIANA VENDOR: 00352984 Page 1 of 1
ONE CIVIC SQUARE FLEET SERVICES
CARMEL, INDIANA 46032 PO BOX 6293 CHECK AMOUNT: $1,061.83
CAROL STREAM IL 60197 CHECK NUMBER: 201120
CHECK DATE: 9/13/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231400 27037768 1,061.83 0453 -00- 794629 -6
FLEET SERVICES INVOICE/STATEMENT
INVOICE NUMBER: 27037768
ACCOUNT NAME: CARMEL FIRE DEPARTMENT
PAGE 1 OF 1
ACCCUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0453.00- 794629 -6 8,10 0.00 31 08 -31 -2011 09 -26 -2011 1 83
ACTIVITY DESCRIPTION C.HARGESIDEBI S PAYMENTS /CREDITS
08 19.2€?91 PAYMENT RECEIVED -THANK YOU 983.85
Q8 37 20.11„ RETAIL FUEL PURCHASES 7;;039 831
08 81 -20.11 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 INVOICEISTATEMENT
PREVIOUS BALANCE PAYMENTS )PURCHASES )DEBITS CREDITS LATE FEE NEW BALANCE
983.85 983.85 1039.83 22.00 0.00 0.00 1061.83
$10.00 MINIMUM LATE FEE
PAY ONLINE AT: www.waxonline.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 0 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.wexon line- corn.
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
Cal! 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: 08 -31 -2011
FLEET S E Iii/ I C E S ACCOUNT NO: 0453 -00- 794629 -6
DELIVER TO:
DENISE SNYDER
CARMEL FIRE DEPARTMENT
2 CIVIC SQ
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 -64.26 0.00 FEDERAL E85 351.230 1,176.90 0.18300 1.
KI~pl~R 4i. TC1 ALS -64 N
26 D DD 354 1:76 90,
IN 356000972 72.81 0.00 STATE SALES E85 351.230 1,176.90 0.07000
IN STATE TOTALS ?2 81 fl OD
ACCOUNT TOTALS 1:37.07 0.00
1k
(c) WRIGHT EXPRESS CORPORATION 2011 PAGE 1
FLEET SERVICES STANDARD REPORT
INVOICE NUMBER: 27037768
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 -0 0 794629 6 8,100.00 31 08 -31 -2011 09 -26 -2011 1,061.83
CARD LOCATION DATE TIME DRIVER ODOMETER PRODUCT UNITS COST/ ITEM TOTAL
NO. NO. UNIT TOTAL AMOUNT
0001 MH 001 074 07 -28 -2011 14:19 SMITH, KEITH 14,500 E85 15.860 3259 54.94 54.94
MH 001 074 07 -29 -2011 14:15 SMITH, KEITH 14,500 E85 11.120 3.259 36.24 36.24
MH 001 074 08 -04 -2011 12:29 SMITH, KEITH 14,500 E85 15.790 3.360 53.05 53.05
MH 001 C74 08 -05 -2011 12:10 SMITH, KEITH 14,500 E85 7.560 3.360 25.40 25.40
MH 001 074 08 -08 -2011 12.57 SMITH, KEITH 14,500 E85 13.670 3.358 45.90 45.90
MH 001 074 08 -26 -2011 12:12 SMITH, KEITH 14,500 E85 18.140 3.359 60,94 60.94
CARD SUBTOTALS 83.140 276.47
0002 MH 001 074 08 -02 -2011 09:06 HULETT, MARK 90,560 E85 12.410 3.360 41.70 41.70
MH 001 078 08 -04 -2011 17:36 HULETT, MARK 90,754 E85 12.510 1360 4203 42.03
MH 001 074 06 -08 -2011 13:11 HULETT, MARK 90,906 E85 9,620 3.358 32.30 32.30
MH 001 078 08 -18 -2011 15:51 HULETT, MARK 91,525 E86 12.090 1358 40.60 40.60
MH 001 080 08 -25 -2011 07:41 HULETT, MARK 91,898 E85 12.510 3.357 42.00 42.00
CARD SUBTOTALS 59.140 198.63
0003 MH 001 074 08 -03 -2011 13:15 STEELE, JEFF 5,630 E85 26.230 1359 88.10 88.10
MH 001 074 08 -09 -2011 12:33 STEELE, JEFF 5,841 E85 22,310 3.359 74.93 74.93
MH 001 074 08 -12 -2011 16:04 STEELE, JEFF 5,013 E85 19140 3.359 64.29 64.29
MH 001 074 08 -19 -2011 16.33 STEELE, JEFF 6,261 E85 25.150 3.359 84.47 84.47
MH 001 074 08 -25 -2011 16:54 STEELE, JEFF 6,464 E85 22.530 3.359 75.67 75.67
CARD SUBTOTALS 115.360 387.46
0004 MH 001 074 08 -05 -2011 07:30 HABOUSH, DAVE 4,332 E85 25.410 3.359 85.35 85.35
MH 001.074 08 -09 -2011 08:43 HABOUSH, DAVE 4,588 E85 22.370 3.358 75.12 75.12
MH 001 074 08 -19 -2011 17:59 HABOUSH, DAVE 4,786 E85 20.310 3,359 68.22 68.22
MH 001 074 08 -25 -2011 18:53 HABOUSH, DAVE 5,043 E85 25.500 3.359 85.65 85.66
CARD SUBTOTALS 93.590 314.34
TOTAL PURCHASES 351.230 1,176.90
Y -T -D PURCHASES 2,885.260 9,071.95
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 17 1,062.27
MH 001 078 MEIJER 5303 E SOUTHPORT RD INDIANAPOLIS IN 46237 2 82.63
MH 001 080 MEIJER 6630 SCATTERFIELD RD ANDERSON IN 46013 1 42.00
PRODUCTS: E85= ETHANL85 W-1
VOUCHER NO. WARRANT NO.
Fleet Services ALLOWED 20
iN SUM OF
P.O. Box 6293
Carol Stream, IL 60197
$1,963.96
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# 1 Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1120 27037768 j 42- 314.00 1 $1,061.83 1 hereby certify that the attached invoice(s), or
1120 27034609 42- 314.00 $902.13 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
t1
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))
27037768 $1,061.83
27034609 $902.13
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