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211609 08/14/2012 - CITY OF CARMEL, INDIANA VENDOR: 366015 Page 1 of 1 0 ONE CIVIC SQUARE WRIGHT EXPRESS FSC CARMEL, INDIANA 46032 PO BOX 6293 CHECK AMOUNT: $287.18 CAROL STREAM IL 60197-6293 CHECK NUMBER: 211609 oH CHECK DATE: 8114/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1205 4231400 30195776 287 . 18 0496-00-138002-1 Invoice Statement INVOICE NUMBER: 30195776 ACCOUNT NAME: City of Carmel Admin. PAGE I OF I ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD � BILL CLOSING DATE PAYMENT IDUEDATE AMOUNT DUE 0496-00-138002-1 55 0.00 31 JUL-31-2012 AUG-24-2012 287 TaAFE::::;;:z>:::> ACTIVITY DESCRIPTION :PMA BITS PAYMENTS/CREDITS 10-2012­­1 PAYMENT-THANK YOU 130.56 JUL­31.20f2.:.:.:: . FUEL 287A.8 .......... ......... .......... ...... ............- .......................... ........... ....... ...... REMINDER . . ........... REMINDER PLEASE BE SURE TO INCLUDE REMITTANCE STUB ............. WITH PAYMENT. MAIL TO THE ADDRESS SHOWN IN THE .............. RIGHT PORTION OF THE REMITTANCE STUB. .................... ............11............ ........................ .......... .......... . ................ ................... ............ ............. ......... ................... .............. .................. ......... .......... :XXX.... .............. ................ ............ ... ................. ............ .......... ................. .............. ................ ................... ............ ........ ­�:XXX: ........... .............. ................. ............ .......... .......... ...... ......... . .......... .... .. ....... ...... ............... ........... ....... .......... ........ ... ........ .... ........... .......... ............ .............. ........... .......... ...........- ...... ........... .............. ................. ........ ...... ........... ........... ­......-........... ...... ...- ................... . ..... .............. ............ .......... ...... ....... ..... ...... ............ ........... .............. ................ ............. ...... ............. ............. ........... ....-.......... .............. PURCHASES,RETURNS AND PAYMENTS MADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT INVOICE/STATEMENT. PREVIOUS BALANCE MPAYMENTS (+)PURCHASES J_ +DEBITS I (-)CREDITS I (+)LATEFEEI =NEW BALANCE 130.561 130.561 287.181 0.001 0.001 0.001 287.181 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 % 0.00 SEE REVERSE SIDE FOR IMPORTANT INFORMATION AND TERMS. - ------- ­---------- BOTTOM PORTION WITH OUR 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.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. Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995) 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. PO Ox 6293 Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 07731/12 Gasoline -Util Uept . 07/31/12 30142708 Gaso"ne - Police Dept 07131112 30153803 Gasoline - Fire Dept $ 3 .85 07/31/12 30195776 Gasoline - Admin Dept $287.18 $1,318.52 Total 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 VOUCHER NO. WARRANT NO. 08/14/12 ALLOWED 20 Wright Express, FSC IN SUM OF $ PO Box 6293 Carol Stream, IL 60197-6293 $ $1 ,318.52 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for W02 33111+1 3 which charge is made were ordered and 111C 3014270 314 $296.1 teceived except 112C 3015380B 314 .35 19nF 2019S776 18 ,20 ft to / L % - Title Cost distribution ledger classification if claim paid motor vehicle highway fund