179059 11/10/2009 CITY OF CARMEL, INDIANA VENDOR: 069001 Page 1 of 1
ONE CIVIC SQUARE CRYSTAL FLASH PETROLEUM
PO BOX 105080 CHECK AMOUNT: $73.00
CARMEL, INDIANA 46032
ATLANTA GA 30348 -5080 CHECK NUMBER: 179059
CHECK DATE: 11/10/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
-,651 5023990 BG1298219 73.00 BG1298219
YS7A—L7PL Local Office: Crystal Flash Petroleum PL
PO BOX 105080 For billing questions call: (800) 903 -9368
ATLANTA, GA 30348 -5080
Account BG1298219
Please reference account on all payments
11111111111111111111111111 IN IN 137 STATEMENT# NP21869124
DATE 11/02/2009
CITY OF CARMEL ITILITIES DUE DATE 12102/2009
1 CIVIC SQ TOTAL BALANCE DUE $73.00
CARMEL IN 46032 -2584
PAYMENT TERMS Net 30 MN
For online statements and simple, automated payment setup, contact customer service at card servicesCfleetcor.com.
DESCRIPTION OF CURRENT ACTIVITIES
Services and Fees as reported 10/31/2009
Date Description Gallons Amount Due
11/02/2009 Fleet 1315591 Name: CITY OF CARMEL- UTILITIES 29.211 $73.00
Current Activity
Previous
Statement Prior Balance Payments and
Ad Adjustments
Gallons Charges Total Balance Due
Date J
10/0112009 $0.00 $0.00 29.211 $73.00 $73.00
FOR PROPER PAYMENT POSTING, PLEASE SUBMIT YOUR CHECK WITH ONLY THE REMITTANCE COPY BELOW.
_1
PO BOX 1050BO FLEET MANAGEMENT REPORT
ATLANTA, GA 30348 -5080 Account BG1298219
FLEET 1315591
Provided By: Name: CITY OF CARMEL- UTILITIES
Crystal Flash Petroleum PL
(800) 903 -9368 MATCHING STATEMENT NP21869124
Page: 1 of 1
CITY OF CARMEL ITILITIES
1 CIVIC SO
CARMEL IN 46032
FLEET MANAGEMENT REPORT FOR 10/1/2009 10/31/2009
SUMMARY OF TRANSACTIONS-1 TI 113 REPORTIN PERIOD FOR ALL VEHICLES IN YOUR FLEET
PRODUCT QUANTITY BASE PRICE FEDERAL STATE OTHER TOTAL
UNL 29.211 $57.93 $5.44 $9.63 $0.00 $73.00
Total 29.211 $57.93 $5.44 $9 63 $0:00 $73.00
This report is for information only.
Please see remittance copy on the statement for the total payment amount.
TOTAL MILES: 0
Transaction Detail for,Customer N0.,1315591, CITY.OF „CARMEL ITILITIES; 10/1/2009 1013112009.
a FUEL NET TOTAL EXCEPT
DATE TIME SITE DRIVER ODOMETER MPG TYPE QTY PRICE TAXES AMT COD
567171. 2007 -:FORD F250 24
x
10/09 15:52 885419 DRIVER 1 27078 0.0 UNL 29.211 1.98320 0.51557 $73.00
Miles: 29.211 $73.00
SITE LEGEND
SITE SITE NAME AD CITY STATE
885419 Crystal Flash #67 545 S Rangeline Rd Carmel IN
Prescribed State Board Accounts ACCOUNTS PAYABLE VOUCHER
Form i'h. 301 01 -5 (Rev. 1995)
j TO
ADDRESS
Invoice Date Invoice Number Item Amount
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
19
Signature Title
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.
Officer Title
Voucher No. Warrant No.
s
ACCOUNTS PAYABLE DETAILED ACCOUNTS
SANITATION DEPARTMENT ACCT.
CARMEL, INDIANA
F I d S Favor Of
PO (V O 1 d A 10.55660
AA/w fA Gib 3a 5y b
Total Amount of Voucher
.Deductions
00
DI. 5001()
Amount of Warrant Z, Q
Month of 1 19
VOUCHER RECORD Acct. No.
Collection System
Operation
Plant
Commercial
General
Undistributed
Construction
Depreciation Reserve
Stock Accounts Merchandise
Total
Allowed
Board Members
Filed
BOYCE FORMS SYSTEMS 1- 800- 382 -8702 325