226186 11/19/2013 CITY OF CARMEL, INDIANA VENDOR: 00351794 Page 1 of 1
ONE CIVIC SQUARE SHELL CREDIT CARD CENTER CHECK AMOUNT: $737.34
CARMEL, INDIANA 46032 PO BOX 183019
COLUMBUS OH 43218-3019 CHECK NUMBER: 226186
CHECK DATE: 11/19/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4231400 65129116311 737 . 34 065-129-116
Account Statement
Commercial Account
u�&
Customer Service: oARwsL POLICE DEPARTMENT
� I shellifleetcardacoountorI
Shell Fleet Plus Card Account Inquiries: Account Number: 065 1 N 116
91 1-800-377-5150 Fax 1-866-533-5302 Invoice,Number-, 00000000651-29 116311
�mm
rsummary of Account Activity Payment Information
Previous Balance $730.89 Current Due $737.34
PayMents 730-89 Past Due Amount + $0.00
Credits -$43.03 Minimum Payment Due $737.34
Debits +$0.06-- LPayment Due Date 11/30/13
Late Fees +$0.00 treclit Line
New Balance $737.34
Total Transactions 15 Credit Available $3,462
Closing Date 11/05/13
LSend Notice of Billing Errors and Customer Service Inquiries to: Next Cl sing Date 12/06/13
SHELL
.0.Box 6406,Sioux Falls,SID 57117-6406
Everything you need to know about your account is here: account number, paymantn, contact information and more.
P|oano see the enclosed sample for additional information on how to read your statement.
e
TRANSACTIONS
cr- Trans Trans Trans msg Prod
Date Time m Location/Description ouomnv ovuo ouue Exempt Tax Amount
PAYMENTS,CREDITS,FEES AND ADJUSTMENTS
10/25 1 PAYMENT-THANK YOU $730.89-
e
punoxxoeS AND DEBITS
CARD NUMBER oovu
10/13 14:17 1 0924597 808 W'��IN ST CARMEL IN 27.681 8 UNL $5.67
T $9575
i 1 27.681 GAL UNLEADED $95.75
8.881 GAL UNLEADED $30.01
10/16 13:14 0996405 1230 S RANGELINE RD CARMEL IN 19.680 8 UNIL $3.60 $66.52
19.680 GAL UNLEADED $66.52
10/26 05:53 1 0509885 1360 N GREEN BROWNSBURG IN 23.610 8 UNIL S4.32 $75.08
23.610 GAL UNLEADED $75.08
CARD NUMBER 0002 TOTAL 79.852
_
| ) | ,.csz GAL nmLoaoou ^uo.vz
---__- _ IMPORTANT INFORMATION Pa e 1 of-j- __ —__ '— _
4, Please detach and return lower portion with vour pavrnent to insure proper credit, Retain upper portion for your records. 41
Information About Your Account Payment Other Than By Mail.
When Your Payment WIII Be Credited.If we receive your payment in Phone.Call the phone number on Page 1 of your statement to make
proper form at our processing facility by 5 p.m.local time there,it will a payment.We may process your payment electronically after we
be credited as of that day.A payment received there in proper form verify your identity.You will be charged$14.95 to use this service.
after that time will be credited as of the next day.Allow 5 to 7 days for The payment cutoff time for Phone Payments is midnight Eastern
payments by regular mail to reach us.There may be a delay of up to time.This means that we will credit your account as of the calendar
5 days in crediting a payment we receive that is not in proper form or day,based on Eastern time,that we receive your payment request.
is not sent to the correct address.The correct address for regular mail If you send an eligible check with this payment coupon,you authorize
is the address on the front of the payment coupon. us to complete your payment by electronic debit.If we do,the checking
Proper Form.For a payment sent by mail or courier to be in proper account will be debited In the amount on the check.We may do this as
form,you must: soon as the day we receive the check.Also,the check will be destroyed.
Enclose a valid check or money order.No cash,gift cards, Report a Lost or Stolen Card Immediately.You may call Customer
or foreign currency please. Service 24 hours a day,7 days a week.
Include your name and the last four digits of your account number.
—0
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T04563-H2-9366-8015-0001-OOL--0---04/01/91-272-60-P--0--0-0-0-SHFLE ET2---03/31/10-SH33-October 6,2013---
PLOCOMM OCT13
Page 2 of 4
Account: **** **** **** 9116
TRANSACTIONS (cont.)
Trans Trans Trans Msg Prod
Date_ Time ID Location/Description _ _ _Quantity Code Code Exempt Tax Amount_
10/28 i 17:18 0068254 230 S RANGELINE RD CARMEL IN �j 9.551 y 8 UNL $1.7575 $30.00
9.551 GAL UNLEADED $30.00
10/30
14:51 1 0080192 1230 S RANGELINE RD CARMEL IN 9.612 � 8 {�{ UNL i $1.76 ; $30.00�
j ( i 9.612 GAL UNLEADED $30.00
`CARD NUMBER 0003 TOTAL 1_-26.414 ; { $4.84 I $85.01
CARD NUMBER 0006
10/10 09:28 i[0654798 3748 N HIGH SCHOOL RD INDIANAPOLIS IN 16.943 i TS UNL^ $3.10 $57.44
16.943 GAL UNLEADED $51.44
ff I
10/16 t 09:46 0263061 2040 E WASHINGTON INDIANAPOLIS IN 16.723 f 8 j UNL j $3.06 $59.52
` 16.723 GAL UNLEADED $59.52
10/24 14:30 ! 0352310 2108 N EMERSON AVE INDIANAPOLIS IN 16.514 8 UNL I $3.02 $54.48,/
i 16.514 GAL UNLEADED $54.48
10/30 08:55 0441667 8924 E 116TH ST FISHERS IN i 15.851 8 UNL $2.90 $49.60
15.851 GAL UNLEADED $49.60
11/04 16:49 0115774 i 1230 S RANGELINE RD CARMEL IN ` 16.050 1 8 UNL ! $2.94 i $52.95
16.050 GAL UNLEADED $52.95 t i
i
CARD NUMBER 0006 TOTAL} 82.081 ���� i $15_02 $273.99
CARD NUMBER 0011
10/19 1 11:17 0016188 1230 S RANGELINE RD CARMEL IN 13.770 8 UNL $2.52 $49.01 a
13.770 GAL UNLEADED $49.01
CARD NUMBER 0011 TOTAL 13.770 S2.52 $49.01
L-j CARD NUMBER 0014_
Er 10/07 12-1- .00 !95633 9599 N MERIDIAN ST INDIANAPOLIS IN A I 15.384 �~7 UNL ; --� $2.82 v $50.00 e
C3 f 15.384 GAL UNLEADED $50.00
nj 10/28 1 18:05 0068742 1230 S RANGELINE RD CARMEL IN } 17.521 8 ` UNL j $3.21 $55.00
17.521 GAL UNLEADED $55.00
} I CARD NUMBER 0014 TOTAL ; 32.905 j $6.03 j $105.00
GRAND TOTAL i 235.022 $43.03 j $780.37
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 i
L.- ... .,.__ .-__.__ . _ _ _... .... --- ----
TAX EXEMPTION SUMMARY
Description Amount
FEDERAL EXCISE TAX,
235.0 GALLONS GASOLINE $43.03
Page 3 of 4 1-800-377-5150 shellfleetcard.accountonline.com
Account: **** **** **** 9116
You naWU Watement,
,
Clear: Statements show you exactly how much you've spent, how much you owe, and your
available credit.
Concise: The information is "bucketed" into sections that make it simple to find what you're
looking for and is written in normal, everyday language.
Account Number/ Account Statement
Contact Information A-1
Payment Information }
Shell Fleet Plus Card Customer Service: °° susl
6d � Shows what you owe,
Summary Of *" Accountln uareB: ADDOureNumber.9999 9999 9999 99e9
I-NP99Gi9999 F..I�BO0000.9090 InvdCe NlmBef: 9B9D999999999999%H due dates and minimum
Account Activity Summary of Account Activity Payment Information payment information
A nick, complete Ho mus Bala ce $9699.999.99 Current Due $9999,999.99
p Payne
C,.dus ��-._ ....- P _ _
±
Transactions
view Of Your account- P A $9.699,696.99
-
Debts -. _x__ ___93999.995_89 Paymen,Due Date MMlDD/VV Lists your-purchase
all in one place Taie FeIa.
Ne Belenee $91M. .99 Credit Line $6.999,999 activity, including
11,Tolat Trareaction3 9,999.999 Gediz AVailade $9,988.989
Amoum Over Credl C - -- $e99s99s" dates, locations,
• Sand Nn..1& %mar Gu.In9 ws R, Closing Date _ - -__M_M_IDD/YY_ r
PO BOX 9996,GTV ST M"s-8999 N.m closing D.I. MMIDDMI quantity of gallons, F
L-I >' and type of fuel
a- TRANSACTIONS - Payments,C
1] Tmn. Trem Tram M.9 Prod y , redits, }
-Year-to-Date ➢ Dam Tma ID La.AMVOyttPUan oaamty coa c.. E—MT.. Amo nt
➢ PAYMFT113,CALMS,FEES AND AD.NSTMENTB °
Summary V MMrDO; I PAYMENT�IHANKroU I I I 59899,9BA A0.
Fees and Adjustments
A summary of MMmD I ;`FEDITA0.)USIMENTTOYCURAC000NT,. 60880,888.80. A record of payments
.MD I •LOYALTY REWARDi I SP�000098&
total gallons this M °° DISCOUNTS I °° °Aa you've made and credit
PURCMASESANDDEMS adjustments affecting
statement period sum 99000000 HAME1
CARD NUMBER00M _ _ _ __ _ _ __ _ _ _
" MM�DO BO BO 23459) 29 MAIN STREETANYWHERE,USA 908086 5� SUP TABBBBBBB99 SBBBBBBBBB your account
and year-to-date 247 993 GAL DII.EADED
_ I 1 CAM NUMBER 00MTOT sss.o Remit Coupon
CARDNUMBER 0002 ___ ___
MM+00 9999 123M6) 234 MAIN STREET ANYYMERE.US4 000.898 B . REG eYmB9,8PGs` f-58,9889BB
Tax Exemption 90
1 247.993 GAL D[II.EADBD Identifies payment
CARD NUMBER 0002 TOTAL 086008, i $BANAB9Be `.
Summary TOTALSUSACCT999B8899NAMEt ,eA?oBOe?6_j3aac_9sa.aa due date, new balance,
A summary of the any past due amount,
NOTICE'.SEE REVERSE SIDE FOR IMPORTANT INFORMATION Pa9a t a X 9B XX. 1Tb A—tnl V u.Lied b,Cftft ek N.A. '
tax exemption minimum payment
credits by state, city. a, s.e due, and an area to
Your A-1 NUmb9ri8 9999 9999 9999 9999 lll'IIII'f 11111111"111111II��j�l
county, and federal Shell Flea Nee Cad Invoice Number �\ 98988999998IDIDID 99 write in the amount r
u Payment Due Date 'II DD.YVVV
for qualified tax Ne Balance $9.999,999.99 of your payment
exams t aCCOUntS Pa3t ueAmoum' $9,999,999.99
f-' Payment Due $9,999,999.99 Discount Summary
• Statement Enclosed
`E^"°sed Represents merchant
funded and program
... .. 9999 Anwan, k.P.yable I. }.
w,� °ca�'ae E.amP,Ty E discounts. Merchant
TRAN$ACTION$loonL)* o..alvr ° xxxxx�xxxxxx
_ T T'O 9NDa.Flwn ___ 99 " funded discounts
PURCHASES AND DEBITS(Font) 4111��I,11 II ,I,NI III ,I� are broken down by --
4 SIIBACCT 89988999 NAME2 _
CARD NUM.BFA ydaIMIN STREET ANYWHERE,USA
b B.al S)3.W each merchant when
ruwo t ee:eaTzs'' T'sAUES xAx s a.s9 '; 1AAAAAAAA CLAD
' ACCESSORY 5 21.99 l 1B 4711 II
applicable
` 123x68]{120a MNN STREET ANYWHERE,USA S 2.00 y--�
MMmD I ee:aa,$ D1scaNr s bT.00 ,I Account:.,«••+•.
LmLEADED a�00 ».9999
� 1 Joe S
�I CAPD NUMBER pOM TOTAI_te.T11 DlSCOUNT$U& '
S_r MARY
� � _ _` �•--'°.^ -__. _'- I � 4o°eNOrWaacrlCllon
~NUMBER mot,,.. ET ANVWHFAA�,,pP $]5.51 1 DI.c Tlar •
�AISD,BB.eB 1 1234901�1123a WIN'�ODLBADED 18.509 I S 1294 aN T aBCOUM TYPa aa... p:Mn
16,1 gtitEET ANYWHERE USA 572.00 SmEETgNYYAt[RE,USA ONA% Caaa O^9.
CARD NUMBEP 0002 TOTAL 198)3 STRFETANYW,tggE USA I C U UNL PureA Da6r sale. ol.a
' MMIDD BB:BE 11P�58)'12la WIN OAL ONLFADED 4EC11Lr•P t 1294 MAIN
1 1I 98998899 NAME2.899-898 I 1284 MAIN I C I j Amp,nt
I R TOTAL tp1BAC 1989.999 SETAM"V]HERE USA U 1 SuP r , �O
,t II !-� I 989.999.998 ,
294 MAIN 9TREETAN SU9�TOTAL i U I DSL '���
GRAND TOTAL MAMg I'WNERE;US �1, O20p 999989.999
a-Elxtronlc Sale wlVnut Authorize TgEETANVMPIERE.USa C
'� 1,Elecllul C S k with P4AMA ADO S.Keyed Sete wltMUl AutAIMOII t FOP 1 I
'99893
f �Mjesa9e COdea: Sale )M AUTW`rellOr! �.--- -- r OT - --J�1_
_ __ s9
_ .99999
- ---T.._.'LL Y6ACNa yg 898.98
➢ _ �� tee..+r.�^^"'.-.._ "WRAM ANCO �_ 59999.999.99
➢ `---,�,.�.�-+"'•'~•� T0990rm1 1" -L�.��_ SB 99p,9BB.p
I v YEAR-TOM-DATE5UAI1AARY 9EP.5B9.9Ba ,
_—T-
TA4 D S9_B9g pB8.�
Told GalbPOIC Otnla fA�telnanl�,�-.988.889.990 l ALL FUELSi 0.01 t
Total Galbna PUloNased inVYVY - % U PLL FUELS 0 �-' 59908.999.99
TAX EXEMIM SUMMARY TOTAL PROGRAM SU„p'.SDtAL 0250 -I - _59999.999.94
I'gU�M; II ! f 889,899;89
Da.eT7twn - - Dx T1ca TOTAL DISCOUNT
ME 6TATE MOTOR FUELTA% -% Paaenl oI DMp goy,C';Cantu
(STATE NA 1. ._ --•.•."•--Y y ParUm --39988 BBP.98
f,9BB BGALLON6�ASOUNE ➢ T Besis�U 19,90,99-,9"
9sB.Bas9 GALLONS DIESEL FU6 � .._-• lknn Wrdre.ed,DDO9ar Sa es I�•�•
MOTOP FUEL TA.X _ .9.�
•'
(STATE NAME)STATE -
r 9BO,BBB.O GALLON6
999s0B.0GALLNS DIE6EC FUEL For illustration purpOSE's oidy. SH F2 TL HTR 10/13 t�•,
ISE TAx
FEDERAL E%0
Page 4 of 4 1-800-377-5150 shellfleetcard.accountonline.com
VOUCHER NO. WARRANT NO.
ALLOWED 20
Shell Fleet Plus
Processing Center IN SUM OF $
P.O. Box 183019
Columbus, OH 43218-3019
$737.34
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#lrITLE AMOUNT Board Members
1110 I 65129116311 I 42-314.00 I $737.34 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, November 14, 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))
11/13/13 65129116311 monthly payment $737.34
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