206099 02/14/2012 a CITY OF CARMEL, INDIANA VENDOR: 366015 Page 1 of 1
4� ONE CIVIC SQUARE WRIGHT EXPRESS FSC CHECK AMOUNT: $666.34
CARMEL, INDIANA 46032 PO Box 6293
�L <ro 0 CAROL STREAM IL 60197 -6293 CHECK NUMBER: 206099
CHECK DATE: 2/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231400 28447251 666.34 0453 -00- 794629 -6
FLEET SERVICES INVOICE /STATEMENT
INVOICE NUMBER: 28447251
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 0.00 31 01 -31 -2012 02 -24 -2012 666.34
DATE ACTIVITY DESCRIPTION
Gi3ARGE51EBiT:S: PAYMENTS/CREDITS
01 .19.2012... PAYMENT RECEIVED THANK YOU 816.43
RETAIL FUEL PURCHASES
2Q12. MONTHLY CARD CHG 22Q0!
BALANCE INCLUDES PAST DUE AMOUNT
IF PAYMENT HAS BEEN MADE, PLEASE DISREGARD
THIS
PAST DUE ACCOUNTS ARE SUBJECT TO SERVICE
NOTICE. S
INTERRUPTION
im
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
848.73 816.43 602.04 22.00 0.00 10.00 666.34
$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 32.30
SEE REVERSE SIDE FOR MORE INFORMATION AND TERMS.
TO ENSURE PROPER CREDIT TEAR AT PERFORATION AND INCLUDE BOTTOM PORTION WITH YOUR PAYMENT_
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 Call 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: /w-ww.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: 01 -31 -2012
FLEET SERVICES ACCOUNT NO: 0453 -00- 794529 -6
DELIVER TO:
DENISE SNYDER
CARMEL FIRE DEPARTMENT
2 CIVIC SQ
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 -35.04 0.00 FEDERAL E85 197.080 626.21 0.18300
3.02 0.00 FEDERAL GASOLINE 16,530 5684 0.18300
FRERAE TOTALS 39;06 0 00
2 E3.6 EO 683:05
IN 356000972 0.00 2.98 STATE EXCISE GASOLINE 16.530 56.84 0.18000
-38.62 0.00 STATE SALES E85 197.080 626,21 0.07000
-3.33 0.00 STATE SALES GASOLINE 16.530 56.84 0.07000
fN STATE TOTAE S 41.195 2 98
ACCOUNT TOTALS -81.01 2.98
(c) WRIGHT EXPRESS CORPORATION 2012 PAGE 1
FLEET SERVICES STANDARD REPORT
INVOICE NUMBER: 28447251
ACCOUNT NAME: CARMEL FIRE DEPARTMENT
PAGE 1 OF 2
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD I BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0453 -00- 794629 6 8,100.00 31 01 -31 -2012 02 -24 -2012 666.34
CARD LOCATION DATE TIME DRIVER ODOMETER PRODUCT UNITS COST/ ITEM TOTAL
NO. NO. UNIT TOTA AMOUNT
0001 MH 001 074 01 -10 -2012 1203 SMITH, KEITH 14,500 E85 15.550 3199 49.74 49.74
MH 001 074 01 -18 -2012 1208 SMITH, KEITH 14,500 E85 11.690 3.200 37.41 37.41
MH 001 074 01 -25 -2012 11:57 SMITH, KEITH 14,500 E85 17.720 3.199 56.68 56.68
CARD SUBTOTALS 44.960 143.83
0002 MH 001 078 01 -03 -2012 15,29 HULETT, MARK 97,983 E85 12.260 3.100 38.00 38.00
MH 001 078 01 -06 -2012 16,09 HULETT, MARK 98,200 E85 13130 3.199 42.00 42.00
MH 001 078 01 -17 -2012 06:56 HULETT, MARK 98,597 E85 13,360 3.200 42.75 42.75
MH 001 078 01 -20 -2012 14:00 HULETT, MARK 98,887 E85 8.440 3.199 27,00 27.00
MH 001 074 01 -24 -2012 07:51 HULETT, MARK 99,028 E85 10.570 3.198 33.80 33.80
MH 001 074 01 -26 -2012 14:27 HULETT, MARK 99,194 E85 10.710 3.100 33.20 33.20
CARD SUBTOTALS 68.470 216.75
0003 MH 001 074 01 -13 -2012 08.28 STEELE, JEFF 12,355 E85 26.030 3.199 83.27 83.27
CARD SUBTOTALS 26.030 83.27
0004 MH 001 074 01 -03 -2012 16.55 HABOUSH, DAVE 9,960 E85 19.630 3.099 60.84 60.84
MH 001 074 01 -10 -2012 16:55 HABOUSH, DAVE 10,178 E85 20.230 3.199 64.71 64.71
MH 001 074 01 -20 -2012 08:36 HABOUSH, DAVE 10,335 E85 17.760 3,199 56.81 56.81
CARD SUBTOTALS 57.620 182.36
0007 MH 001 154 01 -29 -2012 13:47 SMITH, KEITH 135,046 UNL 16.530 3.439 56.84 56.84
CARD SUBTOTALS 16.530 56,84
TOTAL PURCHASES 213.610 683.05
Y -T -D PURCHASES 213.610 683.05
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 9 476.46
MH 001 078 MEIJER 5303 E SOUTHPORT RD INDIANAPOLIS IN 46237 4 149.75
MH 001 154 MEIJER 17000 MERCANTILE RD NOBLESVILLE IN 46050 1 56.84
PRODUCTS: E85= ETHANL85 UNL= UNLEADED
FLEET SERVICES
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VOUCHER NO. WARR NO.
Fleet Services ALLOWED 20
IN SUM OF
P.O. Box 6293
Carol Stream, IL 60197
$666.34
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. I ACCT #/TITLE I AMOUNT Board Members
1120 I 2847477251 I 42- 314.00 I $666.34 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
c
which charge c ar e is made were ordered and
OO received except
FEB 13 2917
Y CAI.
e 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))
2847477251 $666.34
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