220037 05/21/2013 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: $582.47
ti„ro_ COLUMBUS OH 43218-3019 CHECK NUMBER: 220037
CHECK DATE: 5/21/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4231400 065129116305 582 .47 065-129-116
www.shellfleetcard.accountonline.com
ACCOUNT NUMBER TOTAL TRANSACTIONS INVOICE NUMBER SEND INQUIRIES TO:
065-129-116 12 065129116305 RO. BOX CENTER
P.O. BOX 689081
CLOSING DATE DUE DATE CYCLE DAYS DES MOINES,IA 50368-9081
05-06-2013 05-31-2013 31 TELEPHONE: 1.800.377-5150
FAX: 1-515-226-4045
NEW CHARGES FLEET FEE REVIOUS BALANCE PAYMENTS/ADJUSTMENTS LATE FEE NEW BALANCE
614.04 .00 691.30 722.87 CR .00 582.47
A
PAYMENT OF NEW BALANCE MUST BE RECEIVED BY 05-31-2013
Card TRANS kCTION TRANS TRANSACTION LOCATION/DESCRIPTION QUANTITY MSG PROD EXEMPT TRANSACTION
Nwnbei DATE TIME ID CD CD TAX AMOUNT
04-27 PAYMENT-THANK YOU 691.30 CR
0001 04-11 1640 0744383 1230 S RANGELINE RD CARMEL IN 16.440 8 UNL 3.01 57.54
16.440 GAL UNLEADED X57.54
_ 0001 04-19 07.16 0792358 1230 S RANGELINE RD CARMEL IN 15.412 8 UNL 2.82 51.77✓
15.412 GAL UNLEADED $51.77
® TOTAL CARD 0001 31.852 5.83 109.31
® 0006 04-15 08.13 0935130 1183 E MAIN GREENWOOD IN 23.421 8 UNL 4.29 77.29✓
e 23.421 GAL UNLEADED $77.29
e 0006 04-16 21 52 0009647 8924 E 116TH ST FISHERS IN 11.520 8 UNL 2.11 41.00
11.520 GAL UNLEADED S41.00
0006 04-23 21:09 0132761 2540 N HIGH SCHOOL RD SPEEDWAY IN 15 030 8 UNL 2.75 55.01
15.030 GAL UNLEADED $55.01 /
0006 04-25 2129 0312884 201 W 38TH ST INDIANAPOLIS IN 8 150 8 SUP 1.49 30.01 Y
8.150 GAL SUPER $30.01
® 0006 05-05 1131 0156661 8924 E 116TH ST FISHERS IN 5.320 8 UNL 0.97 20.00
® 5.320 GAL UNLEADED $20.00
TOTAL CARD 0006 63.441 11.61 223.31
0009 04-08 14 25 0838169 2121 US 41 SCHERERVILLE IN 14.440 8 UNL 2.64 52.00✓
14.440 GAL UNLEADED S52.00
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 .00
6057 0014 GUG 1 7 2 130506 9366 8015 SH33 5189
NOTICE:SCE REVERSE SIDE FOR IMPORTANT INFORMATION PLEASE KEEP THIS PORTION FOR YOUR RECORDS
Z
Z 0005189 Page 1 of 2 FLET2GUG
Information About Your Account
Report a Lost or Stolen Card Immediately. You may call Customer Service 24 hours a day,7 days a week.
When Your Payment Will Be Credited. If we receive your payment in proper form at our processing facility by 5 p.m.local time there.it will be credited as of that day.A payment received there
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 regular mail is the address on the front of the payment coupon.
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,gift cards,or foreign currency please.
•Include your name and the last four digits of your account number.
Payment Other Than By Mail.
Phone. Call the phone number on Page 1 of your statement to make a payment.We may process your payment electronically after we verify your identity. You will be charged$14 95 to use this
service. The payment cutoff time for Phone Payments is midnight Eastern time This means that we will credit your account as of the calendar day,based on Eastern time,that we receive your
payment request.
If you send an eligible check with this 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.
This Account is Issued by Citibank,N A
PLOCOMM Rev 04/13
www.shelifleetcard.accountonline.com
ACCOUNT NUMBER TOTAL TRANSACTIONS INVOICE NUMBER SEND INQUIRIES TO:
SHELL CARD CENTER
065-129-116 12 065129116305 P.O. BOX 689081
CLOSING DATE DUE DATE 'CYCLE DAYS DES MOINES,IA 50368-9081
05-06-2013 05-31-2013 31 TELEPHONE: 1.800377-5150
FAX: 1315-226-4045
Card TRANS TRANSACTION LOCATION/DESCRIPTION QUANTITY MSG PROD EXEMPT TRANSACTION
Number DATE TIME ID CD CD TAX AMOUNT
0009 04-26 09.29 0793935 11601 ALLISONVILLE RD FISHERS IN 15.562 8 UNL 2.85 56.01
15.562 GAL UNLEADED $56.01
TOTAL CARD 0009 30.002 5.49 108.01 *t
0014 04-07 1100 0617415 11601 ALLISONVILLE RD FISHERS IN 15.163 8 UNL 2.77 55-031✓
15.163 GAL UNLEADED S55.03
0014 04-28 1202 0862201 1230 S RANGELINE RD CARMEL IN 17.382 8 UNL 118 6169
17.382 GAL UNLEADED $61.69
0014 05-03 1253 0866699 11601 ALLISONVILLE RD FISHERS IN 14.690 8 UNL 2.69 56.69
14.690 GAL UNLEADED $56.69
TOTAL CARD 0014 47.235 8.64 173.41
GRAND TOTAL 172.530 31.57 614.04 **
s FEDERAL EXCISEITAX
172.5 GALLONS GASOLINE 31.57 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 130506 9366 8015 SH33 5189
NOTICE:SEE REVERSE SIDE FOR IMPORTANT INFORMATION PLEASE KEEP THIS PORTION FOR YOUR RECORDS
Z 0005189 Page 2 of 2 FLET2GUG
Z
Information About Your Account
Report a Lost or Stolen Card Immediately, You may call Customer Service 24 hours a day,7 days a week.
When Your Payment Will Be Credited. If we receive your payment in proper form at our processing facility by 5 p m.local time there,it will be credited as of that day.A payment received there
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 regular mail is the address on the front of the payment coupon.
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,gift cards,or foreign currency please.
•Include your name and the last four digits of your account number.
Payment Other Than By Mail.
Phone. Call the phone number on Page 1 of your statement to make a payment.We may process your payment electronically after we verify your identity. You will be charged$14 95 to use this
service The payment cutoff time for Phone Payments is midnight Eastern time. This means that we will credit your account as of the calendar day,based on Eastern time.that we receive your
payment request
If you send an eligible check with this 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.
This Account is Issued by Citibank,N A.
PLOCOMM Rev 04/13
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))
05/06/13 65129116305 gasoline $582.47
I 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
Shell Fleet Plus
Processing Center IN SUM OF $
P.O. Box 183019
Columbus, OH 43218-3019
$582.47
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 I 65129116305 I 42-314.00 I $582.47 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, May 16, 2013
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund