219119 04/11/2013 CITY OF CARMEL, INDIANA VENDOR: 366015 Page 1 of 1
ONE CIVIC SQUARE WEX BANK
CARMEL, INDIANA 46032 PO Box 6293 CHECK AMOUNT: $635.48
CAROL STREAM IL 60197-6293
CHECK NUMBER: 219119
CHECK DATE: 4/1112013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231400 32531362 635 .48 0453-00-794629-6
FLEET SERVICES INVOICE/STATEMENT
INVOICE NUMBER: 32531362
ACCOUNT NAME: CARMEL FIRE DEPARTMENT
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0453-00-794629-6 8,100.00 31 03-31-2013 04-26-2013 635.48
. ACTIVITY DESCRIPTION ;CHARGES/flEMTS. PAYMENTS/CREDITS
t73c1$ > PAYMENT RECEIVED THANK YOU 464.65
03 29�2G'f:3?`? ` RETAIL FUEL PURCHASES
;:; MONTHLY CARD CHG
REMINDER
PLEASE BE SURE TO INCLUDE REMITTANCE STUB WITH
PAYMENT. MAIL TO THE ADDRESS DDRESS SHOWN IN THE RIGHT
H
PO RTION OF THE REMITTANCE STUB.
PURCHASES;RETURNS AND PAYMENTS MADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT INVOICE/STATEMENT
PREVIOUS BALANCE PAYMENTS (+)PURCHASES (+)DEBITS CREDITS +LATE FEE =NEW BALANCE
464.65 464.65 613.48 22.00 0.00 0.00 635.48
$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 PERFORATION AND INCLUDE BOTTOM PORTION WITH YOUR PAYMENT
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,WEX Bank,under a Business Be prepared with your fleet card account number and a sample
Charge Account Agreement with the cardholder named on the check to enter your bank account number and routing number.
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: 03-31-2013
FLEET SERVICES ACCOUNT NO: 0453-00-79
4629-6
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 -30.47 0.00 FEDERAL E85 166.400 551.53 0.18300
. 6.
53
0.00 FEDERAL GASOLINE 32 5.A7166. g 1 33.:
03 0.18300
.. ........... ... ........ . .. ... .
:::<:>::? 1'::: :; -'::::::: 3740F E O VTO T A S..........::> :..:
IN 356000972 0.00 3.65 STATE EXCISE GASOLINE 20.286 76.26 0.18000
-34.08 0.00 STATE SALES E85 166.400 551.53 0.07000
0 00 4.51 STATE SALES GASOLINE 20.286 76.26 0.07000
.. ....
.... ..
IN:::STATE TOTALS` .. .;':'.;`:;:;»: a as iris:;::.>:»;:.: : :<s ;,..., .....
34 4$::: :.:;;;::;;:::;:; :8,16;:`. >:i> ..;;::::>:>::;. ;,,:;. ...;:::: ;::;:;::..... ;:<:::.
ACCOUNT TOTALS -71.08 8.16
(c)WFX INC.2013 PAGE 1
FLEET SERVICES STANDARD REPORT
INVOICE NUMBER: 32531362
ACCOUNT NAME: CARMEL FIRE DEPARTMENT
PAGE 1 OF 2
ACCOUNT NUMBER CREDIT LIMIT I DAYS THIS PERIOD I BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0453-00-794629-6 8,100.00 31 03-31-2013 04-26-2013 635.48
CARD LOCATION DATE TIME DRIVER _ ODOMETER PRODUCT UNITS COST/ ITEM TOTAL
NO. NO. UNIT TOTAL AMOUNT
0004 MH 001 074 03-04-2013 11:09 HABOUSH,DAVE 25,052 E85 21.840 3.359 73.36 73.36
MH 001 074 03-08-2013 10:14 HABOUSH,DAVE 25,228 E85 16.540 3.299 54.56 54.56
MH 001 074 03-16-2013 17:14 HABOUSH,DAVE 25,458 E85 21.600 3.300 71.27 71.27
MH 001 074 03-23-2013 22:03 HABOUSH,DAVE 25,681 E85 21.620 3.299 71.32 71.32
CARD SUBTOTALS 81.600 270.51
0007 MH 001 074 02-28-2013 17:18 SMITH,KEITH 15,000 E85 20.800 3.359 69.87 69.87
MH 001 095: 03-09-2013 21:44 SMITH,KEITH 15,276 E85 24.510 3.298 80.84 80.84
MH 001 095 03-13-2013 08:13 SMITH,KEITH 15,426 E85 13.930 3.300 45.97 45.97
MH 001 074. 03-23-2013 11:15 SMITH,KEITH 16,019 E85 25.560 3.300 84.34 84.34
CARD SUBTOTALS 84.800 281.02
4550 MH001050 03-01-2013 14:53 HABOUSH,DAVE 109,375 UNL 15.430 3.679 56.77 56.77
CARD SUBTOTALS 15.430 56.77
4551 MF 002 983 03-28-2013 12:02 VANVOORST,BOB 96,684 UNL 20.286 3.759 76.26 76.26
CARD SUBTOTALS 20.286 76.26
TOTAL PURCHASES 202.116 684.56
Y-T-D PURCHASES 423.356 1,404.89
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 6 424.72
MH 001 095 MEIJER 8225 E 96TH ST INDIANAPOLIS IN 46256 2 126.81
MF 002 983 7-ELEVEN 58458 S.R.19 ELKHART IN 46517 1 76.26
MH 001 050 MEIJER 1675 HILLIARD-ROME COLUMBUS OH 43228 1 56.77
PRODUCTS, E85=ETHANL85 UNL=UNLEADED -01
FLEET SERVICES
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Wex Bank
IN SUM OF $
P.O. Box 6293
Carol Stream, IL 60197
$635.48
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 I 32531362 I 42-314.00 I $635.48 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
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
'rescribed 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))
32531362 $635.48
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