177162 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 069001 Page 1 of 1
ONE CIVIC SQUARE CRYSTAL FLASH CHECK AMOUNT: $190.34
CARMEL, INDIANA 46032 PO BOX 105080
ATLANTA GA 30348 -5080
CHECK NUMBER: 177162
CHECK DATE: 9115/2009
DE PART M ENT ACCOUNT PO NUMBER IN NUMBER AMOUNT DESCRI
1205 4231400 BG1298100 190.34 GASOLINE
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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
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111ff111111111111111111111111111111 135 STATEMENT NP20891992
DATE 09104/2009
CITY OF CARMEL- MAINTENANCE DUE DATE 10/04/2009
1 CIVIC SQ TOTAL BALANCE DUE $322.32
CARMEL IN 46032 -2584
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 8/31/2009
Date Description Gallons Amount Due
08/24/2009 PAYMENT: Lockbox Payment Thank You $184.76 CR
09/04/2009 Fleet 1315492 Name: CITY OF CARMEL- MAINTENANCE 74.767 $215.34
Current Activity
Previous
Statement Prior Balance Payments and Gallons Charges Total Balance Due
Date Adjustments
08/01/2009 $290.34 $184.76 CR 74.767 $216.74 $322.32
FOR PROPER PAYMENT POSTING, PLEASE SUBMIT YOUR CHECK WITH ONLY THE REMITTANCE COPY BELOW.
2f.];i101 20040�O195?01 00135
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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
(800) 903 -9368 MATCHING STATEMENT NP20891992
Page: 1 of 1
�4
CITY OF CARMEL- MAINTENANCE
1 CIVIC SQ
CARMEL IN 46032
FLEET MANAGEMENT REPORT FOR 8/1/2009 8/31/2009
SUMMARY Or TRANSACTIONS THIS REPORTING PERIOD FOR ALL VEHICLES 1 YOUR FLEET
PRODUCT QUANTITY BASE PRICE FEDERAL STATE OTHER TOTAL
UNL 74.767 $151.58 $13.91 $24.85 $0.00 $190.34
qs r d
Total
74 767 $151 58 $13.91 $24
77s" A, Late Fee on Invoice #19811654 $25.00
Finance Charge $1.40
Report Total $216.74
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 Detail fo Customer N0 1315492 ;'CITY OF CARMEL%MAIN7ENANCE, 811/2009 8/31/2009
RM w...._ yam
FUEL NET TOTAL EXCEPT
DATE TIME SITE DRIVER ODOMETER MPG TYPE QTY PRICE TAXES AMT CODE
581400GRASS 42
s 4
08104 16:40 885419 DRIVER 1 0 0.0 UNL 16.412 2.13380 0.52579 $43.64 11
08/10 11:39 885419 DRIVER 1 0 0.0 UNL 15.911 2.02120 0.51794 $40.40 11
08/17 11:41 885419 DRIVER 1 0 0.0 UNL 15.055 1.92690 0.51140 $36.72 11
08/23 11:52 885419 DRIVER 1 0 0.0 UNL 16.169 2.04900 0.52000 $41.54 11
08/28 16:38 885419 DRIVER 1 0 0.0 UNL 11.220 1.98400 0.51583 $28.04 11
Miles: 74.767 $190.34
SITE LEGEND
SITE SITE NAME ADDRESS CITY STATE
885419 Crystal Flash #67 545 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
C ryjn p Po lei i PI Purchase Order No.
r
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
'09 BG12981 -_-s
Total $190.34
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
VOUCHER N6 /09 W ARRANT NO.
ALLOWED 20
R .G. IN SUM OF
Atlanta, GA 30348 -5080
$190.34
ON ACCOUI`&T&F�P ON FOR
1205 Administration
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
120 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
�graatur
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund