225245 10/23/2013 „wf CITY OF CARMEL, INDIANA VENDOR: 00351794 Page 1 of 1
1� ONE CIVIC SQUARE SHELL CREDIT CARD CENTER CHECK AMOUNT: $730.89
CARMEL, INDIANA 46032 PO BOX 183019
COLUMBUS OH 43218-3019 CHECK NUMBER: 225245
CHECK DATE: 10/23/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4231400 065129116310 730 . 89 065-129-116
www.shelifleetcard.accountonline.com
ACCOUNT NUMBER TOTAL TRANSACTIONS INVOICE NUMBER SEND INQUIRIES TO:
SHELL CARD CENTER
065-129-116 16 065129116310 P.O. BOX 689081
CLOSING DATE DUE DATE CYCLE DAYS DES MOINES,IA 50368-9081
10-06-2013 10-31-2013 31 TELEPHONE: 1.800-377-5150
FAX: 1-515.226-4045
NEW CHARGES FLEET FEE REVIOUS BALANCE PAYMENTS/ADJUSTMENTS LATE FEE NEW BALANCE
773.08 .00 479.98 522.17 CR .00 730.89
A
PAYMENT OF NEW BALANCE MUST BE RECEIVED BY 10-31-2013
Card TRANS kCTION TRANS TRANSACTION LOCATION/DESCRIPTION QUANTITY MSG PROD EXEMPT TRANSACTION
Number DATE TIME ID CD CD TAX AMOUNT
09-27 PAYMENT-THANK YOU 479.98 CR
0002 09-08 1355 0758433 808 W MAIN ST CARMEL IN 13.640 8 UNL 2.50 48.00
13.640 GAL UNLEADED $48.00
0002 09-17 17:40 0138149 545 S RANGE LINE RD CARMEL IN 17.173 8 UNL 3.14 57.00✓
17.173 GAL UNLEADED S57.00
-_ 0002 09-30 21:27 0852970 1821 E 151ST ST CARMEL IN 23.264 8 UNL 426 76.75
23.264 GAL UNLEADED $76.75
TOTAL CARD 0002 54.077 9.90 181.75
0003 10-04 22:07 0932228 1230 S RANGELINE RD CARMEL IN 16.114 8 UNL 2.95 53.00
16.114 GAL UNLEADED S53.00
TOTAL CARD 0003 16.114 2.95 53:00 //
0006 09-06 19:13 0972612 9510 E 126TH ST FISHERS IN 5.711 8 UNL 1.05 20.00✓
5.711 GAL UNLEADED S20.00
0006 09-10 20:34 0899211 1014 N US 31 NEW WHITELAND IN 22.441 8 UNL 4.11 76.28 J
®_ 22.441 GAL UNLEADED $76.28 /
0006 09-12 22:32 0392647 8501 E WASHINGTON ST INDIANAPOLIS IN 17.652 8 UNL 3.23 60.00,/
17.652 GAL UNLEADED $60.00 r
0006 09-17 18:28 0136143 4221 S EMERSON AVE INDIANAPOLIS IN 12.771 8 UNL 2.34 40.60
12.771 GAL UNLEADED S40.60
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 131006 9366 8015 SH33 5276
NOTICE:SEE REVERSE SIDE FOR IMPORTANT INFORMATION PLEASE KEEP THIS PORTION FOR YOUR RECORDS
z
Z 0005276 Page 1 012 FLET2GUG
i
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.accountonIine.com
ACCOUNT NUMBER TOTAL TRANSACTIONS INVOICE NUMBER SEND INQUIRIES TO:
065-129-116 16 065129116310 SHELL CARD CENTER
P.O. BOX 689081
CLOSING DATE DUE DATE CYCLE DAYS DES MOINES,IA 50368-9081
10-06-2013 10-31-2013 31 TELEPHONE: 1-8003773150
FAX: 1315-226-4045
Card TRANS TRANSACTION LOCATION/DESCRIPTION QUANTITY MSG PROD EXEMPT TRANSACTION
Number DATE TIME ID CD CD TAX AMOUNT
0006 09-19 14:14 0400739 8501 E WASHINGTON ST INDIANAPOLIS IN 11.761 8 UNL 2.15 40.00
11.761 GAL UNLEADED $40.00 /
0006 09-23 16:28 0192526 2108 N EMERSON AVE INDIANAPOLIS IN 13.252 8 UNL 2.43 45.591/
13.252 GAL UNLEADED $45.59 /
0006 09-25 1026 0203653 1201 S HOLT RD INDIANAPOLIS IN 15.272 8 SUP 2.79 54.98,/
15.272 GAL SUPER $54.98
0006 1002 12:25 0232017 2040 E WASHINGTON INDIANAPOLIS IN 14.822 8 UNL 2.71 45.80
14.822 GAL UNLEADED $45.80
TOTAL CARD 0006 113.682 20.81 38325 **
0009 09-25 10:51 0875252 1230 S RANGELINE RD CARMEL IN 3.430 8 UNL 0.63 12.01✓
3.430 GAL UNLEADED $12.01
TOTAL CARD 0009 3.430 0.63 12.01
0014 09-14 0850 0144162 8924 E 116TH ST FISHERS IN 14.023 8 UNL 2.57 45.83
14.023 GAL UNLEADED $45.83
0014 09-17 18:21 0171843 8924 E 116TH ST FISHERS IN 15.493 8 UNL 2.84 49.58
15.493 GAL UNLEADED $49.58
0014 09-20 21:07 0039958 9609 OLIO RD MCCORDSVILLE IN 13.621 8 UNL 2.49 47.66
13.621 GAL UNLEADED $47.66
TOTAL CARD 0014 43.137 7.90 143.07 **
GRAND TOTAL 230.440 42.19 773.08
_ FEDERAL EXCISE TAX
s 230.4 GALLONS GASOLINE 42.19 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 131006 9366 8015 SH33 5276
NOTICE:SEE REVERSE SIDE FOR IMPORTANT INFORMATION PLEASE KEEP THIS PORTION FOR YOUR RECORDS
Z
Z 0005276 Page 2 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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Shell Fleet Plus
Processing Center
IN SUM OF $
P.O. Box 183019
Columbus, OH 43218-3019
$730.89
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 It)65129116310 I 42-314.00 $730.89
I 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
VI }� received except
Thursday, October 17, 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))
10/06/13 65129116310 monthly payment $730.89
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