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212835 09/18/2012 CITY OF CARMEL, INDIANA VENDOR: 366015 Page 1 of 1 ONE CIVIC SQUARE WRIGHT EXPRESS FSC CARMEL, INDIANA 46032 PO BOX 6293 CHECK AMOUNT: $992.11 CAROL STREAM IL 60197-6293 CHECK NUMBER: 212835 CHECK DATE: 9/18/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4231400 30448241 992 . 11 0453-00-794629-6 FLEET SERVICES INVOICE/STATEMENT INVOICE NUMBER: 30448241 ACCOUNT NAME: CARMEL FIRE DEPARTMENT PAGE 1 OF 1 ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD � BILL CLOSING DATE PAYMENT IDUEDATE AMOUNT DUE 0453-00-794629-6 8,10 0.00 31 08-31-2012 09-26-2012 992.11 PAYMENTS/CREDITS ACTIVITY DESCRIPTION PAYMENT RECEIVED-THANK YOU 838.94 ............ RETAIL FUEL PURCHASES MONTHLY CARD CHG „.x$:39_- (}7 _ . ... ....... ... ......................... .............................. ...... ........... ......................... . ......... ................ .......... REMINDER .............. PLEASE BE SURE TO INCLUDE REMITTANCE STUB WITH PAYMENT. MAIL TO THE ADDRESS SHOWN IN THE RIGHT PORTION OF THE REMITTANCE STUB. ................... .......................... ............ ............ ..... ................ ......................... .... .. ................. .......... .......... ....... ............. ...... ........ .................. ............ ........ ......... .................... ............................ .................. ....... ............ .... .............. ........... ............ ... . ......... ......... ................ ..... ...... .......... . . ........ . .............. . .......... .................... ................. ... ....... ........... ....- .......... ... . ........ ......... ... ................... ......... .................. ............. .............. ...... ............... ............ -.. ... ....- . ........­.­­- . ..... ... ....... .......... .......... .............. .......... ................ .... ........ __',11­..................... ........... PURCHASES,RETURNS AND PAYMENTS MADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT INVOICE/STATEMENT PREVIOUS BALANCE I (-)PAYMENTS I (+)PURCHASES I (+)DEBITS I (-)CREDITS I (+)LATE FEE I (=)NEW BALANCE 838.941 838.941 970.111 22.001 0.001 0.001 992.1 $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 0: 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. Tn FN.q[]RF PPOPFR rRFDIT TFAR AT PFRFnRATION Akin wri tinF ROTTOM IP()RTI0N WITH Yn[IR IPAYIMFNT 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 anon-business day,payment is due on the business day before the payment due date.Delinquent are credited to your account on the same day. There is no fee for 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 cans 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://www.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: 08-31-2012 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 -45.19 0.00 FEDERAL E85 246.990 858.39 0.18300 v,::i:;.,..;.. -11.23 0.00 FEDERAL GASOLINE 61.330 235.27 0.18300 FEDERAL TO A S. zz -56.42 ;: 6 ;:.;.:.:.3fl$:32Q :: 40$3:66:>?:'>»>>::::>:>::::::. <:>: IN 356000972 0.00 11.04 STATE EXCISE GASOLINE 61.330 235.27 0.18000 -53.20 0.00 STATE SALES E85 246.990 858.39 0.07000 .. . .............. . -13.93 0.00 STATE SALES GASOLINE 61.330 235.27 0.07000 >:W;:STATE TOTALS »`-67:13 19¢04»> »`is»s:>:;;: :»»»»»:: ' »:>s;;>:!>::>: :::»:;:;;:::'>:»>:»::::>:>.;;;;;;;: s:;is;;>.....:...... ':: »::>::>:.::;::;:<>::>::>"s> >::>: s> ..; ACCOUNT TOTALS -123.55 11.04 (c)WRIGHT EXPRESS CORPORATION 2012 PAGE 1 FLEET SERVICES STANDARD REPORT INVOICE NUMBER: 30448241 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 0453-00-794629-0 8,100.00 31 08-31-2012 09-26-2012 992.11 CARD LOCATION DATE TIME DRIVER ODOMETER PRODUCT UNITS COST/ ITEM TOTAL NO. NO. UNIT TOTAL AMOUNT 0002 MH 001 078 08-08-2012 15:57 HULETT,MARK 4,222 E85 12.140 3.398 41.25 41.25 MH 001 074 08-10-2012 12:21 HULETT, MARK 4,354 E85 12.580 3.498 44.00 44.00 MH 001 078 08-12-2012 11:20 HULETT,MARK 4,502 E85 11.750 3.498 41.10 41.10 MH 001 078 08-18-2012 12:54 HULETT, MARK 4,983 E85 11.160 3.499 39.05 39.05 MH 001 074 08-21-2012 15:00 HULETT,MARK 5,118 E85 11.790 3.499 41.25 41.25 MH 001 078 08-26-2012 12:14 HULETT, MARK 5,453 E85 11.860 3.499 41.50 41.50 MH 001 074 08-29-2012 10:24 HULETT, MARK 5,659 E85 16.720 3.499 58.50 58.50 CARD SUBTOTALS 88.000 306.65 0004 MH 001 074 08-05-2012 14:17 HABOUSH,DAVE 17,652 UNL 23.770 3.959 94.11 94.11 MH 001 074 08-15-2012 08:50 HABOUSH,DAVE 17,023 E85 22.310 3.499 78.07 78.07 MH 001 074 08-22-2012 13:04 HABOUSH,DAVE 17,264 E85 23.250 1499 81.36 81.36 MH 001 074 08-30-2012 08:44 HABOUSH,DAVE 17,542 E85 24.920 3.499 87.19 87.19 CARD SUBTOTALS 94.250 340.73 0007 MH 001 078 07-30-2012 20:06 SMITH,KEITH 14,500 E85 19.750 3.359 66.34 66.34 MH 001 074 08-06-2012 11:53 SMITH,KEITH 14,500 E85 18.180 3.399 61.80 61.80 MH 001 074 08-13-2012 12:34 SMITH,KEITH 14,500 UNL 12.490 3.898 48.69 48.69 MH 001 074 08-17-2012 12:15 SMITH,KEITH 14,500 E85 5.170 3.497 18.08 18.08 MH 001 074 08-24-2012 12:03 SMITH,KEITH 14,500 E85 19.690 1499 68.90 68.90 CARD SUBTOTALS 75.280 263.81 4502 MH 001 074 08-02-2012 11:06 STEELE,JEFF 21,650 UNL 25.070 3.688 92.47 92.47 MH 001 095 08-18-2012 12:56 STEELE,JEFF 22,328 E85 25.720 3.499 90.00 90.00 CARD SUBTOTALS 50.790 182.47 TOTAL PURCHASES 308.320 1,093.66 Y-T-D PURCHASES 2,018.230 6,823.89 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 12 774.42 MH 001 078 MEIJER 5303 E SOUTHPORT RD INDIANAPOLIS IN 46237 5 229.24 MH 001 095 MEIJER 8225 E 96TH ST INDIANAPOLIS IN 46256 1 90.00 PRODUCTS E85=ETHANL85 UNL=UNLEADED SO FLEET SERVICES This page is intentionally left blank. VOUCHER NO. WARRANT NO. ALLOWED 20 Fleet Services IN SUM OF $ P.O. Box 6293 Carol Stream, IL 60197 $992.11 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 I 30448241 I 42-314.00 I $992.11 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 SEO 12 2W .00/1 r s-- 0 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)) 30448241 $992.11 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