208959 05/16/2012 CITY OF CARMEL, INDIANA VENDOR: 066015 Page 1 of 1
ONE CIVIC SQUARE WRIGHT EXPRESS FSC
CARMEL, INDIANA 46032 PO BOX 6293 CHECK AMOUNT: $1,045.74
CAROL STREAM IL 60197 -6293 CHECK NUMBER: 208959
CHECK DATE: 5/16/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231400 29293740 777.39 0496 -00- 138012 -0
1205 4231400 29293740 777.39 GASOLINE
1120 4231400 29296549 1,045.74 0453 -00- 794629 -6
FLEET SERVICES INVOICE/STATEMENT
INVOICE NUMBER: 29296549
ACCOUNT NAME: CARMEL FIRE DEPARTMENT
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIO CLOSING DATE PAYMENT DUE DATE AMOUNT [DUE
0453 0 -79=629-6 8100.00 30 0-201: 05-2 2012 9 9
1.045.741
F�
CH. PAY MENTS /CREDITS
ACTIVITY DESCRIPTION
PAYMENT RECEIVED THANK YOU 967.03
RETAIL FUEL PURCHASES
MONTHLY CARD CHG
REMINDER
PLEASE BE SURE TO IN REMITTANCE STUB WITH
PAYMENT. MAIL O T H E A ADDRESS SHOWN IN THE RIGHT
PORTION F T H E R REMITTANCE STUB.
PURCHASES, RETURNS AND PAYMENTS MADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT INVOICE/STATEMENT
PREVIOUS BALANCE (-)PAYMENTS (+)PURCH (+)DEBIfS (-)CREDITS I LATE FEE I NEW BALANCE
967.03 967.03 1,023.741 22.001 0.001 0.001 104574
$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 0.00
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 Allow 10 business days prior to the due date for mailing to help
during that period. The total balance due will then be multiplied avoid late fees. Mail payments to:
by the applicable periodic rate to determine your late fee. In the
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: /Iwww.e- fleet.com
Call 1- 888 3875665, 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.
�'1 ACCOUNT: CARMEL FIRE DEPARTMENT CLOSING DATE: 04 -30 -2012
FLEE S E RV I l v E S ACCOUNT NO: 0453 -00- 794629 -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 -60.54 0.00 FEDERAL E85 330.880 1,155.92 0.18300
E1±13RA1QAt 5 ..t►54 9..
ti Bit ......2
AN 356000972 -71.64 0.00 STATE SALES E85 330.880 1,155.92 0.07000
EN.: S
7164 0 00
ACCOUNT TOTALS 432.18 0.00
(c) WRIGHT EXPRESS CORPORATION 2012 PAGE 1
FLEET SERVICES STANDARD REPORT
INVOICE NUMBER: 29296549
ACCOUNT NAME: CARMEL FIRE DEPARTMENT
PAGE 1 OF 2
ACCOUNT NUMBER CREDIT LIMIT I DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0453 -00 794629 -6 8,100.00 30 04 -30 -2012 05 -25 -2012 1,045.74
CARD LOCATION DATE TIME DRIVER ODOMETER PRODUCT UNITS COST/ ITEM TOTAL
NO. NO. UNIT TOTAL AMOUNT
0002 MH 001 074 04 -03 -2012 12:15 HULETT, MARK 102,425 E85 9.680 3.559 34.45 34.45
MH 001 078 04 -05 -2012 15:14 HULETT, MARK 102,679 E85 13.780 3.560 49.05 49.05
MH 001 078 04 -09 -2012 23:55 HULETT, MARK 102,866 E85 12.360 3.560 44.00 44.00
MH 001 078 04 -12 -2012 22:44 HULETT, MARK 103,084 E85 13.210 3.558 47.00 47.00
MH 001 078 04 -16 -2012 15:55 HULETT, MARK 103,318 E85 13.780 3.560 49.05 49.05
MH 001 074 04 -25 -2012 21:14 HULETT, MARK 103,842 E85 9.390 3.397 31.90 31.90
MH 001 078 04 -27 -2012 1146 HULETT, MARK 103,981 E85 8.470 3.400 28.80 28.80
CARD SUBTOTALS 80.670 284.25
0004 MH 001 074 04 -18 -2012 21:46 HABOUSH, DAVE 12,535 E85 25.610 3.399 87.06 87.06
MH 001 074 04 -25 -2012 23:17 HABOUSH, DAVE 12,778 E85 23.000 3.398 78.16 78.16
CARD SUBTOTALS 48.610 165.22
0007 MH 001 074 03 -30 -2012 13:07 SMITH, KEITH 14,500 E85 21.830 3.559 77.70 77.70
MH 001 074 04 -03 -2012 12:09 SMITH, KEITH 14,500 E85 20.340 3.559 72.40 72.40
MH 001 078 04 -08 -2012 10:44 SMITH, KEITH 14,500 E85 16.980 3.558 60.42 60.42
MH 001 074 04 -13 -2012 12:51 SMITH, KEITH 14,500 E85 24.110 3.559 85.80 85.80
MH 001 074 04 -20 -2012 11:27 SMITH, KEITH 14,500 E85 14.780 3.399 50.23 50.23
MH 001 074 04 -24 -2012 12:47 SMITH, KEITH 14,500 E85 15.690 3.398 53.32 53.32
MH 001 074 04 -27 -2012 13:18 SMITH, KEITH 14,500 E85 13.370 3.399 45.45 45.45
CARD SUBTOTALS 127.100 445.32
4502 MH 001 095 04 -06 -2012 17:00 STEELE, JEFF 15,875 E85 24.720 3.559 87.98 87.98
MH 001 074 04 -12 -2012 08:14 STEELE, JEFF 16,142 E85 24.730 3.559 88.01 88.01
MH 001 074 04 -24 -2012 15:07 STEELE, JEFF 16,791 E85 25.050 3.399 85.14 85.14
CARD SUBTOTALS 74.500 261.13
TOTAL PURCHASES 330.880 1,155.92
Y -T -D PURCHASES 906.530 3,029.07
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 12 789.62
MH 001 078 MEIJER 5303 E SOUTHPORT RD INDIANAPOLIS IN 46237 6 278.32
MH 001 095 MEIJER 8225 E 96TH ST INDIANAPOLIS IN 46256 1 87.98
PRODUCTS: E85= ETHANL85
t
FLEET SERVICES
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Wrights Express FSC
IN SUM OF
P.O. Box 6293
Carol Stream, IL 60197
$1,0
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE I AMOUNT Board Members
1120 I 29296549 I 42- 314.00 I $1,045.74 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
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))
29296549 $1,04 5.74
I 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