213296 10/09/2012 CITY OF CARMEL, INDIANA VENDOR: 366015 Page 1 of 1
0 ONE CIVIC SQUARE WRIGHT EXPRESS FSC CHECK AMOUNT: $933.59
'o CARMEL, INDIANA 46032 PO BOX 6293
CAROL STREAM IL 60197-6293 CHECK NUMBER: 213296
CHECK DATE: 10/9/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231400 30718983 933 . 59 0496-00-138012-0
Vehicle ID Date Transactior Posted Date Site Name Site Street Address Site City Site Zip Code Produ Units Unit Cost Gross Cost Federal ExE Net Cost Reported T Fuel Cost
Chief Smitr 9/3/2012 12:52:00 9/5/2012 Mac's Convenience Sto 3801 S Post Rd Indianapoli 46239-8302 UNL 9.38 $3.96 $37.17 ($1.72) $35.45 ($3.90) $37.17
Chief Smitl 9/10/2012 9:34:00 9/12/2012 Circle K Store 2368 545 S Range Line Rd Carmel 46032-2140 UNL 18.05 $3.69 $66.62 ($3.30) $63.32 ($7.18) $66.62
Chief Smitr 9/13/2012 12:12:00 9/17/2012 Circle K Store 2368 545 S Range Line Rd Carmel 46032-2140 UNL 10.86 $3.69 $40.07 ($1.99) $38.08 ($4.31) $40.07
Chief Smith 9/14/2012 10:22:00 9/18/2012 Circle K Store 2368 545 S Range Line Rd Carmel 46032-2140 UNL 12.74 $4.00 $50.96 ($2.33) $48.63 ($5.32) $50.96
Chief Smitl• 9/18/2012 12:59:00 9/20/2012 Circle K Store 2368 545 S Range Line Rd Carmel 46032-2140 UNL 11.4 $3.69 $42.07 ($2.09) $39.98 ($4.53) $42.07
Chief Smitr 9/20/2012 15:26:00 9/24/2012 Circle K Store 2368 545 S Range Line Rd Carmel 46032-2140 UNL 21.01 $3.70 $77.74 ($3.84) $73.90 ($8.37) $77.74
Chief Smitr 9/23/2012 12:22:00 9/25/2012 Mac's Convenience Sto 3801 S Post Rd Indianapoli 46239-8302 UNL 13.6 $3.67 $49.91 ($2.49) $47.42 ($5.39) $49.91
Chief Smitr 9/26/2012 17:12:00 9/28/2012 Mac's Convenience Sto 3801 S Post Rd Indianapoli 46239-8302 UNL 11.51 $3.87 $44.55 ($2.11) $42.44 ($4.71) $44.55
Asst. Chief 9/17/2012 12:36:00 9/19/2012 Circle K Store 2368 545 S Range Line Rd Carmel 46032-2140 UNL 23.97 $3.69 $88.43 ($4.39) $84.04 ($9.53) $88.43
Asst. Chief 9/24/2012 15:45:00 9/26/2012 Circle K Store 2368 545 S Range Line Rd Carmel 46032-2140 UNL 23.76 $3.70 $87.91 ($4.35) $83.56 ($9.47) $87.91
EMS Chief 1 9/9/2012 9:51:00 9/11/2012 Circle K Store 2368 545 S Range Line Rd Carmel 46032-2140 UNL 13.82 $3.69 $51.01 ($2.53) $48.48 ($5.50) $51.01
EMS Chief 1 9/18/2012 6:51:00 9/20/2012 Circle K Store 2368 545 S Range Line Rd Carmel 46032-2140 UNL 12.4 $3.69 $45.75 ($2.27) $43.48 ($4.93) $45.75
EMS Chief 1 9/27/2012 12:54:00 10/1/2012 Circle K Store 2368 545 S Range Line Rd Carmel 46032-2140 UNL 10.9 $3.67 $40.00 ($1.99) $38.01 ($4.32) $40.00
Battalion C 9/24/2012 8:00:00 9/26/2012 Circle K Store 2368 545 S Range Line Rd Carmel 46032-2140 UN+ 25.51 $3.92 $100.00 ($4.67) $95.33 ($10.52) $100.00
9/7/2012 7:00:00 9/11/2012 Circle K Store 2368 545 S Range Line Rd Carmel 46032-2140 UNL 24.39 $3.69 $89.99 ($4.46) $85.53 ($9.70) $89.99
9/11/2012 13:07:00 9/13/2012 Circle K Store 2368 545 S Range Line Rd Carmel 46032-2140 UNL 18.23 $3.80 $69.28 ($3.34) $65.94 ($7.38) $69.28
I nvoi oe Statement
INVOICE NUMBER: 30718983
ACCOUNT NAME: City of Carmel Fire
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
049600-138012-0 3,550.001 30 1 SEP-30-2012 OCT-26-2012 933.59
DATE ACTIVITY DESCRIPTION CHARGES/DEBITS PAYMENTS/CREDITS
SEP-13-2012 PAYMENT-THANK YOU 1,393.41
SEP-28-2012 FUEL PURCHASES 933.59
REMINDER
REMINDER PLEASE BE SURE TO INCLUDE REMITTANCE STUB
WITH PAYMENT. MAIL TO THE ADDRESS SHOWN IN THE
RIGHT PORTION OF THE REMITTANCE STUB.
PURCHASES RETURNSAND PAYMENTS MADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT INVOICE/STATEMENT.
PREVIOUS BALANCE PAYMENTS (+)PURCHASES (+)DEBITS CREDITS + LATE FE = NEW BALANCE
1393.41 1393.41 933.59 0.00 0.00 0.00 933.59
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.
TO ENSURE PROPER CREDIT.TEAR AT PERFORATION AND INCLUDE EOTTOM PORTION WITH YOUR PAYMENT.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Wrights Express FSC
IN SUM OF $
P.O. Box 6293
Carol Stream, IL 60197
$933.59
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
T Board Members
1120 I 30718983 I 42-314.00 I $933.59 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
OCT
a
Ay// yC LJ A
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Irescribed 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))
30718983 $933.59
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
120
Clerk-Treasurer