169757 03/17/2009 a CITY OF CARMEL, INDIANA VENDOR: 069001 Page 1 of 1
ONE CIVIC SQUARE CRYSTAL FLASH
e,+ CHECK AMOUNT: $191.10
CARMEL, INDIANA 46032 PO BOX 105080
*•roe o ATLANTA GA 30348 -5080 CHECK NUMBER: 169757
CHECK DATE: 3/17/2009
CZPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1202 4231400 BG1298100 191.10 BG1298100
_1
26]3101.200903011901 .00100
1
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
III) II I IIIIIIII III I II III 108 STATEMENT NP16769325
DATE 03/02/2009
CITY OF CARMEL- MAINTENANCE DUE DATE 04/01/2009
1 CIVIC SQ TOTAL BALANCE DUE $271.05
CARMEL IN 46032 -2584
PAYMENT TERMS Net 30 MN
Fur statements and simple, autornated payment setup, contact customer service at cardservices @fleetcor.com.
DESCRIPTION OF CURRENT ACTIVITIES
Services and Fees as reported 2/28/2009
Date Description Gallons Amount Due
02/20/2009 PAYMENT: Lockbox Payment Thank You $194.21 CR
03/02/2009 Fleet 1315492 Name: CITY OF CARMEL- MAINTENANCE 106.101 $191.10
Current Activity
Previous
Statement Prior Balance Payments and
Ad Adjustments
Gallons Charges Total Balance Due
Date 1
02/01/2009 $274.16 $194.21 CR 106.101 $191.10 $271.05
FOR PROPER PAYMENT POSTING, PLEASE SUBMIT YOUR CHECK WITH ONLY THE REMITTANCE COPY BELOW.
'-i73101 2W. 301
T;.i
J�
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 NP16769325
Page: 1 of 1
CITY OF CARMEL- MAINTENANCE
1 CIVIC SQ
CARMEL IN 46032
FLEET MANAGEMENT REPORT FOR 2/1/2009 2/28/2009
SUMMARY- -OF TRANSACTIONS THIS REPORTING PERIOD FOR ALL VEHICLES IN YOUR FLEET
PRODUCT QUANTITY BASE PRICE FEDERAL STATE OTHER TOTAL
UNL 106 $141.27 $19.71 $30.12 $0.00 $191.10
¢Total 106 01 �1 W
$0003 x$191 1_0
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.
F
ansaction Detail for Customer „NO 1315492 CITY OFs'CARMEL
Tr MAINTENANCE2/1/200
9 2`/28L20�09
w f a. w ..r
FUEL NET TOTAL EXCEPT
DATE TIME SITE DRIVER ODOMETER MPG TYPE QTY PRICE TAXES AMT CODE
Q581400 �GRASS�42 gar s
02/03 16:34 885419 DRIVER 1 0 0.0 UNL 13.175 1.26450 0.46470 $22.78 11
02/08 12:36 885419 DRIVER 1 0 0.0 UNL 16.570 1.26370 0.46522 $28.65 11
02/08 14:39 885419 DRIVER 1 0 0.0 UNL 13.701 1.26340 0.46494 $23.69 11
02/13 08:03 885419 DRIVER 1 0 0.0 UNL 17.840 1.47930 0.48016 $34.95 11
02/19 16:30 885419 DRIVER 1 0 0.0 UNL 16.036 1.34820 0.47069 $29.17 11
02/23 16:34 885419 DRIVER 1 0 0.0 UNL 16.407 1.29210 0.46732 $28.86 11
02/28 16:45 885419 DRIVER 1 0 0.0 UNL 12.372 1.38620 0.47370 $23.00 11
Miles: 106.101 $191.10
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
Crystal Flash Petroleum PL Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
03102109 BG1298 Gas
Total
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 NP 6 IN NAR RANT NO.
tim Corp ALLOWED 20
B6x1$5 IN SUM OF
A tlanta, GA 30348 -5080
$191.10
ON ACCOUYT�FgWILOPbIATIION FOR ND
1202 Information Systems
tDq 2 1LZ Board Members
DEPT INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
12 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
n re
�r t
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund