208170 04/24/2012 CITY OF CARMEL, INDIANA VENDOR: 366015 Page 1 of 1
ONE CIVIC SQUARE WRIGHT EXPRESS FSC CHECK AMOUNT: $146.75
0 CARMEL, INDIANA 46032 PO BOX 6293
CAROL STREAM IL 60197 -6293 CHECK NUMBER: 208170
iro 'co
CHECK DATE: 4/24/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4231400 28995399 146.75 0496 -00- 138007 -0
Invoice Statement
INVOICE NUMBER: 28995399
N o ACCOUNT NAME: City of Carmel Police
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0496 -00 138007-0 2100.00 31 MAR -31 -2012 APR -26 -2012 146.75
ACTIVITY DESCRIPTION G3 fARG£SfC8IT:5 PAYMENTS /CREDITS
MAF <3t2D1:2: FUEL PURCHASES k4:675:
REMINDER
REMINDER PLEASE BE SURE TO INCLUDE REMITTANCE STUB
PAYMENT. AIL TO ADDRESS OWN
WITH ENT. M THE ESS SH IN THE
RIGHT PORTION OF THE REMITTANCE STUB.
PURCHASES, RETURNS AND PAYMENTS MADE JUST PRIOR TO Ell LUNG DATE MAY NOT APPEAR UNTIL THE NEXT INVOICE/STATEMENT.
PREVIOUS BALANCE PAYMENTS )PURCHASES )DEBITS CREDITS LATE FEE NEW BALANCE
0.00 0.00 146,75 0.00 0.00 0.00 146.75
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
apoying a monthly rate of RATE of fee for this riod which is
2.08 24.99 0.00
SEE REVERSE SIDE FOR IMPORTANT INFORMATION AND TERMS.
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: hftp: /www.e- fleet.com
Call 1- 866 -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 Police City of Carmel Police
L NU 0496-00-138007-0
MAR -01 -2012 TO MAR-31-2012
Purchase Activity Report PAGE 1 OF 4
:1 PLATE: ST V 7
10146 822 Police
DATE TIME SITE ADDRESS PROMPT TRANI ODOM. PROD UNITS COST/ FUEL OTHER EXEMPT NET$ REPORTED EXC.
MM-DD INFO CODE UNIT TAX TAX CODES
PREVIOUS ODOMETER 5,859
03-22 09:31 545 S Range Line Carmel IN 1 Driver OP 7,693 SUP 4.330 4.239 18.37 0.79- 17.58 1.88-
PER100
7, WSB x:88.
330: 837i
Y.TD.T.OTALS,
1 7.
0i 9:
PERIOD AVERAGE: PPG 4.242
YTD AVERAGE: PPG 4.242
TO ENSURE MORE CURATE MILEAGE- REPO F TING, VEHIC EMILEAGE 3 3TATISTICS AF; E NOT
CAI CULATED WHEN KEY DDOME TER READINGS ARE NOT WITHIN AN ACCEPT 6,BLE RANGE.
TRANSACTION CODES:
OF Outdoor Payment Terminal
PARENT ACCOUNT: REPORT FOR:
City of Carmel Police City of Carmel Police
0496-00-138007-0
so MAR-01-2012 TO MAR-31-2012
Purchase Activity Report PAGE 2 OF 4
OF 'A
0078 10235 Unassigned
DATE TIME SITE ADDRESS PROMPT TRAN ODOM. PROD UNITS COST/ FUEL OTHER EXEMPT NET$ REPORTED EXC.
MM-DD INFO CODE UNIT TAX TAX CODES
PREVIOUS ODOMETER
03-17 13:26 545 S Range Line Carmel IN 1 Driver OF 7,081 UNL 10.770 3.789 40.81 1.97- 38.84 4.35-
03-21 07:26 545 S Range Line Carmel IN 1 Driver OP 7,218 UNL 12.210 3.999 48.86 2.23- 46.63 5.10-
I .20 9:
P.M00.10TALS: I
:89 67. 4
I
YTD TOTALS
2Q.:*�'*::�:::'::::::::: 05A7. OAS'-
xx:as 67:
I
PERIOD AVERAGE: PPG 3.902
YTD AVERAGE: PPG 3.902
TO ENSURE MORE A- MILEAG=- REPO FTING, VEHICLE MILEAGE 3TATISTICS AF E NOT
CAI CULATED WHEN KEY DDOME TER READ I NGS ARE NOT WITHIN AN ACCEPT 'kBLE RANGE,
TRANSACTION CODES:
OP Outdoor Payment Terminal
PARENT ACCOUNT: REPORT FOR:
City of Carmel Police City of Carmel Police
0496-00-138007-0
MAR-01-2012 TO MAR-31-2012
Purchase Activity Report PAGE 3 OF 4
CARP Nl1M8EE CAf2p EM
:($T
N
10135 14210 1 Unassigned
DATE TIME SITE ADDRESS PROMPT TRANI ODOM. PROD UNITS COST/ FUEL OTHER EXEMPT NET$ REPORTED EXC.
MM-DD PREVIOUS ODOMETER INFO CODE 41,837 UNIT TAX TAX CODES
03-22 07:39 2166 E Hadley Rd Plainfield IN 1 Driver OP 43,813 UNL 11.660 3.929 45.83 2.13- 43.70 4.82-
PEMOWTOT
]:]Xxx�:�:
YTD TOTALS
660 AS 83 :2,13: 3 :4.
PERIOD AVERAGE: PPG 3.931
YTD AVERAGE: PPG 3.931
TO ENSURE MORE ,4:;CUR ATE MILEAGE REPORTING, VEHICLE MILEAGE DTATISTICS AF E NOT
CAI CULATED WHEN KEY DDOME TER READINGS AR NOT WITHIN AN ACCEP BLE RANGE.
TRANSACTION CODES:
OF Outdoor Payment Terminal
P0
This page is intentionally left blank.
IMPM
PARENT ACCOUNT: REPORT FOR:
City of Carmel Police City of Carmel Police
LNG 0496 -00- 138007 -0
MAR -01 -2012 TO MAR -31 -2012
Financial Summary PAGE OF 2
DEPARTMENT DESCRIPTION FEES PURCHASES TOTAL FEES
QTY COST /FEE TOTAL FEES FUEL OTHER EXEMPTED TAX NET PURCHASES
Police Unleaded Super 18.37 0.79- 17.58
PERIOD 0:40 1837 000 Q79 77.58..
YTD`.: 0:00 :1837 000, 079_ E758 1758
UNASSIGNED Unleaded Regular 135.50 6.33- 129.17
PI±RIOp Q.00 1 35 50 0130 6 33- 12817 128:17
YT -i 0:00 1:65 50 l3QQ.:...: 7.9ff,- 15760 157:60:
ACCOUNT TOTALS Unleaded Regular 135.50 6.33- 129.17
Unleaded Super 18.37 0.79- 17.58
PERIOD 000 153 87 000: 7 12 146 7S 146:75
Y1 D:; 0:00 1:83: 7 0.
QQ 69 17518, 7:75,18
ACCOUNTS RECEIVA LE SUMMARY -invoice 289 5399
PREVIOUS BALANCE 0.00
PAYMENTS 0.00
PURCHASES 146.75
DEBITS 0.00
CREDITS 0.00
ANCILLARIES 0.00
AMOUNT DUE 146.75
NO
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PARENT ACCOUNT: REPORT FOR:
City of Carmel Police City of Carmel Police
0496-00-138007-0
No MAR-01-2012 TO MAR-31-2012
Site Summary PAGE 1 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 3 27.310 108.04 4.99- 103.05
2166 E Hadley Rd Plainfield IN 46168 1 11.660 45.83 2.13- 43.70
I?ERIOD:.T
11 1s x:
L!90
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PARENT ACCOUNT: REPORT FOR:
City of Carmel Police City of Carmel Police
No 0496 -00- 138007 -0
MAR -01 -2012 TO MAR -31 -2012
Tax 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 -7.12 Federal Excise Gasoline Unblended 38.970 153.87 0.18300
FEDERAL TOTALS 7 1Z l 38.970: 153 3T
IN 356000972 JUN -18 -2012 -9.13 State Sales Gasoline Unblended 38.970 153.87 0.07000
-7.02 State Excise Gasoline Unblended 38.970 153.87 0.18000
IN STATE TdTAt
1:15.
ACCOUNT TOTALS -7.12 -16.15
NO
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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))
03/31/12 28995399 gasoline $146.75
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
VOUCHER NO. WARRANT NO.
Wright Express FSC ALLOWED 20
IN SUM OF
P.O. Box 6293
Carol Stream, IL 60197 -6293
$146.75
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1110 I 28995399 I 42- 314.00 I $146.75 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
which charge is made were ordered and
received except
r_
Wednesday, April 18, 2012
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund