204692 12/20/2011 CITY OF CARMEL, INDIANA VENDOR: 00352984 Page 1 of 1
ONE CIVIC SQUARE FLEET SERVICES
CARMEL, INDIANA 46032 PO BOX 6293 CHECK AMOUNT: $157.31
CAROL STREAM IL 60197
CHECK NUMBER: 204692
CHECK DATE: 12/20/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4231400 27888177 157.31 0496 -00- 138002 -1
Invoice Statement
INVOICE NUMBER: 27888177
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
0496 -00- 138002 -1 550.00 30 NOV -30 -2011 DEC -23 -2011 227 31
{SATE I ACTIVITY DESCRIPTION C:HARGES/DEBFS PAYMENTSICREDITS
NOV 14 2x1.1 °I PAYMENT THANK YOU 196.34
NOV 30= '.2011 FUEL PURCHASES :157,'3.1:
REMINDER
BALANCE INCLUDES PAST DUE AMOUNT IF PAYMENT HAS
BEEN MADE, PLEASE DISREGARD THIS NOTICE. PAST DUE
ACCOUNTS ARE SUBJECT TO SERVICE INTERRUPTION
11
D
L 19 2011
I
By
PURCHASES, RETURNS AND PAYMENTS MADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT INVOICElSTATEMENT.
CURRENT PERiC ONE BILLING PERIOD PAST DU TWO BILLING PERIODS PAST DUO THREE+ BILLING PERIODS PAST DUEJ TOTAL DUE
167.31 60.00 0.00 0.00 227.31
PREVIOUS BALANCE PAYMENTS )PURCHASES )DEBITS CREDITS LATE FEE NEW BALANCE
256.34 196.34 157.31 0.00 0.00 10.00 227.31
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
apPying a monthly rate cf RATE of fee for this period which is
2.00 24.00 170.35
SEE REVERSE SIDE FOR IMPORTANT INFORMATION AND TERMS.
Tn FNSI IRF PROPFR CRFIIIT TFAR AT PFR1:r1PATlnIU Amn INCi i tni= RnTTnM PnPTI(1N'WITI -I VnIIP PAVRAFAIT
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 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- 866 -544 -1715 and select the menu
no later than sixty (60) days from the billing date or they 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 f=inancial Services Be prepa(ed 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 Admin. City of Carmel Admin.
L9V 0496 -00- 138002 -1
NOV -01 -2011 TO NOV -30 -2011
Purchase Activity Report PAGE OF 2
CARD'NVMBER 0ARD:EN180SsING VE1ICLEfASS. ET;fDF- wtFIER VEHICLEIDESCR1PTiOi� E.f_ATE ST V.IN
0001 Mercury mariner
DATE TIME SITE ADDRESS VEWASSET TRAM ODOM. PROD I UNITS COSTI FUEL OTHER EXEMPT NET REPORTED EXC.
MM -D DESCRIPTION CODE UNIT TAX TAX CODES
PREVIOUS ODOMETER 1,955
10 -31 1210 545 S Range Line Carmel IN 1 Driver OP 2,340 UNL 15.480 1459 53.58 283- 50.75 5.93-
11-10 12.04 633 W Main Sr 32 Westfield IN 1 Driver OP 2,340 UNL 17.700 3.549 62.84 3.24- 59.60 6.88-
11-28 11:53 545 S Range Line Carmel IN 1 Driver OF 2,340 UNL 16.100 3.099 49.91 2.95- 46.96 5.78-
PERIOD TOTALS 38S' 49:250 166 33 902! 157 31 i 1859
1?DTOTALS I_. 643:598 2,230 88 117 76,;
PERIOD AVERAGES: MPG, PPG, PM 7.81 3.375 0.43
YTD AVERAGE: PPG 3.466
TO ENSURE MOREACCURA71E MILEAG REPO TING, VEHICLE MILEAGE STATISTICS APE NOT
CALCULATED WHEN KEY DI TER READ NGS AR NOT WITHIN AN ACCEPT BLE RANGE.
i
TRANSACTION CODES:
OF Outdoor Payment Terminal
RWA
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PARENT ACCOUNT: REPORT FOR:
City of Carmel Admin. City of Carmel Admin.
0496-00-138002-1
LNO NOV-01-2011 TO NOV-30-2011
Financial Summary PAGE 1 OF 2
DEPARTMENT DESCRIPTION FEES PURCHASES TOTAL FEES
CITY COSTIFEE TOTAL FEES FUEL$ OTHER EXEMPTED TAX NET$ PURCHASES
ACCOUNT TOTALS Unleaded Regular 16633 9.02- 157,31
2-.
PERIOD
.33:
:166, 57.31:'
2 86 ::`:4-17,76 112
YTD,.
ACCOUNTS RECEIVA31LE SUMMARY Invoice 278;8177
PREVIOUS BALANCE 256.34
PAYMENTS 196.34
PURCHASES 157.31
DEBITS 0.00
CREDITS 0.00
ANCILLARIES 0.00
LATE FEES 10.00
AMOUNT DUE 227.31
MAIN
Ne
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PARENT ACCOUNT: REPORT FOP.:
City of Carmel Admin. City of Carmel Admin.
0496-00-138002-1
NOV-01-2011 TO NOV-30-2011
Site Summary PAGE I OF 2
BRAND ADDRESS CITY STATE ZIP NO. FUEL UNITS FUEL$ OTHER$ EXEMPT NET$
TRANS TAX
SHELL 546S Range Line Rd Carmel IN 46032 2 31.580 103,49 5.78- 97.71
633 W Main Sr 32 Westfield IN 46074 1 17.700 62,84 3.24- 59.60
0:
9 0
Ne
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PARENT ACCOUNT: REPORT FOP,:
City of Carmel Admin. City of Carmel Admin.
0496 -00- 138002 -1
MQM(D NOV -01 -2011 TO NOV -30 -2011
Tax Summary PAGES OF 2
TAX JURISDICTION ID EXPIRATION EXEMPTED TAX REPORTED TAX TAX TYPE TAX PRODUCT CLASS UNITS GROSS TAX RATE
FEDERAL 356000972 JUN -18 -2012 -9,02 Federal Excise Gasoline Unblended 49.280 166.33 0.18300
FEDERAL TOTALS 9 02 19 280 9 66.33: i:. IN 356000972 JUN -18 -2012 -9.71 State Sales Gasoline Unblended 49.280 166.33 0.07000
8.88 State Excise Gasoline Unblended 49.280 166.33 0.18000
1N STATE:TOTALS- 1959
ACCOUNT TOTALS -9.02 -18.59
911'.
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VOUCHER NO. WARRANT NO.
ALLOWED 20
--G4ek Fleet Services
IN SUM OF
PO Box 6293
Carol Steam, IL 60197 -6293
$157.31
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1205 27888177 42- 314.00 $157.31 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
Monday, December 19, 2011
r
Director, Administrati
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City f=orm 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))
11/30/11 27888177 $157.31
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