216332 01/15/2013 CITY OF CARMEL, INDIANA VENDOR: 00351794 Page 1 of 1
ONE CIVIC SQUARE SHELL CREDIT CARD CENTER CHECK AMOUNT: $805.70
CARMEL, INDIANA 46032 PO BOX 183019
COLUMBUS OH 43218-3019 CHECK NUMBER: 216332
CHECK DATE: 1/15/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4231400 065127193301 805 . 70 065-127-193
i
www.shellfleetcard.accountonline.com
ACCOUNT NUMBER TOTAL TRANSACTIONS INVOICE NUMBER SEND INQUIRIES TO:
065-127-193 17 065127193301 HELL CARD CENTER
P.O. BOX 689081
CLOSING DATE DUE DATE CYCLE DAYS DES MOINES,IA 50368-9081
01-06-2013 01-31-2013 31 TELEPHONE: 1.800377.5150
FAX: 1-515.226-4045
NEW CHARGES FLEET FEE REVIOUS BALANCE PAYMENTS/ADJUSTMENTS LATE FEE NEW BALANCE
853.67 .00 795.69 843.66 CR .00 805.70
PAYMENT OF NEW BALANCE MUST BE RECEIVED BY 01-31-2013
Cord T IAU- TI ii TRANS I I TRANSACTION LOCATION/DESCRIPTION QUANTITY I hISG PROD EXEMPT TRANSACTION
Numbe( DATE TIME ID I CD I CD TAX AMOUNT
12-20 PAYMENT-THANK YOU I 795.69 CR
®_ 0003 12-19 1550 0251660 7788 E 06TH ST FISHERS IN 13.580 8 UNL 2.49 41.42
13.580 GAL UNLEADED S41.42
® TOTAL CARD 0003 13.580 249 41.42 **
0004 12-06 16:14 0079335 545 3 RANGE LINE RD CARRIEL IN I 23.333 8 UNL 427 77.00
23.333 GAL 'UNLEADED 577.00 I
0004 12-25 171M 0202218 545 S RANGE LINE RD CARMEL IN 14.692 8 UNL 2.69 4700
®_ 14.692 GAL UNLEADED S47.00
® 0004 01-04 09:19 0145326 1230 S RANGELINE RD CARMEL IN 22.572 8 UNL 4.13 69.50
22.572 GAL UNLEADED S69.50 j
® TOTAL CARD 0004 60.597 11.09 19350 *�
® 0()79 (Ot-04 16:33 0521641 P510 E 126TH ST FISHERS IN I 14.433 6 UNL 2.64 45.32
j 14.433 GAL UNLEADED 545.32 j ...///
1 TOTAL CARD 0009 j 14.433 2.64 45.32
® 0014 12-13 15:18 0062646 10596 N COLLEGE AVE INDIANAPOLIS IN 14.071 8 UNL 2.57 47.00
14.071 GAL UNLEADED $47.00
0014 12-26 1 08.45 00°2007 1230 S RANGELINE RD CARMEL IN 10.400 8 UNL 1.90 3298
1 10.400 GAL UNLEADED 532.98 I
® ; TOTAL CARD 0014 I 24.471 1 4.47 79.98
Message Codes: 1-Electronic Sale with Authorization 4-Electronic Sale without Authorization 8-Electronic Sale at Pump
2-Keyed Sale with Authorization 5-Keyed Sale without Authorization 9-Manual Sale
®_ SCHEDULE OF LATE FEE
® PERIODIC RATE ANNUAL MONTHLY MINIMUM BALANCE SUBJECT TO LATE FEE
®_ (MONTHLY) PERCENTAGE RATE SEE REVERSE SIDE
®
0.000% 0.00% 0.00 AO
6057 0014 GUG 1 7 2 130106 9366 8015 51133 5416
® NOTICE:SEE REVERSE SIDE FOR IMPORTANT 114FORILMTION PLEASF KEEP TI-RS PORTION FOR YOUR RECORDS
(4.'`05416 Page 1 of 2 FLET2GUG
Information About Your Account
Report a Lost or Stolen Card Immediately: Our Customer Service Representatives are available by phone 24 hours a day,7
days a week.
Payment Instructions: We must receive your payment in proper form at our processing facility by 5 p.m.local time there. If we
do, it will be credited as of that day. A payment received at the processing facility in proper form after that time will be credited as
of the next day. Allow 5 to 7 days for payments by regular mail to reach us.There may be a delay of up to 5 days in crediting a
payment we receive that is not in proper form or is not sent to the correct address. The correct address for a payment sent by
regular mail is the address listed on the return envelope or on the front of the payment coupon. If you wish to send a payment by
express courier,you must call us for the correct address at the Customer Service number shown on the front of this statement.
Proper Form. For a payment sent by mail or courier to be in proper form,you must:
•Enclose a valid check or money order.No cash or foreign currency please.
e Include your name and account number on the front of your check or money order.
If you send an eligible check with the payment coupon,you authorize us to complete your payment by electronic debit.If
we do,the checking account will be debited in the amount on the check. We may do this as soon as the day we receive
the check. Also,the check will be destroyed.
Optional Pay by Phone Service. You may use this optional service any time to make a payment by phone.You will be charged
$14.95 to use this service. Call by 5 p.m.Eastern time to have your payment credited as of that day. If you call after that time,
your payment will be credited as of the next day. We may process your payment electronically after we verify your identity.
This Account is Issued by Citibank. N.A.
• -' PLOGOM\A ii9v 01/12
www.shelifleetcard.accountonline.com
ACCOUNT NUMBER TOTAL TRANSACTIONS INVOICE NUMBER SEND INQUIRIES TO:
065-127-193 17 065127193301 HELL CARD CENTER
P.O, BOX 66?051
CLOSING DATE DUE DATE CYCLE DAYS DES MOINES.IA 50368-9051
01-06-2013 01-31-2013 31 TELEPHONE: 1-500377-5150
FAX: 1-515-226-4045
Card i I TRANS
MSG PROD I EXEMPT I TRANSACTION I TRANSACTION LOCATION/DESCRIPTION I QUANTITY 1 i
Numlar DATEc TIASE ID i 1 CD CD ( TAX AMOUNT
0016 12-06 07:52 0262267 9510E 126TH ST FISHERS IN 16.070 i 6 i UNL I 2.94 I 5C.07
16.070 GAL UNLEADED 556.07 i
i
0016 12-11 07:52 0309005 9510 E 12GTH ST FISHERS IN 13.020 9 UNL 2.38 43.50
13.020 GAL UNLEADED $43.50 {
TOTAL CARD 0016 29,090 5.32 99.57 =;
0018 12.26 10:43 0614024 11601 ALLISONVILLE RD FISHERS IN 15.462 8 UNL 2.63 49,45
15.462 GAL UNLEADED S49.48
TOTAL CARD 0018 i 15.462 i 2.83 49.48 *J
0025 12-07 16:24 0512459 806 t4'MAIN ST CARMEL IN I 13,973 8 UNL ' 256 � 46.C5
13.973 GAL UNLEADED S46.95 I
0025 12-24 16.08 0230F12 1821 E 151ST ST CARMEL IN � 13.5-32 8 i UNL 2.45 � 4420
® 13.562 GAL UNLEADED S44.20
®_ TOTAL CARD 0025 27.535 5.04 I 91,15 =�
° 0027 12-12 17:53 01200e7 545 S RANGE LINE RD CARMEL IN 12.340 8 UNL 2.2G 41.09
12.340 GAL UNLEADED S41.08
TOTAL CARD 0027 1J 12.340 2.26 41.03 +x
0026 12-17 17:52 0152298 545 S RANGE LINE RD CARMEL IN 17.493 6 I UNL 3.20 5203
®_ 17.493 GAL UNLEADED S57.03 *�
TOTAL CARD 0028 17.493 3.20 I 57.03
® 0030 12.11 0828 0190280 7788 E°5TH ST FISHERS IN 14.902 8 UNL 2.73 49,7
14.902 GAL UNLEADED $49.76
® 0030 12-15 02:29 0022095 I 1230 S RANGELINE RD CARMEL IN 16.393 B UNL 3.00 53.77
16.393 GAL UNLEADED $53.77
0030 12.22 1248 0279539 7766 E 96TH ST FISHERS IN 15.631 6 UNL 2.90 I 51,61
® 15.831 GAL UNLEADED S51.61
TOTAL CARD 0030 47.126 8,63 I 155.14 {�
GRAND TOTAL 262.127 1 47.97 853.67 R"
®_ FEDERAL EXCISE TAX
262.1 GALLONS GASOL INE I 47.97 CR
TOTAL'FINANCE CHARGE' BILLED IN 2012
®_ Message Codes: 1-Electronic Sale with Authorization 4-Electronic Sale without Authorization 8-Electronic Sale at Pump
2-Keyed Sale with Authorization 5-Keyed Sale without Authorization 9-Manual Sale
6057 0014 GUG 1 7 2 130106 9366 8015 SH33 541G
® NOTICE:SEE REVERSE SIDE FOR IMPORTANT INFORMATION PLEASE KEEP THIS PORTION FOR YOUR RECORDS
`z 0005416 Paoe 2 of 2 FLET2GUG
Information About Your Account
Report a Lost or Stolen Card Immediately: Our Customer Service Representatives are available by phone 24 hours a day,7
days a week.
Payment Instructions: We must receive your payment in proper form at our processing facility by 5 p.m.local time there. If we
do, it will be credited as of that day. A payment received at the processing facility in proper form after that time will be credited as
of the next day. Allow 5 to 7 days for payments by regular mail to reach us.There may be a delay of up to 5 days in crediting a
payment we receive that is not in proper form or is not sent to the correct address. The correct address for a payment sent by
regular mail is the address listed on the return envelope or on the front of the payment coupon. If you wish to send a payment by
express courier,you must call us for the correct address at the Customer Service number shown on the front of this statement.
Proper Form. For a payment sent by mail or courier to be in proper form,you must:
•Enclose a valid check or money order.No cash or foreign currency please.
•Include your name and account number on the front of your check or money order.
If you send an eligible check with the payment coupon,you authorize us to complete your payment by electronic debit.If
we do,the checking account will be debited in the amount on the check. We may do this as soon as the day we receive
the check. Also,the check will be destroyed.
Optional Pay by Phone Service. You may use this optional service any time to make a payment by phone.You will be charged
$14.95 to use this service. Call by 5 p.m.Eastern time to have your payment credited as of that day. If you call after that time,
your payment will be credited as of the next day. We may process your payment electronically after we verify your identity.
This Account is Issued by Citibank,N.A.
PLOCOMM Rev 01/12
VOUCHER NO. WARRANT NO.
ALLOWED 20
Shell Fleet Plus
Processing Center IN SUM OF $
P.O. Box 183019
Columbus, OH 43218-3019
$805.70
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 I 65127193301 I 42-314.00 I $805.70 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
Mond/ay, January 14, 2013
Chief of Police
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))
01/06/13 65127193301 gasoline $805.70
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