205371 01/17/2012 CITY OF CARMEL, INDIANA VENDOR: 00352984 Page 1 of 1
ONE CIVIC SQUARE FLEET SERVICES
CHECK AMOUNT: $816.43
CARMEL, INDIANA 46032 PO BOX 6293
CAROL STREAM 11 60197 CHECK NUMBER: 205371
CHECK DATE: 1/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231400 28157810 816.43 0453 -00- 794629.6
FLEET SERVICES INVOICE/STATEMENT
INVOICE NUMBER: 28157810
ACCOUNT NAME: CARMEL FIRE DEPARTMENT
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0453 -00 794629 -6 8 100.00 31 12 -31 -2011 01 -26- 2012 848.73
BATE:: ACTIVITY DESCRIPTION CHAR ;S0EBf`fS PAYMENTS /CREDITS
PAYMENT RECEIVED THANK YOU 1,008.54
12 3Q.21I1 E RETAIL FUEL PURCHASES
12 $t1 p11 MONTHLY CARD CHGt1'
REMINDER
PLEASE BE SURE TO INCLUDE REMITTANCE STUB WITH
PAYMENT. MAIL TO THE ADDRESS SHOWN IN THE RIGHT
PORTION OF THE REMITTANCE STUB.
PURCHASES, RETURNS AND PAYMENTS MADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT INVOICE/STATEMENT
PREVIOUS BALANCE PAYMENTS )PURCHASES )DEBITS CREDITS +LATE FEE =NEW BALANCE
1008.54 1008.54 794.43 22.00 0.00 32.30 848.73'
$10.00 MINIMUM LATE FEE
PAY ONLINE AT: www.wexonline.com
CALL CUSTOMER SERVICE TO PAY BY PHONE The Late Fee is determined by Which is an ANNUAL To the Balance subject to late
FEDERAL TAX ID: 84- 1425616 applying a monthly periodic rate of PERCENTAGE RATE of fee for this period which is
2.08 24.99 1
SEE REVERSE SIDE FOR MORE INFORMATION AND TERMS.
TO ENSURE PROPER CREDIT. TEAR AT PERFORATION AND INCLUnF ROTTnM PnRTtnM wfTU Vnt 10 DAVU=Ktr
Balance Subject to Late Fee Payment Options
The late fee will be calculated by determining the total balance Mail
due on the date your account becomes delinquent, as follows: Be sure to include bottom portion of invoice with your payment.
adding the total amount due on your account on the payment due Write your account number or invoice number on the check to help
date together with any purchases posted to your account from avoid delays in payment processing if the check and remit stub
the end of the last billing cycle through the payment due date and become separated.
subtracting from that amount any payments and/or credits entered
during that period. The total balance due will then be multiplied Allow 10 business days prior to the due date for mailing to help
by the applicable periodic rate to determine your late fee. In the avoid late fees. Mail payments to:
event that the calculated late fee is less than ten dollars ($10.00), Fleet Services
a minimum late fee of ten dollars ($10.00) will be charged. PO Box 6293
Your account will be delinquent if you do not pay it in full within Carol Stream, IL 60197 -6293
26 calendar days of the billing date appearing on your invoice. Online
Certain customers, based upon our credit review, may be required Authorized users can elect to receive an email notification when an
to make payment in less than 26 calendar days on a cycle that we invoice is ready for online viewing and payment. Log in or register to
may establish for you. In addition, certain customers may elect a set up an online account at www.wexonline.com.
shorter billing or payment cycle as offered by us.
Online payments scheduled by 3:00 PM ET (on business days)
If your payment due date falls on a non business day, payment is are credited to your account on the same day. There is no fee for
due on the business day before the payment due date. Delinquent online payments,
accounts will be subject to late fees, suspension, or termination
of credit privileges, without notice. All charges must be paid in Phone
full regardless of disputes. Charges must be disputed in writing Cali Customer Service at 1- 888 -387 -5665 and select the menu
no later than sixty (60) days from the billing date or they will be option for Billing Inquiries. In addition to scheduling a payment, you
considered final and binding. can also check your balance.
Card Issuer Payments scheduled by 3:00 PM ET (on business days)
The Fleet Services Card is issued by, and all card transactions are credited to your account on the same day.
are funded by and payable to, Wright Express Financial Services Be prepared with your fleet card account number and a sample
Corporation, under a Business Charge Account Agreement with check to enter your bank account number and routing number.
the cardholder named on the reverse. There is no fee for phone payments.
Customer Service Automated Clearing House (ACH)
For account Inquiries and correspondence in regard to account To make a one -time electronic payment go to:
service or billing: http: /lwww.e- fleet.com
Call 1- 888 -387 -5665, or ACH payments scheduled by 2:30 PM ET (on business days) are
credited to your account on the same day. There is a fee for each
Fax to 1- 800 395 -0809, or ACH payment.
Mail to P.O. Box 639, Portland, ME 04104
Be sure to include your account number on all correspondence.
ACCOUNT: CARMEL FIRE DEPARTMENT CLOSING DATE: 12 -31 -2011
FLEET SERVICES A CCOUNT NO: 0453 -00- 794629 -6
DELIVER TO:
DENISE SNYDER
CARMEL FIRE DEPARTMENT
2 CIVIC SO
CARMEL IN 46032 -2584
Tax Summary
TAX JURISDICTION ID EXPIRATION EXEMPTED TAX REPORTED TAX TAX TYPE TAX PRODUCT CLASS GALLONS GROSS COST TAX RATE
FEDERAL 356000972 -4828 0.00 FEDERAL E85 263.850 819.97 0.18300
-4.58 000 FEDERAL GASOLINE 25.040 82.61 0.18300
ED R4 5286 Q 00 i. 28$89x..
IN 356000972 0.00 4.51 STATE EXCISE GASOLINE 25.040 82.61 0.18000
-50.48 0.00 STATE SALES E85 263.850 819.97 0.07000
4.81 0.00 STATE SALES GASOLINE 25.040 82.61 0,07000
IN
AT A 7E.TST�CLS.
ACCOUNT TOTALS 108.15 4.51
(c) WRIGHT EXPRESS CORPORATION 2011 PAGE 1
FLEET SERVICES STANDARD REPORT
INVOICE NUMBER: 28157810
ACCOUNT NAME: CARMEL FIRE DEPARTMENT
PAGE 1 OF 2
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0453 -00 794629-6 8,100.00 31 12 -31 -2011 01-26-2012 848.73
CARD LOCATION DATE TIME DRIVER ODOMETER PRODUCT UNITS COST/ ITEM TOTAL
NO. NO. UNIT TOTAL AMOUNT
0001 MH 001 074 12 -06 -2011 11:57 SMITH, KEITH 14,500 E85 16.120 3.099 49.96 49.96
MH 001 074 12 -14 -2011 12:12 SMITH, KEITH 14,500 E85 8.560 3.099 26.53 26.53
MH 001 074 12 -19 -2011 11:49 SMITH, KEITH 14,500 E85 12.320 3.098 36.17 38.17
MH 001 078 12 -23 -2011 12:50 SMITH, KEITH 14,500 E85 21.940 3.098 67.98 67.98
MH 001 074 12 -29 -2011 13:23 SMITH, KEITH 14,500 E85 18.470 3.099 57.24 57.24
CARD SUBTOTALS 77.410 239.88
0002 MH 001 074 11 -30 -2011 12.14 HULETT, MARK 96,797 E66 12.350 3.159 39.01 39.01
MH 001 078 12 -05 -2011 15:31 HULETT, MARK 96,998 E85 13.410 3.098 41.55 41.55
MH 001 078 12 -12 -2011 14:39 HULETT, MARK 97,207 E85 13.160 3.100 40.80 40.80
MH 001 078 12 -22 -2011 14.16 HULETT, MARK 97,620 E85 14.390 3.099 44.60 44.60
MH 001 074 12 -29 -2011 10:53 HULETT, MARK 97,783 E85 11.810 3.099 36,60 36.60
CARD SUBTOTALS 65.120 202.56
0003 MH 001 074 12 -05 -2011 09:27 STEELE, JEFF 10,525 E85 26.460 3.159 83.58 83.58
MH 001 074 12 -25 -2011 17:46 STEELE, JEFF 11,496 E86 26.000 1099 80.57 80.57
CARD SUBTOTALS 52.460 164.15
0004 MH 001 074 12 -03 -2011 13:22 HABOUSH, DAVE 8,698 UNL 25,040 3.299 82.51 82.61
MH 001 074 12 -13 -2011 07:27 HABOUSH, DAVE 9,023 E85 25.520 3.098 79.07 79.07
MH 001 074 12 -17 -2011 09:11 HABOUSH, DAVE 9,245 E85 20.120 3.098 62.34 62.34
MH 001 074 12 -20 -2011 13:45 HABOUSH, DAVE 9,546 E85 23.220 3.099 71.97 71.97
CARD SUBTOTALS 93.900 295.99
TOTAL PURCHASES 288.890 902.58
Y -T -D PURCHASES 4,178.930 13,210.33
SITES USED THIS MONTH NO. PURCHASES TOTAL AMOUNT
Location No. Brand Street City State Zip
MH 001 074 MEIJER 1426 W CARMEL DR CARMEL IN 46032 12 707.65
MH 001 078 MEIJER 5303 E SOUTHPORT RD INDIANAPOLIS IN 46237 4 194.93
PRODUCTS: E85= ETHANL85 UNL UNLEADED
FLEET SERVICES
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VOUCHER NO. WARRANT NO,
ALLOWED 20
Fleet Services
IN SUM OF
P.O. Box 6293
Carol Stream, IL 60197
$1,473.49
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE N0. ACCT #/TITLE AMOUNT Board Members
1120 28165218 j 42- 314.00 j $624.76 1 hereby certify that the attached invoice(s), or
1120 28157810 42- 314.00 $ft" bill(s) is (are) true and correct and that the
k J6 L/ g materials or services itemized thereon for
which charge is made were ordered and
received except
JAN JAN 2012
A
A,� •`J�•-
Y V U r
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
28165218 $624.76
28157810 $848.73
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