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221857 07/17/2013 CITY OF CARMEL, INDIANA VENDOR: 366015 Page 1 of 1 ONE CIVIC SQUARE WEX BANK CARMEL, INDIANA 46032 PO Box 6293 CHECK AMOUNT: $627.94 CAROL STREAM IL 60197-6293 CHECK NUMBER: 221857 CHECK DATE: 7/1712013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4231400 33429678 627 . 94 0453-00-794629-6 FLEET SERVICES INVOICE/STATEMENT INVOICE NUMBER: 33429678 ACCOUNT NAME: CARMEL FIRE DEPARTMENT PAGE 1 OF 1 ACCOUNT NUMBER CREDIT LIMIT 8,100.00 r� DAYS THIS PE!!!�[!LL CLOSING DATE PAYMENT AMOUNT 0453-00-794629-6 30 06-30-2013 07-26-2013 4,97.94 QATE.. ACTIVITY DESCRIPTION CHARGES/DEWS: PAYMENTS/CREDITS 06_21:2013 PAYMENT RECEIVED-THANK YOU 749.29 �::66-28_2013_. RETAIL FUEL PURCHASES 6 Q5.94 06-2,5- MONTHLY CARD CHG -,201:3: 22.00 REMINDER PLEASE BE SURE TO INCLUDE REMITTANCE STUB WITH PAYMENT. MAIL TO THE ADDRESS SHOWN IN THE RIGHT PORTION OF THE REMITTANCE STUB. PURCHASES,RETURNS AND PAYMENTS MADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE_NEXT INVOICE/STATEMENT PREVIOUS BALANCE I (-)PAYMENTS (I)PURCHASE--S—F (,)DEBITS I (-)CREDITS I (+)LATE FEE I -(=)NEW BALANCE 1 749.291 749.29 605.94 22.001 0.001 0.001 627.941 $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 month)y 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: 06-30-2013 FLEET SERVICES ACCOUNT NO: 0453-00-794629-6 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 -27.17 0.00 FEDERAL E85 148.480 507.72 0.18300 -8.30 000 FEDERAL GASOLINE 45.340 173.88 0.18300 FEDERAL TOTALS -35A7 0.00 :193.820 681.60 IN 356000972 0.00 23.76 STATE EXCISE E85 148.480 507.72 0.16000 0.00 8.16 STATE EXCISE GASOLINE 45.340 173.88 0.18000 -29.89 0.00 STATE SALES E85 148.480 507.72 0.07000 10.30 0.00 STATE SALES GASOLINE 45.340 173788 0.07000 IN STATE tOtALS -40.19 31.92' ACCOUNT TOTALS -75.66 31.92 (c)WEX INC 2013 PAGE 1 FLEET SERVICES STANDARD REPORT INVOICE NUMBER: 33429678 ACCOUNT NAME: CARMEL FIRE DEPARTMENT PAGE 1 OF 2 ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD I BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE 0453-00-794629-6 8,100.00 30 06-30-2013 07-26-2013 627.94 CARD LOCATION DATE TIME DRIVER ODOMETER PRODUCT UNITS COST/ ITEM TOTAL NO. NO. UNIT TOTAL AMOUNT 0004 MH 001 074 06-15-2013 21:14 HABOUSH,DAVE 28,008 E85 18.580 3.500 6503 65.03 MH 001 074 06-24-2013 11:02 HABOUSH,DAVE 28,203 E85 21.080 3.300 69.56 69.56 CARD SUBTOTALS 39.660 134.59 0007 MH 001 154 06-05-2013 14:06 SMITH,KEITH 18,730 UNL 22.060 3.989 88.00 88.00 MH 001 074 06-12-2013 21:44 SMITH,KEITH 19,024 E85 23.190 3.498 81.13 81.13 MH 001 095 06-16-2013 16:05 SMITH,KEITH 19,344 E85 24.560 3.500 85.95 85.95 MH 001 095 06-21-2013 19:08 SMITH,KEITH 19,573 E85 25.220 3.399 85.72 85.72 MH 001 095 06-27-2013 08:30 SMITH,KEITH 19,805 E85 15.240 3.299 5028 50.28 CARD SUBTOTALS 110.270 391.08 4551 MH 001 154 06-18-2013 17.40 VANVOORST,BOB 100,171 E85 20.610 3.399 70.05 70.05 93006168 06-21-2013 10:00 VANVOORST,BOB 100,494 UNL 23.280 3.689 85.88 85.88 CARD SUBTOTALS 43.890 155.93 TOTAL PURCHASES 193.820 681.60 Y-T-D PURCHASES 1,026.249 3,416.02 SITES USED THIS MONTH NO.PURCHASES TOTAL AMOUNT Location No. Brand Street City State Zip MH 001 095 MEIJER 8225 E 96TH ST INDIANAPOLIS IN 46256 3 221.95 MH 001 074 MEIJER 1426 W CARMEL DR CARMEL IN 46032 3 215.72 MH 001 154 MEIJER 17000 MERCANTILE RD NOBLESVILLE IN 46060 2 15805 93 006 168 MARATHON 710 WESTFIELD ROAD NOBLESVILLE IN 46062 1 8588 PRODUCTS E85=ETHANL85 UNL=UNLEADED FLEET SERVICES This page is intentionally left blank. VOUCHER NO. WARRANT NO. I ALLOWED 20 Wex Bank IN SUM OF $ P.O. Box 6293 Carol Stream, IL 60197 $627.94 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 I 33429678 I 42-314.00 I $627.94 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 JUL 112013 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund Drescribed 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 Nhom, 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)) 33429678 $627.94 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