177967 10/13/2009 CITY OF CARMEL, INDIANA VENDOR: 069001 Page 1 of 1
ONE CIVIC SQUARE CRYSTAL FLASH PETROLEUM
CARMEL, INDIANA 46032 PO BOX 105080 CHECK AMOUNT: $235.07
ATLANTA GA 30348 -5080 CHECK NUMBER: 177967
CHECK DATE: 10/13/2009
!}EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231400 BG1297998 235.07 BG1297998
10/02/%1)09 1:57:51 PM —0400 FLEETDETAILS PAGE 2 OF 3
r
Local Office: Crystal Flash Petroleum PL
PO BOX 105080 For billing questions call: (800) 903 -9368
ATLANTA, GA 30348 -5080
Account BG1297998
Please reference account on all payments
STATEMENT 4 NP21339571
DATE 10/02/2009
CITY OF CARMEL -FIRE DUE DATE 11101/2009
1 CIVIC SQ
CARMEL IN 46032 TOTAL BALANCE DUE $245.08
PAYMENT TERMS Net 30 MN
For online statements and simple, automated payment setup, contact customer service at
cardservices @fleetcor.com.
DESCRIPTION OF CURRENT ACTIVITIES
Services and Fees as reported 9/30/2009
Date Description Gallons Amount Due
09119/2009 PAYMENT: Lockbox Payment Thank You $1712.46 CR
10/02/2009 Fleet 1315390 Name: CITY OF CARMEL -FIRE 80.842 $235.07
Current Activity
Previous
Statement Prior Balance Payments and Gallons Charges Total Balance Due
Date Adjustments
09/01/2009 $1,712.46 $1,712.46 CR 80.842 $245.08 $245.08
FOR PROPER PAYMENT POSTING, PLEASE SUBMIT YOUR CHECK WITH 9MLY THE REMIT C OPY BELOW.
10/02/2009 1:57:51 PM -0400 FLEETDETAILS PAGE 3 OF 3
CAWH7AL7PLAL H_ FLEET MANAGEMENT REPORT
PO Box 105080
ATLANTA, GA 30348 -5080 ACCOU11t BG1297998
FLEET 1315390
Provided By: Name: CITY OF CARMEL FIRE
Crystal Flash Petroleum PL MATCHING STATEMENT NP21339571
(800) 903 -9368
Page: 1 of 1
CITY OF CARMEL -FIRE
1 Civic SQ
CARMEL IN 46032
FLEET MANAGEMENT REPORT FOR 9/1/2009 9/30/2009
SUMMARY OF TRANSACTIONS THIS REPORTING PERIOD FOR ALL VEHICLES IN YOUR FLEET
PRODUCT QUANTITY BASE PRICE FEDERAL STA O THER T OTAL
UNL 30.265 $57.89 $5.63 $9.83 $0.00 $73.35
UNL+ 50.577 $84.92 $9.41 $15.59 $0.00 $109.92
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Late Fee on Invoice #20351905 $51.80
Finance Charge $10.01
Report Total $245.08
This report is for Information only.
Please see remittance copy on the statement for the total payment amount.
TOTAL MILES: 258
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FUEL NET TOTAL EXCEPT
DATE TIME SITE DRIVER ODOMETER MPG TYPE QTY PRICE TAXES AMT CODE
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09/08 08:29 885419 DRIVER 1 14500 0.0 UNL+ 18.076 1,70340 0.49595 $39.75
09125 08:28 885419 DRIVER 1 14500 0.0 UNL+ 16.174 1.66560 0.49337 $34.92
09129 08:21 885419 DRIVER 1 14500 0.0 UNL+ 16.327 1.66530 0.49350 $35.25
Miles: 50.577 $109.92
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09127 11:07 685531 DRIVER 1 94553 0.0 UNL 13.439 1.82450 0.50463 $31.30
Miles: 13.439 $31.30
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09/03 16:32 885419 DRVER 1 74582 15.3 UNL 16.826 1.98320 0.51556 542.05
Miles: 258 15.3 16.826 $42,05
SITE LEGEND
SITE SITE NAME ADDRESS CRY STATE
685531 Crystal Flash #71 14554 Herriman Blvd Noblesville IN
885419 Crystal Flash #67 545 S Rangeline Rd Carmel IN
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))
BG 1297998 $245.08
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 N_O. WARRAN NO.
—4 ALLOWED 20
Crystal Flash
IN SUM OF
P.O. Box 684
Indianapolis, IN 46206
$245.08
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1120 BG1297998 42- 314.00 9— 1 hereby certify that the attached invoice(s), or
7 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
OCT 12 2003
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund