219195 04/24/2013 CITY OF CARMEL, INDIANA VENDOR: 00351794 Page 1 of 1
` ONE CIVIC SQUARE SHELL CREDIT CARD CENTER
CARMEL, INDIANA 46032 PO BOX 183019 CHECK AMOUNT: $691.30
COLUMBUS OH 43218-3019 CHECK NUMBER: 219195
CHECK DATE: 4/24/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4231400 65129116304 691 . 30 GASOLINE
i
www.shelifleetcard.accountonline.com
ACCOUNT NUMBER TOTAL TRANSACTIONS INVOICE NUMBER SEND INQUIRIES TO:
SHELL CARD CENTER
065-129-116 14 065129116304 P.O. BOX 689081
CLOSING DATE DUE DATE CYCLE DAYS DES MOINES,IA50368-9081
04-05.2013 04-30-2013 30 TELEP14ONE: 1-800-3773150
FAX: 1-515-226.4045
NEW CHARGES FLEET FEE REVIOUS BALANCE PAYMENTS/ADJUSTMENTS LATE FEE NEW BALANCE
726.06 .00 682.66 717.42 CR 00 691.30
A
PAYMENT OF NEW BALANCE MUST BE RECEIVED BY 04-30-2013
Card TRANS TRANSACTION LOCATION/DESCRIPTION QUANTITY MSG PROD EXEMPT TRANSACTION
Number DATE TIME ID CD CD TAX AMOUNT
03-23 PAYMENT-THANK YOU 682.66 C/R/
® 0001 03-19 18.02 0614651 1230 S RANGELINE RD CARMEL IN 8.970 8 UNL 1.64 35.01 y
® 8.970 GAL UNLEADED $35.01
® 0001 03-21 1907 0627687 1230 S RANGELINE RD CARMEL IN 12.230 8 UNL 224 47.71 t✓
12.230 GAL UNLEADED $47.71
TOTAL CARD 0001 21.200 3.88 8272 /
0002 03-26 20:52 0965236 808 W MAIN ST CARMEL IN 14.511 8 UNL 2.66 56.00 J
14.511 GAL UNLEADED $56.00
_- TOTAL CARD 0002 14.511 2.66 56.00 *
® 0006 03-07 08:37 0057430 2108 N EMERSON AVE INDIANAPOLIS IN 13.661 8 UNL 2.50 50.00
13.661 GAL UNLEADED $50.00
®_ 0006 03-10 2014 0442186 6955 S EMERSON INDIANAPOLIS IN 5.660 8 UNL 1 04 20.00
5.660 GAL UNLEADED $20.00
-- 0006 03-12 ' 14:21 0786343 2040 E WASHINGTON INDIANAPOLIS IN 8.200 8 UNL 150 32.00
8.200 GAL UNLEADED $32.00
-- 0006 03-19 21 07 0645259 1163E MAIN GREENWOOD IN 10.251 8 UNL 1.88 40.00
30.251 GAL UNLEADED S40.00
TOTAL CARD 0006 37.772 6.92 142.00
L0009 03-22 13::3 0943829 806 W MAIN ST CARMEL IN 29.056 8 UNL 5.32 113.29
Message Codes: 1- E!ectronic 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
F PERIODIC RAF E ANNUAL MONTHLY MINIMUM BALANCE SUBJECT TO LATE FEE
(MONTHLY) PERCENTAGE RATE SEE REVERSE SIDE
0.000% 0.00% 0.00 .00
-- ---1 --
6657 0014 GUG 1 7 2 130405 9366 8015 SH33 5389
NOTICE:SEE REVERSE SIDE FOR IMPORTANT INFORMATION PLEASE KEEP THIS PORTION FOR YOUR RECORDS
Z 0005399 Page 1 or 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
i
www.shellfleetcard.accountonfine.com
ACCOUNT NUMBER TOTAL TRANSACTIONS INVOICE NUMBER SEND INQUIRIES TO:
065-129-116 14 065129116304 SHELL CARD CENTER
-- P.O. BOX 669081
CLOSING DATE DUE DATE CYCLE DAYS DES MOINES IA 50368-9081
04-05-2013 04-30-2013 30 TELEPHONE: 1-800-377-5150
FAX: 1-515-226-4045
Card ! TRANS TRANSACTION LOCATION/DESCRIPTION QUANTITY MSG PROD EXEMPT TRANSACTION
Number DATE TIME ID CD CD TAX AMOUNT
29.056 GAL UNLEADED $113.29 r✓
TOTAL CARD 0009 29.056 5.32 113.29
0011 03-20 21.01 0622118 1230 S RANGELINE RD CARMEL IN 11.920 8 UNL 2.18 46 50
11.920 GAL UNLEADED $46.50
0011 04-03 0926 0692889 1230 S RANGELINE RD CARMEL IN 18 824 8 UNL 3.44 6888
18.824 GAL UNLEADED $68.88
TOTAL CARD 0011 30.744 5.62 115.38
0014 03-07 1101 0541169 1230 S RANGELINE RD CARMEL IN 6.550 8 UNL 1.20 25 01 /
14
6.550 GAL UNLEADED $25.01 1///
00 03-17 1443 0303438 2320 CHESTER BLVD.RICHMOND IN 17.021 8 UNL 3.11 64.00
17.021 GAL UNLEADED $64.00 ✓//
0014 03-22 0900 0629667 1230 S RANGELINE RU CARMEL IN 15.833 8 UNL 2.90 61.75
® 15.833 GAL UNLEADED $61.75
® 0014 03-26 1343 0765081 9599 N MERIDIAN ST INDIANAPOLIS IN 17.213 8 UNL 3.15 65.9
17.213 GAL UNLEADED $65.91
TOTAL CARD 0014 56.617 10.36 216.67 kx
GRAND TOTAL 189.900 34.76 726.06 *
FEDERAL EXCISE TAX
189.9 GALLONS GASOLINE 34.76 CR
® 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 130405 9366 8015 SH33 5389
NOTICE:SEE REVERSE SIDE FOR IMPORTANT INFORMATION PLEASE KEEP THIS PORTION FOR YOUR RECORDS
Z 0005389 Page 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.
Shell Fleet Plus ALLOWED 20
Processing Center IN SUM OF $
P.O. Box 183019
Columbus, OH 43218-3019
$691.30
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 I 65129116304 I 42-314.00 I $691.30 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
Thursday, April 18, 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))
04/05/13 65129116304 gasoline $691.30
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