224386 09/25/2013 CITY OF CARMEL, INDIANA VENDOR: 00351794 Page 1 of 1
` ONE CIVIC SQUARE SHELL CREDIT CARD CENTER CHECK AMOUNT: $679.15
CARMEL, INDIANA 46032 PO BOX 183019
COLUMBUS OH 43218-3019 CHECK NUMBER: 224386
CHECK DATE: 9/25/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4231400 065127193309 679 . 15 065-127-193
www.shelifleetcard.accountonline.com
ACCOUNT NUMBER TOTAL TRANSACTIONS INVOICE NUMBER SEND INQUIRIES TO:
065-127-193 13 065127193309 SHELL CARD CENTER
P.O. BOX 689081
CLOSING DATE DUE DATE CYCLE DAYS DES MOINES,IA 50368-9081
09-05-2013 09-30-2013 30 TELEPHONE: 1-800-377-5150
FAX: 1-515-226-4045
NEW CHARGES FLEET FEE PREVIOUS BALANCE PAYMENTS/ADJUSTMENTS LATE FEE NEW BALANCE
715.36 .00 1,065.68 1,101.89 CR 00 679.15
PAYMENT OF NEW BALANCE MUST BE RECEIVED BY 09-30-2013
Card TRANS TRANSACTION LOCATION/DESCRIPTION QUANTITY MSG PROD EXEMPT TRANSACTION
Number DATE TIME ID CD CD TAX AMOUNT
08-29 PAYMENT-THANK YOU 1,065.68 CR
0003 08-10 1322 0069765 7788 E 96TH ST FISHERS IN 8.751 8 UNL 1.60 30.01✓
8.751 GAL UNLEADED S30.01
TOTAL CARD 0003 8.751 1.60 30.01
_ 0004 08-07 22:05 0836866 545 S RANGE LINE RD CARMEL IN 23.642 8 UNL 4.33 86.53
23.642 GAL UNLEADED $86.53
0004 08-19 1823 0921148 545 S RANGE LINE RD CARMEL IN 21.231 8 UNL 3.89 76.01
21.231 GAL UNLEADED S76.01
0004 08-28 09:55 0982777 545 S RANGE LINE RD CARMEL IN 22.003 8 UNL 4.03 80.51
22.003 GAL UNLEADED $80.51
TOTAL CARD 0004 66.876 12.25 243.05 **
0014 08-13 0843 0615344 1230 S RANGELINE RD CARMEL IN 16.944 8 UNL 3.10 61.00
16.944 GAL UNLEADED $61.00
® TOTAL CARD 0014 16.944 3.10 61.00 **
0016 08-11 0731 0698449 9510 E 126TH ST FISHERS IN 13.463 8 UNL 2.46 48.32
13.463 GAL UNLEADED 548.32
_ TOTAL CARD 0016 13.463 2.46 48.32 *"
_ 0018 08-19 1644 0455766 1821 E 151 ST ST CARMEL IN 6.670 8 UNL 1.22 22.64
6.670 GAL UNLEADED S22.64
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 130905 9366 8015 SH33 5464
NOTICE:SEE REVERSE SIDE FOR IMPORTANT INFORMATION PLEASE KEEP THIS PORTION FOR YOUR RECORDS
z
Z 0005464 Page 1 of 2 FLET2GUG
imurmauun rioour Tour Hccoum
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 514.95 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.shelitleetcard.accountonline.com
ACCOUNT NUMBER TOTAL TRANSACTIONS INVOICE NUMBER SEND INQUIRIES TO:
065-127-193 13 065127193309 SHELL CARD CENTER
P.O. BOX 689081
CLOSING DATE DUE DATE CYCLE DAYS DES MOINES,IA 50368-9081
09-05-2013 09-30-2013 30 TELEPHONE: 1.800377-5150
FAX: 1-515-226-4045
Caid TRANSACTION TRANS TRANSACTION LOCATION/DESCRIPTION QUANTITY MSG PROD EXEMPT TRANSACTION
Number DATE TIME ID CD CD TAX AMOUNT
0018 09-01 21:25 0585224 1821 E 151ST ST CARMEL IN 16.743 8 UNL 3.06 61.60
16.743 GAL UNLEADED 561.60
TOTAL CARD 0018 23.413 4.28 84.24
0023 08-10 0953 0368134 457 BENEFIT STREET PROVIDENCE RI 13.880 8 UNL 2.54 52.33
13.880 GAL UNLEADED 552.33
TOTAL CARD 0023 13.880 2.54 52.33
0025 08-06 2121 0596528 808 W MAIN ST CARMEL IN 14.880 8 UNL 2.72 54.91
14.880 GAL UNLEADED 554.91
TOTAL CARD 0025 14.880 2.72 54.91 **
° 0027 08-23 1433 0676171 1230 S RANGELINE RD CARMEL IN 9.830 8 UNL 1.80 36.00 Y
_ 9.830 GAL UNLEADED S36.00
TOTAL CARD 0027 9.830 1.80 36.00
® 0030 08-10 2043 0073858 7788 E 96TH ST FISHERS IN 15.032 8 UNL 2.75 51.56
15.032 GAL UNLEADED S51.56 /
0030 08-25 0026 0007815 8924 E 116TH ST FISHERS IN 14.822 8 UNL 2.71 53.94{/
14.822 GAL UNLEADED 553.94
TOTAL CARD 0030 29.854 5.46 105.50 **
GRAND TOTAL 197.891 36.21 715.36 **
_ FEDERAL EXCISE TAX
° 197.8 GALLONS GASOLINE 36.21 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 130905 9366 8015 SH33 5464
NOTICE:SEE REVERSE SIDE FOR IMPORTANT INFORMATION PLEASE KEEP THIS PORTION FOR YOUR RECORDS
z
K- 0005464 Page 2 of 2 FLET2GUG
uuvunauun t.uvui rout t.cwum
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 514.95 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
VOUCHER NO. WARRANT NO,
Shell Fleet Plus ALLOWED 20
Processing Center IN SUM OF $
P.O. Box 183019
Columbus, OH 43218-3019
$679.15
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 I 65127193309 I 42-314.00 I $679.15 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, September 19, 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))
09/05/13 65127193309 gasoline $679.15
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