205372 01/17/2012 CITY OF CARMEL, INDIANA VENDOR: 00352984 Page T of 1
ONE CIVIC SQUARE FLEET SERVICES
o CARMEL, INDIANA 46032 PO Box 62e3
CHECK AMOUNT: $624.76
•a, p g CAROL STREAM IL 60197 CHECK NUMBER: 205372
CHECK DATE: 1/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231400 28165218 624.76 0496 -00- 138012 -0
Invoice Statement
INVOICE NUMBER: 28166218
[Ke ACCOUNT NAME: City of Carmel Fire
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0496 00 138012-0 3,400.00 31 DEC-31 JAN 26.2012 1 113.47
DAVE: ACTIVITY DESCRIPTION :ZHARGESIDEB #TS PAYMENTSICREDITS
DEC 3Q -2011 FUEL PURCHASES �3
REMINDER
BALANCE INCLUDES PAST DUE AMOUNT IF PAYMENT HAS
BEEN MADE, PLEASE DISREGARD THIS NOTICE. PAST DUE
ACCOUNTS ARE SUBJECT TO SERVICE INTERRUPTION
PURCHAS RETURNS AND PAYMENT MADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NDIT INVOICEISTATEMENT.
CURRENT_PERIO ONE BILLING PERIOD PAST DUI TWO BILLING PERIODS PAST DU THREE+ BILLING PERIODS PAST DUE TOTAL DUE
624 .76 488.71 0.00 0.00 1 113.47
PREVI E PAYMENTS PURCHASES DEBITS CREDITS +LATE FEE NEW BALANCE
488.71 0.00 603.63 0.00 0.00 21.13 1113,47
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
2.08 24.99 1,014.60
SEE REVERSE SIDE FOR IMPORTANT INFORMATInN ANn TFRIwc
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.wextools.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 Call Customer Service at 1 -866- 544 -1715 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 making a payment, you can
considered final and binding. also check your balance.
Card issuer Payments scheduled by 3:00 PM ET (on business days)
The Circle K Fleet 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: /Avww.e- fleet.com
Call 1$66-544 -1715, or ACH payments made by 2:30 PM ET (on business days) are
credited to your account on the same day. There is a fee for each
Fax to 1- 800 395 -0809, or ACH payment.
Mail to P.O. Box 639, Portland, ME 04104
Be sure to include your account number on all correspondence.
PARENT ACCOUNT: REPORT FOR:
City of Carmel Fire City of Carmel Fire
0496-00-138012-0
NO
DEC -01 -2011 To DEC-31-2011
Purchase Activity Report PAGE 1 OF 8
;CARONUMBER
10001 Chief Smith 63225
DATE TIME SITE ADDRESS VEHIASSET TRAIN ODOM. PROD UNITS COST/ FUEL$ OTHER EXEMPT NET$ REPORTED EXC.
MM-DD DESCRIPTION CODE UNIT TAX TAX CODES
PREVIOUS ODOMETER 14,500
12-02 09:08 545 S Range Line Carmel IN I driver OP 146 UNL 14.340 3.339 47.90 2.62- 46.28 5.37
12 -04 11:38 3801 S Post Rd Indianspol IN 1 driver OP 14,500 UNL 9.810 3.279 32.17 1.80- 30,37 3.64-
12-09 09:02 545 S Range Line Carmel IN I driver OP 14,500 UNL 18.170 3.459 62.88 3.33- 59.55 6.95-
12-12 08:58 545 S Range Line Carmel IN I driver OP 14,500 UNL 13,620 3.339 45.50 2.49- 43.01 5.10-
12-16 09.10 545 S Range Line Carmel IN 1 driver OP 14,500 UNL 9.220 3.219 29,70 1.69- 28.01 3.38-
bm.
06 $p 159 5SI
PERIOD AVERAGE: PPG 3.348
YTD AVERAGE: PPG 3.519
TO ENSURE MORE CU RA rE MILEAG E REPO F TING, VEHICLE MILEAGE 3TATISTICS AF E NOT
CAI CULATED WHEN KEY DDOME TER READ NGS AR I; NOT WITHIN AN ACCEPT ABLE RANGE.
TRANSACTION CODES:
OP Outdoor Payment Terminal
PARENT ACCOUNT: REPORT FOR:
City of Carmel Fire City of Carmel Fire
0496-00-138012-0
NO DEC-01-2011 TO DEC-31-2011
Purchase Activity Report PAGE2 OF 8
L LATE:i
E J57 s V IIJ d
10002 Asst. Chief Hoffman 1 74957
DATE TIME SITE ADDRESS VEHiASSET TRAN ODOM. PROD UNITS COSTI FUEL OTHER EXEMPT NET$ REPORTED EXC.
MM-1y) DESCRIPTION CODE UNIT TAX TAX CODES
PREVIOUS ODOMETER 7,414
12-12 17:07 11601 Aflisonvil Fishers IN 1 driver OF 10,760 UNL 26.670 3.329 88.79 4,88- 83.91 9.97-
12-21 15:41 9511 Allisonvill Indianapol IN 1 driver OP 11,097 UNL 25.710 3.119 80.22 4.70- 75.52 9.27-
�rm.- I ��'i
PERI 4
69 01
Igo 9:
3, 24
42
1.J02 7: 120,11
PERIOD AVERAGE: PPG 3.227
YTD AVERAGE: PPG 3.478
TO ENSURE MORE A CCUR A TE MILEAG REPO F TING, VEHICL E MILEAGE TATISTICS AF E NOT
CAI CULATED WHEN KEY ODOME TER READ NGS AR I NOT WITHIN AN ACCEPT ABLE RANGE.
TRANSACTION CODES:
OP Outdoor Payment Terminal
PARENT ACCOUNT: REPORT FOR:
City of Carmel Fire City of Carmel Fire
0496-00-138012-0
INO DEC-01-2011 TO DEC-31-2011
Purchase Activity Report PAGE 3 OF 8
PLATE:;
810MM JDE NTIFIE=Z�
S$M:
10003 Asst. Chief Haboush 1 74965
DATE TIME SITE ADDRESS VEHIASSET TRAN ODOM. PROD UNITS COST/ FUEL OTHER EXEMPT NET$ REPORTED EXC.
MM-D) DESCRIPTION CODEJ UNIT TAX TAX CODES
PREVIOUS ODOMETER 7,424
12-26 14.12 545 S Range Line Carmel IN I driver OP 9,776 UNIL 20.990 3.399 71.36 3.64- 67.62 7.96-
'xd�t tF7 52
`,270, 0
070'
03
PERIOD AVERAGE: PPG 3.400
YTD AVERAGE: PPG 3.290
TO ENSURE MORE A aCU MILEAG REPO F TING, VEHICI E MILEAGE TATISTICS AF E NOT
CA[ CULATED WHEN KEY DDOME TER READ NGS AR NOT WITHIN ANACCEP BILE RANGE.
TRANSACTION CODES:
OP Outdoor Payment Terminal
WOW
R" 0-
wr.-M
PARENT ACCOUNT: REPORT FOR:
City of Carmel Fire City of Carmel Fire
0496-00-138012-0
NO DEC-01-2011 TO DEC-31-2011
Purchase Activity Report PAGE 4 OF 8
10004 EMS Chief Hulett 70614
DATE TIME SITE ADDRESS VEH/ASSET TRAN ODOM. PROD UNITS COSTI FUEL OTHER EXEMPT NET$ REPORTED EXC.
MM-DD DESCRIPTION CODE UNIT TAX TAX CODES
PREVIOUS ODOMETER 96,131
12-15 06:68 546 S Range Line Carmel IN 1 driver OF 97,424 UNL 11.250 3.199 36.00 2.06- 33.94 4,12-
001
::::3
3
—ba r
dd
3W
�T x 1:;018 41
0:1 :j 55,53.:
PERIOD AVERAGE: PPG 3.200
YTD AVERAGE: PPG 3,357
TO ENSURE MORE A:=RA rE MILEAG REPO F TING, VEHICI E MILEAGE 3TATI STI C 3 AF E NOT
CAI CULATED WHEN KEY DDOME TER READ NGS ARE NOT WITHIN AN ACCEPT kBLE RANGE.
TRANSACTION CODES:
OP Outdoor Payment Terminal
PARENT ACCOUNT: REPORT FOR:
City of Carmel Fire City of Carmel Fire
0496-00-138012-0
NO DEC-01-2011 TO DEC-31-2011
Purchase Activity Report PAGE 5 OF 8
0005 Bruce Knott 77258
DATE TIME SITE ADDRESS VEHIASSET TRAN ODOM. PROD UNITS COST/ FUEL$ OTHER EXEMPT NET$ REPORTED EX.C.
MM-DD DESCRIPTION CODE UNIT TAX TAX CODES
PREVIOUS ODOMETER 26,060
12-14 15:24 546 S Range Line Carmel IN 1 driver OP 132,110 JNL 21,940 3.269 71.52 4.02- 67.60 8,11-
8
1414---...
PERIOD AVERAGE: PPG 3260
YTD AVERAGE: PPG 3.477
TO ENSURE MORE .A CUR A rE MILEAG REPO P TING, VEHICI E MILEAGE 3TATISTICS AF E NOT
CA CULATED WHEN KEY DDOME TER READ NGS AR NOT WITHIN AN ACCEPT kBLE RANGE.
TRANSACTION CODES:
OP =Outdoor Payment Terminal
ffl Im
155—N
k1 AW
PARENT ACCOUNT: REPORTFOR:
City of Carmel Fire City of Carmel Fire
0496-00-138012-0
No DEC-01-2011 TO DEC-31-2011
Purchase Activity Report PAGE 6 OF 8
t
F 0AROWUMSEWi O�ZMSWSINO� vEWLZ ASSET WENTIFIE VEHIME DESC. RIPTIV4,
10009 1 Keith Freer 70615
DATE TIME SITE ADDRESS VEH/ASSET TRAN ODOM. PROD UNITS COST/ FUEL$ OTHER EXEMPT NET REPORTED EXC.
MM-DD DESCRIPTION CODE UNIT TAX TAX CODES
PREVIOUS ODOMETER 144,047
12-06 10!52 545 S Range Line Carmel IN I driver Op 154,023 UNL 5.310 3.099 15.46 0.97- 15.49 1.91-
12-20 11:34 545 5 Range Line Carmel IN 1 driver Op 155,144 UNL 14.700 3.129 46.00 2.69- 43.31 5.31-
62A6 368 58
ym:
22&$43::'
PERIOD AVERAGE: PPG 3.121
YTD AVERAGE: PPG 3.503
TO ENSURE MORE mCU MILEAGE REPO F TING, VEHICL MILEAGE TATISTICS AF E NOT
CAI CULATED WHEN KEY DOOME TER READ NGS ARE NOT WITHIN AN ACCEPT ABLE RANGE.
TRANSACTION CODES:
OF Outdoor Payment Terminal
PARENT ACCOUNT: REPORT FOR:
City of Carmel Fire City of Carmel Fire
L MA 0496-00-138012-0
M&WIll DEC-01-2011 TO DEC-31-2011
Purchase Activity Report PAGE7 OF 8
1"0AIW.AUM8eR1;: 1W Cp
10011 Steve Reaves IN
DATE TIME SITE ADDRESS VEHIASSET TRAN ODOM. PROD UNITS COST/ FUEL$ OTHER EXEMPT NET$ REPORTED EXC.
MM-DD DESCRIPTION CODE UNIT TAX TAX CODES
PREVIOUS ODOMETER 28,193
12-28 11:17 545 S Range Line Carmel IN 1 driver OP 31,639 UNIL 3.500 3.099 10.86 0.64- 10.22 1.26-
*4
7-M
-76 W,
PERIOD AVERAGE: PPG 3.103
YTD AVERAGE: PPG 3.597
TO ENSURE MORE ACCUR AFEMILEAGE REPORTING, VEHICIE MILEAGE 'TATISTICS APE NOT
CAI CULATED WHEN KEY ODOMETER READ NGS AR NOT WITHIN AN ACCEPT 4,13LE RANGE.
TRANSACTION CODES:
OP Outdoor Payment Terminal
PARENT ACCOUNT: REPORT FOR:
City of Carmel Firs City of Carmel Fire
0496 -00- 138012 -0
N O DEC -01 -2011 TO DEC -31 -2011
Financial Summary PAGE OF 2
DEPARTMENT DESCRIPTION FEES PURCHASES TOTAL FEES
CITY COSTIFEE TOTAL FEES FUEL OTHER EXEMPTED TAX NET PURCHASES
ACCOUNT TOTALS Unleaded Regular 639.36 35.73- 603.63
PERiQ 4f 63436 ;400 3 z 75 80363.: G0383.
s., -0OtY TS$Fr14 42082<. T;16532' 2,f653�.:
ACCOUNTS RECEIVABLE SUMMARY Invoice 281 5218
PREVIOUS BALANCE 488.71
PAYMENTS 0.00
PURCHASES 603.63
DEBITS 0.00
CREDITS 000
ANCILLARIES 0.00
LATE FEES 21.13
AMOUNT DUE 1,113.47
PARENT ACCOUNT: REPORTFOR:
City of Carmel Fire City of Carmel Fire
0496 -00- 138012 -0
N o 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 10 133.040 438.18 24.35- 413.83
11601 Allisonville R Fishers IN 46038 1 26.670 88.79 4.88- 83.91
3801 S Post Rd Indianapolis IN 46239 1 9.810 32.17 1.80- 30.37
9611 Allisonvills Rd Indianapolis IN 46250 1 25.710 80.22 4.70- 75,52
i ioa:rorAL sus �a +U4 s sr►sa
PARENT ACCOUNT: REPORTFOR:
City of Carmel Fire City of Carmel Fire
0496-00-138012-0
NO DEC-01-2011 TO DEC-31-2011
Tax Summary PAGE OF 2
TAX JURISDICTION ID EXPIRATION EXEMPTED TAX REPORTED TAX TAX TYPE TAX PRODUCT CLASS UNITS TAX RATE
FEDERAL 366000972 JUN-18-2012 -35.73 Federal Excise Gasoline Unblended 196.230 639,36 0.18300
FEDERAL .2
7, x;:,:
.A.L 95 30
I.I. A U
IN 356000972 JUN-16-2012 -37.18 State Sales Gasoline Unblended 196.230 639.36 0.07000
-36.16 State Excise Gasoline Unblended 195.230 539,36 0.18000
72
ACCOUNT TOTALS -35.73 -72.34
VOUCHER NO. WARRANT NO.
Fleet Services ALLOWED 20
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 NO. ACCT #FTITLE AMOUNT Board Members
1120 28165218 42- 314.00 $624.76 1 hereby certify that the attached invoice(s), or
1120 28157810 42- 314.00 $ff48-7-3 bill(s) is (are) true and correct and that the
�((p yg materials or services itemized thereon for
which charge is made were ordered and
received except
JAN 1JAN 212
t U
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