217007 02/12/2013 CITY OF CARMEL, INDIANA VENDOR: 366015 Page 1 of 1
4 � ONE CIVIC SQUARE WEX BANK CHECK AMOUNT: $272.80
S!� CARMEL, INDIANA 46032 PO Box 6293
.offs CAROL STREAM IL 60197-6293 CHECK NUMBER: 217007
CHECK DATE: 2/12/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231400 31915181 272 . 80 0496-00-138012-0
Invoice Statement
INVOICE NUMBER: 31915181
® 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
0496-00-138012-0 9,55 O.00 31 JAN- FEB- 272.80
S PAYMENTS/CREDITS
ACTIVITY DESCRIPTION ::CHAR
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PAYMENT THANK YOU 793.89
A,�31*-20.13 FUEL PURCHASES
72: 0
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REMINDER .........
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REMINDER PLEASE BE SURE TO INCLUDE REMITTANCE STUB ... XX
...............
.......... WITH PAYMENT. MAIL TO THE ADDRESS SHOWN IN THE
... .......
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.................. RIGHT PORTION OF THE REMITTANCE STUB. ...
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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—
793.891 793.891 272.801 0.001 0.001 0.001 272.80
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
apoying a month) 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 PR ROPER CREDIT,.TEAR..AT PERFORATION AND INCLUDE BOTTOM PORTION WITH YOUR PAYMENT.
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OUNT:NA*ME>:::>ii�i>�:>�:>ii�i City of Carmel Fire
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:: CCOUN ..
:A T.NUMBE-R...'**.*.*.:.*.:.:. 0496-00-138012-0 Circle K Fleet
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31915181
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JAN-31-2013 FAX CHANGE OF ADDRESS REQUEST TO 1-800-395-0809.
....... Make check payable to:WEX BANK.
:.AM60NT . . 272.80 Use enclosed envelope or send to:
........
................
..... ........
AMOUNT ..............
AMO.UNT.ENCLOSED:...*..*..*..*..*..*.
............ ..........
....... ...
FEB-26-2013
PAYMENTS RECEIVED AFTER THIS DATE SUBJECT TO LATE FEES. A
WEX BANK
P.O. BOX 6293
CAROL STREAM IL 60197-6293
04960013801200000000027280 130226
Balance Subject to Late Fee Mail
The late fee will be calculated by determining the total balance Be sure to include bottom portion of invoice with your payment.
due on the date your account becomes delinquent,as follows: Fite your account number or invoice number on the check to help
adding the total amount due on your Account on the payment due avoid delays in payment processing if the check and remit stub
date together with any purchases posted to your Account from become separated.
the end of the last billing cycle through the payment due date and Allow 10 business days prior to the due date for mailing to help
subtracting from that amount any payments and/or credits entered avoid late fees.Mail payments to:
during that period.The total balance due will then be multiplied
by the applicable periodic rate to determine your late fee.In the Fleet Services
event that the calculated late fee is less than ten dollars($10.00), PO Box 6293
a minimum late fee of ten dollars($10.00)will be charged. Carol Stream,IL 60197-6293
Your Account will be delinquent if you do not pay it in full within Online
26 calendar days of the billing date appearing on your invoice. Authorized users can elect to receive an email notification when an
Certain customers,based upon our credit review,may be required invoice is ready for online viewing and payment.Log in or register to
to make payment in less than 26 calendar days on a cycle that we set up an online account at www.wextools.com.
may establish for you.In addition,certain customers may elect a Online payments scheduled by 3:00 PM ET(on business days)
shorter billing or payment cycle as offered by us. are credited to your account on the same day.There is no fee for
If your payment due date falls on a non-business day,payment is online payments.
due on the business day before the payment due date.Delinquent Phone
Accounts will be subject to late fees,suspension,or termination Call Customer Service at 1-866-544-1715 and select the menu
of credit privileges,without notice.All charges must be paid in
full regardless of disputes.Charges must be disputed in writing option for Billing Inquiries.In addition to making a payment,you can
no later than sixty(60)days from the billing date or they will be also check your balance.
considered final and binding. Payments scheduled by 3:00 PM ET(on business days)
Card Issuer are credited to your account on the same day.
The Circle K Fleet Card is issued by,and all card transactions are Be prepared with your fleet card account number and a sample
funded by and payable to,WEX Bank,under a Business Charge check to enter your bank account number and routing number.
Account Agreement with the cardholder named on the reverse. There is no fee for phone payments.
Customer Service Automated Clearing House(ACH)
To make a one-time electronic payment go to:
For account Inquiries and correspondence in regard to account http://www.e-fleet.com
service or billing:
• 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.
Payment Options
PARENT ACCOUNT: REPORT FOR:
City of Carmel Fire City of Carmel Fire
0496-00-138012-0
No
JAN-01-2013 TO JAN-31-2013
Purchase Activity Report PAGE 1 OF 4
77 . 1
VER CL
FOARD�NUIMSER.............. CARMEMSOSSINa.... xi: (ST�
10004 EMS Chief Hulett 70614 P LAT I- 1W:
DATE TIME SITE ADDRESS PROMPT TRAN ODOM. PROD UNITS COST/ FLIEL$ OTHER EXEMPT NET$ REPORTED EXC.
MM-131) INFO CODE UNIT $ TAX TAX CODES
PREVIOUS ODOMETER 10,760
01-02 07:14 545 S Range Line Carmel IN 1 driver OP 11,493 UNL 10.440 3.829 40.00 1.91- 38.09 4.25-
01-08 08:52 545 S Range Line Carmel IN 1 driver OP 11,762 UNL 11.590 2.759 32.00 2.12- 29.88 3.91-
01-17 08:36 545 S Range Line Carmel IN I driver OF 12,397 UNL 17.060 2.989 51.00 3,12- 47.88 6.00-
01-23 08:15 545 S Range Line Carmel IN I driver OF 12,571 UNL 14.290 3.079 44.00 2.62- 41.38 5.11-
01-25 08:27 545 S Range Line Carmel IN 1 driver OP 12,728 UNL 12.970 3.199 41.50 2.37- 39.13 4,74-
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01-
PERIOD AVERAGES:MPG,PPG,4,PM 29.66 3.142 0.11
YTD AVERAGES:MPG,PPG,CPU 29.66 3.142 0.11
TRANSACTION CODES:
OP=Outdoor Payment Terminal
umm
1Mft'.%U
PARENT ACCOUNT: REPORT FOR:
City of Carmel Fire City of Carmel Fire
0496-00-138012-0
® JAN-01-2013 TO JAN-31-2013
Purchase Activity Report PAGE 2 OF 4
7-- .............................
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ION
_VUHICLUDESCRIPT ...... VIN..":::.:... .........................
..........
10005 Bruce Knott 77258
DATE TIME SITE ADDRESS PROMPT TRAN ODOM. PROD UNITS COST/ FUEL$ OTHER EXEMPT NET$ REPORTED EXC.
MM-DD INFO CODE UNIT $ TAX TAX CODES
PREVIOUS ODOMETER 132,110
01-16 20:15 2507 Lafayette R Crawfordsv IN 1 driver OP 5,061 UNL 11.098 3.159 35.06 4.06- 31.00 2.00-
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.PERIOD..TOTAL$. ... ...... 40
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PERIOD AVERAGE:PPG .... 3.159
YTD AVERAGE:PPG ..... 3.159
TO ENSURE MORE cuRArEMILEAG=-REPO FTING,VEHICLE MILEAGE TATISTICS AF E NOT
CAI CULATED WHEN KEY DDOME TER READ NGS ARE NOT WITHIN AN ACCEPT s\BLE RANGE.
TRANSACTION CODES:
OP=Outdoor Payment Terminal
PARENT ACCOUNT: REPORT FOR:
City of Carmel.Fire City of Carmel Fire
0496-00-138012-0
JAN-01-2013 TO JAN-31-2013
Purchase Activity Report PAGE 3 OF 4
FCAI.MNUM8EW...*.*.. .1—tARD, VskfEGl MAWTJON.... ....
10013 FIRE I (IN)
DATE TIME SITE ADDRESS PROMPT TRAN ODOM. PROD UNITS COST/ FUEL$ OTHER EXEMPT NET$ REPORTED EXC.
MM-DD INFO CODE UNIT $ TAX TAX CODES
PREVIOUS ODOMETER 61,684
01-08 11:13 545 S Range Line Carmel IN I driver OP 62,275 UNL 15.790 3.059 48.33 2.89- 45.44 5.62-
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YTD
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PERIOD AVERAGES:MPG,PPG,(,PM 37.43 3.061 0.08
YTD AVERAGES:MPG,PPG,CPN 37.43 3.061 0.08
TRANSACTION CODES:
OF=Outdoor Payment Terminal
17M
WIN
WN&
PARENT ACCOUNT: REPORT FOR:
City of Carmel Fire City of Carmel Fire
0496-00-138012-0
No JAN-01-2013 TO JAN-31-2013
Site Summary PAGE OF 2
BRAND ADDRESS CITY STATE ZIP NO. FUEL UNITS FUEL$ OTHER$ EXEMPT NET$
TRANS TAX
BP 2507 Lafayette Rd Crawfordsville IN 47933 1 11.098 35.06 4.06- 31.00
SHELL 545 S Range Line Rd Carmel IN 46032 6 82.140 256.83 15.03- 241.80
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ERIODTOTALS.:'> ... .. .;: '7. ' 43:238 29#:88 ....: O:OQ.. :....1'949„ F7280:;
PARENT ACCOUNT: REPORT FOR:
City of Carmel Fire City of Carmel Fire
0496-00-138012-0
NO JAN-01-2013 TO JAN-31-2013
Tax Summary PAGE 1 OF 2
TAX JURISDICTION ID EXPIRATION EXEMPTED TAX$ REPORTED TAX$ TAX TYPE TAX PRODUCT CLASS UNITS GROSS$ TAX RATE
FEDERAL 356000972 JUN-18-2012 -17.06 Federal Excise Gasoline Unblended 93.240 291.89 0.18300
F ..:::..
DERAL TCyTALS»»»»»>< <:»»»»:>`:;:<:::;>:;<:> >i<is>3'>» >: ;isi>isi3»>`»>':'>: :><i>>:::»;:;<a»»»>''. ,:,::<':<:':<is:>::<......i»»»»»»»»:<::::: >: asis:i:<:::>......i:i»»`»>: »:<»asi»?>`>:«:::>:»»>:::>»»#»:>: ><::>"ss`»»»»::;:.:: »>`?»>:<`:<i»:<::,:`:"„:<:;:>;:>:::>:;::: ;>:»»:» `
17 Ofi: 93 240 291 85 .:
IN 356000972 JUN-18-2012 -2.03 -14.85 State Sales Gasoline Unblended 93.240 291.89 0.07000
-15.78...State Excise......................Gasoline Unblended 93.240 291.89 0.18000
EN.S CA fE TOTALS: .
2 03
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ACCOUNT TOTALS -19.09 -31.63
FEW
VIM
I nvoice Statement
198 INVOICE NUMBER: 31915181
ACCOUNT NAME: City of Carmel Fire
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD L CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0496-00-138012-0 9,550.00 BIL
31 JAN-31-2013 FEB-26-2013 272.80
DATE ACTIVITY DESCRIPTION CHARGES/DEBITS PAYMENTS/CREDITS
JAN-14-2013 PAYMENT-THANK YOU 793.89
JAN-31-2013 FUEL PURCHASES 272.80
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 PAYMENTSMADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT INVOICE/STATEMENT.
PREVIOUS BALANCE PAYMENTS (,)PURCHASES (+)DEBITS CREDITS (+)LATE FE (=)NEW BALANCE
793.89 793.89 272.80 0.00 0.00 0.00 272.80
CALL CUSTOMER SERVICE TO PAY BY PHONE
FEDERAL TAX ID: 841425616 The Late Fee is determined by Which is an EFFECTIVE ANNUAL Toth balances bject 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.
————————_TQ ENSURE PROPER CREDI T-TEAR AT PERFORATIQN AND I NCL UDE BOTT9M_PORTI4N WI TFI YOUR PAYMENT.
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))
31915181 $272.80
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Wex Bank
IN SUM OF $
P.O. Box 6293
Carol Stream, IL 60197
$272.80
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 I 31915181 I 42-314.00 I $272.80 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
which charge is made were ordered and
received except
FFR 1 7011
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund