212018 08/15/2012 a CITY OF CARMEL, INDIANA VENDOR: 366015 Page 1 of 1
ONE CIVIC SQUARE WRIGHT EXPRESS FSC
` CARMEL, INDIANA 46032 PO BOX 6293 CHECK AMOUNT: $838.94
CAROL STREAM IL 60197-6293
„o CHECK NUMBER: 212018
CHECK DATE: 8/15/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231400 30157763 838 . 94 0453-00-794629-6
FLEET SERVICES INVOICE/STATEMENT
INVOICE NUMBER: 30157763
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 8,100.00 31 07-31-2012 08-24-2012 838.94
DATE ACTIVITY DESCRIPTION CHARGES/DEBfTS PAYMENTS/CREDITS
G7-23-2012-,:,:--, PAYMENT RECEIVED-THANK YOU
563.79
RETAIL FUEL PURCHASES 816,94
:
b7 311.7.201121. MONTHLY CARD CHG j.2 2*00
REMINDER
PLEASE BE SURE TO INCLUDE REMITTANCE STUB WITH
PAYMENT. MAIL TO THE ADDRESS SHOWN IN THE RIGHT
PORTION OF THE REMITTANCE STUB.
... .. .... ......-
. .........
............
-PURCHASESi-RETURNS-AND-PAYMENTS,MADE-JUST-PRIOR-TO-B!I-LING-DATE=MAY-NOT-APPEAR-UNT"--THE-NEX-7-IN.'OICEISTA,TE.MEt47T
PREVIOUS BALANCE (-)PAYMENTS I (+)PURCHASES I (+)DEBITS I (-)CREDITS I (+)LATE FEE I (=)NEWBALANCE
563.79 563.791 816.94 22.001 0.00� 0.001 838
$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 PFIRFORATION AKjn wri I inF Rr'tTTC)M PrIPTIMI 1AIITW VnI IQ DAVftfig=IIT
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:8www.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: 07-31-2012
FLEET SERVICES 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 -6.01 0.00 FEDERAL DIESEL 24.751 89.08 0.24300
-26.47 0.00 FEDERAL E85 144.590 464.42 0.18300
-19.84 0.00 FEDERAL GASOLINE 108.370 365.76 018300
FEDERAL TOTALS
52:32:
2V1.11
IN 356000972 0.00 3.96 STATE EXCISE DIESEL 24.751 89.08 0.16000
0.00 19.50 STATE EXCISE GASOLINE 108.370 365.76 0.18000
0.00 5.18 STATE SALES DIESEL 24.751 89.08 0.07000
-28.64 0.00 STATE SALES E85 144.590 464.42 0.07000
-21.36 0.00 STATE SALES GASOLINE 108.370 365.76 0.07000
AN:STATE TOTALS 50,.00
ACCOUNT TOTALS -102.32 28.64
(c)WRIGHT EXPRESS CORPORATION 2012 PAGE 1
FLEET SERVICES STANDARD REPORT
INVOICE NUMBER: 30157763
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 07-31-2012 08-24-2012 838.94
CARD LOCATION DATE TIME DRIVER ODOMETER PRODUCT UNITS COST/ ITEM TOTAL
NO. NO. UNIT TOTAL AMOUNT
0001 MH 001 154 07-21-2012 22:52 SMITH,KEITH 146,505 UNL 10.270 3.409 35.01 35.01
CARD SUBTOTALS 10.270 35.01
0002 MH 001 095 07-02-2012 07:15 HULETT, MARK 1,992 E85 9.730 3.000 29.19 29.19
MH 001 078 07-02-2012 21:10 HULETT, MARK 2,074 E85 11.730 3.099 36.35 36.35
MH 001 078 07-05-2012 15:22 HULETT, MARK 2,263 E85 14.720 3.098 45.60 45.60
MH 001 078 07-13-2012 16:29 HULETT, MARK 2,683 E85 10.430 3.260 34.00 34.00
MH 001 078 07-20-2012 14:33 HULETT, MARK 3,098 E85 9.520 3.257 31.01 31.01
MH 001 078 07-27-2012 11:54 HULETT, MARK 3,480 E85 10.520 3.298 34.70 34.70
CARD SUBTOTALS 66.650 210.85
0003 87 029 903 07-08-2012 13:18 REEVES,STEVE 73,289 DSL 24.751 3.599 89.08 89.08
CARD SUBTOTALS 24.751 89.08
0004 MH 001 074 07-02-2012 08:59 HABOUSH,DAVE 15,280 UNL 26.190 3.138 82.19 82.19
MH 001 074 07-21-2012 20:05 HABOUSH,DAVE 16,224 UNL 24.900 3.469 86.38 86.38
CARD SUBTOTALS 51.090 168.57
4502 MH 001 074 07-03-2012 10:46 STEELE,JEFF 20,249 UNL 25.500 3.459 88.20 88.20
MH 001 074 07-11-2012 16:48 STEELE,JEFF 20,556 E85 25.060 3.199 80.16 80.16
MH 001 074 07-17-2012 08:55 STEELE,JEFF 20,794 E85 26.540 3.260 86.51 86.51
MH 001 074 07-22-2012 10:17 STEELE,JEFF 21,031 UNL 21.510 3.439 73.98 73.98
MH 001 095 07-27-2012 15:29 STEELE,JEFF 21,381 E85 26.340 3.299 86.90 86.90
CARD SUBTOTALS 124.950 415.75
TOTAL PURCHASES 277.711 919.26
Y-T-D PURCHASES 1,509.781 4,994.70
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 6 497.42
MH 001 078 MEIJER 5303 E SOUTHPORT RD INDIANAPOLIS IN 46237 5 181.66
MH 001 095 MEIJER 8225 E 96TH ST INDIANAPOLIS IN 46256 2 116.09
87 029 903 PHILL 66 10400 N MICHIGAN ROA ZIONSVILLE IN 46077 1 89.08
MH 001 154 MEIJER 17000 MERCANTILE RD NOBLESVILLE IN 46060 1 35.01
PRODUCTS DSL=DIESEL E85=ETHANL85 UNL=UNLEADED 011
FLEET SERVICES
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VOUCHER NO. WARRANT NO.
Wrights Express FSC ALLOWED 20
IN SUM OF $
P.O. Box 6293
Carol Stream, IL 60197
$838.94
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT
Board Members
1120 I 30157763 I 42-314.00 I $838.94 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
AUG 13'2012 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
4n 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))
30157763 $838.94
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