168837 02/16/2009 CITY OF CARMEL, INDIANA VENDOR: 069001 Page 1 of 1
ONE CIVIC SQUARE CRYSTAL FLASH CHECK AMOUNT: $194.21
CARMEL, INDIANA 46032 PO BOX 105080
ATLANTA GA 30348 -5080
CHECK NUMBER: 168837
CHECK DATE: 2/1612009
DEPARTMENT ACCOU PO NUMB INVOICE NUMBER AMOU DE
1205 4231400 BG1298100 194.21 BG1298100
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2G]t101 ?009(120fNi0N0i OOf189
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Local Office: Crystal Flash Petroleum PL
PO BOX 105080 For billing questions call: (800) 903 -9368
ATLANTA, GA 30348 -5080
i
Account BG1298100
Please reference account on all payments
IIII I I�I II
1111111 N 89 STATEMENT NP16368669
DATE 02/02/2009
CITY OF CARMEL- MAINTENANCE DUE DATE 02/16/2009
1 CIVIC SQ TOTAL BALANCE DUE $274.16
CARMEL IN 46032 -2584
PAYMENT TERMS Net 14 days MN
I
For onlina statements acid simple, automated payment setup., contact customer service at ca:dse. vices @fleetcor.coni. I
DESCRIPTION OF CURRENT ACTIVITIES
Services and Fees as reported 1/31/2009
Date Description Gallons Amount Due
01/23/2009 PAYMENT: Lockbox Payment Thank You $137.19 CR
02/02/2009 Fleet 1315492 Name: CITY OF CARMEL- MAINTENANCE 104.007 $219.21
Current Activity
Previous
Statement Prior Balance Payments and Gallons Charges Total Balance Due
Date Adjustments
01/01/2009 $191.29 $137.19 CR 104.007 $220.06 $274.16
FOR PROPER PAYMENT POSTING. PLEASE SUBMIT YOUR CHECK WITH ONLY THE REMITTANCE COPY BELOW.
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 NP16368669
Page: 1 of 1
CITY OF CARMEL- MAINTENANCE
1 CIVIC SID
CARMEL IN 46032
FLEET MANAGEMENT REPORT FOR 1/1/2009 1/31/2009
SUMMARY OF TPANISACTIONS THIS REPORTING PERIOD FOR ALL VEHICLES IN YOUR FLEET
PRODUCT QUANTITY BASE PRICE FEDERAL STATE OTHER TOTAL
UNL 104.007 $144.91 $19.32 $29.98 $0.00 $194.21
Total r X104 007 $19 32 x$29 98 $0.00 $194 21
$144 91
Late Fee on Invoice# 15910486 0
Finance Charge �i0'85
Report Total $220.06
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 Detatlfor Customer NO 1315492 CITY OF CARMEL MAINT `1%1/2009 1!31/2009 A
FUEL NET TOTAL EXCEPT
DATE TIME SITE DRIVER ODOMETER MPG TYPE QTY PRICE TAXES AMT CODE
581400 'GRASS 42 y a
01105 16:36 885419 DRIVER 1 0 0.0 UNL 14.685 1.38580 0.47328 $27.30 11
01/09 16:39 885419 DRIVER 1 0 0.0 UNL 12.879 1.47920 0.47995 $25.23 11
01/12 16:35 885419 DRIVER 1 0 0.0 UNL 15.550 1.42190 0.47622 $29.53 11
01/16 14:19 885419 DRIVER 1 0 0.0 UNL 14.162 1.51670 0.48252 $28.31 11
01/23 16:34 885419 DRIVER 1 0 0.0 UNL 17.566 1.37650 0.47268 $32.48 11
01/26 16:30 885419 DRIVER 1 0 0.0 UNL 11.658 1.31070 0.46854 $20.74 11
01/29 07:54 885419 DRIVER 1 0 0.0 UNL 17.507 1.28290 0.46615 $30.62 11
Miles: 104.007 $194.21
SITE LEGEND
SITE SITE NAME ADDRESS CITY STATE
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
Crystal Flash Petroleum PL Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
274.16
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 WARRANT NO.
e ro eum Orp ALLOWED 20
OX 1050 IN SUM OF
Atlanta, GA 30348_5020
$-2'74.1
ON ACCOUNT OF APPROPRIATION FOR
GENERALFUND
1205 Administration
Board Members
PO# or
DEPT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
0 314 ?ZA' -16- materials or services itemized thereon for
q Q/j which charge is made were ordered and
received except
20
ignatu�
Title dam
Cost distribution ledger classification if
claim paid motor vehicle highway fund