205370 01/17/2012 CITY OF CARMEL, INDIANA VENDOR: 00352984 Page 1 of 1
ONE CIVIC SQUARE FLEET SERVICES CHECK AMOUNT: $198.87
a CARMEL, INDIANA 46032 PO BOX 6293
CAROL STREAM IL 60197 CHECK NUMBER: 205370
CHECK DATE: 1117/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4231400 28188792 198.87 0496 -00- 138002 -1
Invoice Statement
INVOICE NUMBER: 28188792
ACCOUNT NAME: City of Carmel Admin.
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0496 00 138002 1 550.00 31 DEC JAN 26 2012 278.87
t?AE ACTIVITY DESCRIPTION GHARGIrSIDE3(T5; PAYMENTS /CREDITS
DEC 27 2E311 PAYMENT THANK YOU 157.31
DEC 36 2I11 FUEL PURCHASES 198,87,
REMINDER
BALANCE INCLUDES PAST DUE AMOUNT IF PAYMENT HAS
BEEN MADE, PLEASE DISREGARD THIS NOTICE. PAST DUE
ACCOUNTS ARE SUBJECT TO SERVICE INTERRUPTION
/mot
JAN 7 201
y
PURCHASES, RETURNS AND PAYMENTS MADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE ZCT INVOICE/STATEMENT.
CURRENT PERIO ONE BILLING
ILLING'PERIOD PAST DU TWO 'BILLING PERIODS PAST DU THREE+ BILLING PERIODS PAST DUEJ TOTAL DUE
208.87 70000 0.00 0.00 278.87
PREVIOUS BALANCE PAYMENTS )PURCHASES DEBITS CREDITS LATE FEE NEW BALANCE
227.31 157.31 198.87 0.00 0.00 10.00 278.$7
CALL CUSTOMER SERVICE TO PAY BY PHONE
FEDERAL TAX ID: 841425616 The Late Fee is determined by Which is an EFFECTIVE ANNUAL To the balance subject to late
applying a monthly rate of RATE of fee for this period which is
2.0$ 24.99 426.18
SEE REVERSE SIDE FOR IMPORTANT INFORMATION AND TERMS.
PARENTACCOUNT: REPORTFOR:
City of Carmel Admin. City of Carmel Admin.
0496 -00- 138002 -1
DEC -01 -2011 TO DEC -31 -2011
Purchase Activity Report PAGE OF 2
C?415<tflJ1UJ$ :Ctt�'13:N1SING 1tE# EI€ li,l: A55E#:( CII nf7lfi &RtEIiIGLEpfSCFi1!TU?N.:: PF�41E:ST ftN
0001 Mercu mariner
DATE TIME SITE ADDRESS VEH /ASSET TRAN ODOM. PROD UNITS COST/ FUEL OTHER EXEMPT NET REPORTED EXC.
MM-D DESCRIPTION CODE UNIT TAX TAX CODES
PREVIOUS ODOMETER 2,340
12 -05 16:09 545 S Range Line Carmel IN 1 Driver OF 2,340 UNL 18.670 3.239 60.48 3.42- 57.06 5.87-
12-12 11:56 545 S Range Line Carmel IN 1 Driver OP 2,340 UNL 14.830 3.339 49.54 2.71- 46.83 5.56-
12-16 11:01 545 S Range Line Carmel IN 1 Driver OP 2,340 SUP 15.260 3.459 52.79 2.79- 50.00 5.84-
12-21 12:33 545 S Range Line Carmel IN 1 Driver OP 2,340 UNL 13,980 3.399 47.54 2.56- 44.98 5.30
YTDTOfALS. t mss.
708 338 2;44123 129.24;; 3,311 99 27Q 08i
PERIOD AVERAGE: PPG 3.353
YTD AVERAGE: PPG 3.456
TO ENSURE MORE CU E MILEAG REPORTING, VEHICI E MILEAGE TATISTICS A E NOT
CAI CULATED WHEN KEY DDOME TER READ NGS ART NOT WITHIN AN ACCEPT ABLE RANGE.
TRANSACTION CODES
OF Outdoor Payment Terminal
PARENT ACCOUNT: REPORT FOR:
City of Carmel Admin. City of Carmel Admin.
0496-00-138002-1
DEC-01-2011 TO DEC-31-2011
Financial Summary PAGE 1 OF 2
DEPARTMENT DESCRIPTION FEES PURCHASES TOTAL FEES
CITY COSTIFEE TOTAL FEES FUEL$ OTHER EXEMPTED TAX NET$ PURCHASES
ACCOUNT TOTALS Unleaded Regular 157.56 8.69- 148.87
Unleaded Super 52.79 2,79- 50.00
A.7.:
PER SS
X441',23..
T
ACCOUNTS RECEIVA 3LE SUMMARY Invoice 281188792
PREVIOUS BALANCE 227.31
PAYMENTS 157.31-
PURCHASES 198.87
DEBITS 0.00
CREDITS 0.00
ANCILLARIES 0.00
LATE FEES 10.00
AMOUNT DUE 278,87
PARENT ACCOUNT: REPORT FQR:
City of Carmel Admin. City of Carmel Admin.
0496 -00- 138002 -1
DEC -01 -2011 TO DEC -31 -2011
Site Summary PAGE OF 2
BRAND ADDRESS CITY STATE ZIP NO. FUEL UNITS FUEL OTHER EXEMPT NET
TRANS TAX
SHELL 545 S Range Line Rd Carmel IN 46032 4 62,740 210,35 11.48- 198.87
R1oA TorAt a s2;1"4ptQ 35 fi 44 11 4B- #8$ 87
pol PARENT ACCOUNT: REPORT FOR:
City of Carmel Admin. City of Carmel Admin.
LNG 0496 -00- 138002 -1
DEC -01 -2011 TO DEC -31 -2011
ax Summary PAGE 1 OF 2
TAX JURISDICTION ID EXPIRATION EXEMPTED TAX REPORTED TAX TAX TYPE TAX PRODUCT CLASS UNITS GROSS TAX RATE
FEDERAL 356000972 JUN -18 -2012 -11.48 Federal Excise Gasoline Unblended 62.740 210,35 0.18300
FEDERAL 3 <3T}1L t o t :i 48.. ;.;s 62 74d E;. ,21U 35 i[
IN 366000972 JUN -18 -2012 -12.27 State Sales Gasoline Unblended 62.740 210.35 0.07000
-11.30 State Excise Gasoline Unblended 62.740 210.35 0.18000
EN. STA7 t CtTAGS z3:5
ACCOUNT TOTALS -11.48 -23.57
VOUCHER NO. WARRANT NO.
ALLOWED 20
Circle K Fleet Services
IN SUM OF
PO Box 6293
Carol Steam, IL 60197 -6293
$198.87
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
P1or Year I hereby certify that the attached invoice(s), or
1205 I 28188792 42- 314.00 I $198.87
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
Friday, January 13, 2012
A
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund