227249 12/17/2013 f CITY OF CARMEL, INDIANA VENDOR: 00351794 Page 1 of 1
ONE CIVIC SQUARE SHELL CREDIT CARD CENTER
CHECK AMOUNT: $865.24
CARMEL, INDIANA 46032 PO BOX 183019
COLUMBUS OH 43218-3019
`ti„o�to� CHECK NUMBER: 227249
CHECK DATE: 12/17/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4231400 65127193312 865 . 24 GASOLINE
Account Statement
C Commercial Account
Customer Service:
CARMEL POLICE DEPARTMENT
shelifleetcardaccountonline com
Shell Fleet Plus Card mrll Account Inquiries: Account,Number:.. 065 1217,193
1-800-377-5150 Fax 1-866-533-5302 Invoice Number. 0000000065127193312
Summary of Account Activity Payment Information
Previous Balance $_660.56 Current Due $865.24
Payments _ $660.56 Past Due Amount + $0.00
Credits _ $53.39_ Minimum Payment Due = $865.24
Purchases �y +$918.63 - ---- -- -
Debits _ +$0.00_ Payment Due Date 12/31/13
Late Fees _ +$0.00 Credit Line $3,700
New Balance $865.24 Cr - - — --- --
edit Available $2,784
Total Transactions 21 Cr
Closing_Date _ _12/06/13
Send Notice of Billing Errors and Customer Service Inquiries to: Next Closing Dat_e __ 01/06/14
SHELL
P.O.Box 6406,Sioux Falls,SD 57117-6406 _j
Everything you need to know about your account is here: account number, payments, contact information and more.
Please see the enclosed sample for additional information on how to read your statement.
�
TRANSACTIONS
W Trans Trans Trans Msg Prod
E3 Date Time ID Location/Description Quantity Code Code Exempt Tax Amount
PAYMENTS,CREDITS,FEES AND ADJUSTMENTS
11/21 1 l I PAYMENT-THANK YOU l j ! $660.56-
PURCHASES AND DEBITS
CARD NUMBER 0003
11/30 10:37 i 0570994 380 N THIRD ST TERRE HAUTE IN 20.352�y 8 UNL $3.721 $64.70
20.352 GAL UNLEADED $64.70 i
CARD NUMBER 0003 TOTAL L 20.352 �— S3.72�_ S64.70
CARD NUMBER 0006
12/01 18:19 0663617 8924E 116TH ST FISHERS IN 9.871 8 f UNL i $1.81 $30.00
i 9.871 GAL UNLEADED $30.00 1 1
CARD NUMBER 0006 TOTAL 9.871 1 S1.81 530.00
CARD NUMBER 0007 s
11/08 17:02 0146969 1230 S RANGELINE RD CARMEL IN �V —{— 6.060 8 I UNL e$1.11 -i--- $18.12✓
6.060 GAL UNLEADED $18.12 1
11/12 16:49 0174961 1230 S RANGELINE RD CARMEL IN 12.621 i 8 UNL $2.31 j $37.60)
12.621 GAL UNLEADED $37.60 l f
NOTICE:SEE REVERSE SIDE FOR IMPORTANT INFORMATION Page 1 of 4 This Account is Issued by Citibank,N.A.
_� - - Y'-Pleas`e deiacfi enoretu�n iuwer�orlluirwltti'voiunavrnant=to insu e=oror�errr�dit='r;ainr�n�,Fr-oortinn-tor-�-,ri€c5rr;c^—J-<_----- - - - - -_
Information About Your Account Payment Other Than By Mail.
When Your Payment Will 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.
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T04563-H2-9366-8015-0001-OOL--O---04/01/91-273-56-P--0--0-0-O-SHFLEET2---03131/10-SH33-November 5,2013---
PLOCOMM OCT13
D—n-0 ref A
Account: **** **** **** 7193
TRANSACTIONS (cont.)
Trans Trans Trans Msg Prod
Date Time ID Location/Description Quantity Code Code Exempt Tax Amount
11119 13:44 0109397E 808 W MAIN ST CARMEL IN 12.041 8 f UNL ( $2.20! $39.75
12.041 GAL UNLEADED $39.75 `✓//
12/05 08:53 0317917 1 1230 S RANGELINE RD CARMEL IN E 16.000 8 I UNL { $2.93 $48.00
E 16.000 GAL UNLEADED $48.00 i- I
CARD NUMBER 0007 TOTAL L 46.722 I $8.55 1 $143.47
CARD NUMBER 0008
11/07 21:47 0591305 9510 E 126TH ST FISHERS IN 15.990 {1 8 UNL $2.93 $50.53
15.990 GAL UNLEADED $50.53 I i �'
11/13 15:58 0082206 1 808 W MAIN ST CARMEL IN 15.695 1111; 8 UNL i� $2.87 $46.74
I 15.695 GAL UNLEADED $46.74
11/24 11:47 1 0268169 1821 E 151ST ST CARMEL IN 17.014 I 8 I UNL G $3.11 $55.79
i 17.014 GAL UNLEADED $55.79 {{{{ 1
11/28 17:23 ! 0383380 104 S MAIN ST RUSHVILLE IN 15.383 8 f1l UNL $2.82 E $51.69
f 15.383 GAL UNLEADED $51.69 t 4
12104 20:06 0358150 1821 E 151ST ST CARMEL IN } 18.200 8 UNL $3.33 $51.67
I18.200 GAL UNLEADED $51.67 I
CARD NUMBER 0008 TOTAL ! 82.282 L l 515.06 ! $256.42
CARD.NUMBER 0015
11/07 16:23 0428409 y 2108 N EMERSON AVE INDIANAPOLIS IN �i 16.651 8 UNP�r�- $3.05
I16.651 GAL UNL PLUS $54.10 ( i
NUMBER 0015 TOTAL 16.651 _ I u $3.05-.1_ $54.10
CARD NUMBER 0016
`D 11/21 16:58 .0723452 9510 E 126TH ST FISHERS IN y 16.300 �- -UNL $2.98 $54.77
0 ! I 16.300 GAL UNLEADED $54.77 i I
rU CARD NUMBER 0016 TOTAL 16.300 i� $2i98�u S54.77
CARD NUMBER 0025
11113 08:07 0079483 808 W MAIN ST CARMEL IN ! � 16.201 �- 8 UNL----$2.96 $48.28
16.201 GAL UNLEADED $48.28
11/20 19:33 0242743 ( 1821 E 151ST ST CARMEL IN I 14.801 8 I UNL ? $2.71 $45.87 d
i 14.801 GAL UNLEADED $45.87 i
11/24 21:08 0257212 1230 S RANGELINE,RD CARMEL IN I 13.910 8 I UNL i $2.55 $44.11
13.910 GAL UNLEADED $44.11 I
I I
11/28 11:29 { 0702472 1505 W MCLAIN SCOTTSBURG IN 10.270 8 UNL $1.88 $33.781/
E 10.270 GAL UNLEADED $33.78
CARD NUMBER 0025 TOTAL 55.182 I ! S10.10 $172.04
CARD NUMBER 0027 /
11/266 14:39 0268912 12 S03 RANGELINE RD CARMEL IN - 4.730 8--T UNL f} $0.87 $15.01✓
I 4.730 GAL UNLEADED $15.01 E i
III CARD NUMBER 0027 TOTAL 4.730 $0.87 $15.01
CARD NUMBER 0030
T-
11/11 12:06 0759985 7788E 96TH ST FISHERS IN� A 14.060 8�UNL $2.57 $44.43
14.060 GAL UNLEADED $44.43 /
11121 20:39 0827485 1 7788 E 96TH ST FISHERS IN E 14.744 1 8 ( UNL $2.70 $49.54✓
14.744 GAL UNLEADED $49.54 - 1
12102 20:33 0903716 7788 E 96TH ST FISHERS IN 10.810 8 UNL $1.98 $34.15✓
10.810 GAL UNLEADED $34.15
CARD NUMBER 0030 TOTAL 39.614 I $7.25 $128.12
GRAND TOTAL + 291.704 ! $53.39 i $918.63
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 f
TAX EXEMPTION SUMMARY
Description Amount
FEDERAL EXCISE TAX
291.7 GALLONS GASOLINE -$53.39
Page 3 of 4 1-800-377-5150 shellfleetcard.accountonline.com
I
Account: **** **** **** 7193
f
- t : clear & concise!
Clear: Statements show you exactly how much you've spent, how much you owe, and your
available credit.
I
F 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.
� r
Account Statement
Account Number/ �mmarH�A Payment Information
Contact Information c-tornerservl«: ro NxNED9
Shall Fleet Plui Cord 6 Shows what you owe,
Account In uuirie5: Account Number.99991798899999899 r
Summary of I�,.SOD909i909 FAx,�aroapF999p InVgceNUnbBr 9999989999999999999 due dates and minimum €
Account Activity Summary ofAcDOUnt Activity Payment formation payment information
A uick, complete Re rous dan er.�� $8,999.&99.99 CUrren)Due $9.999,99999
q p Pay1 eMS 59.999.989.99
. Crailm _
Pas Due Amo _ . � Transactions
view-of yo lr-aCcolnt- ��-��
+$9,999.999.99 Mmi Pay—,Due _ __ $9999999.,99-
beblts -"- +$9.999.999.98° Payment Due Date MM/W/YY - Lists your purchase
all in one place Lele Eeea. —� +$9.989.9H8.99
No.eelenee - 59,988,889.99 Gediz Una $9989,999 activity, including
io,z1 rmrleecGDn9 - 9,999,999 GednAvailwC $9.999;999_ dates, locations,
- Arraunt Over CIDdi1 Lne J� $9999.999
{ %sha NOlice ofolamal se Itq ida.� Cbstng Data __J,� MMNDIYY quantity of gallons, 4
j Po Box PaBB,GT/er Ps B 9s i Nma Closing Date ^'MWDD"
1 and type of fuel
w TRANSACRDN$
Q t >
T. Tmru Tmlu Akg Pod Payments,Credits,
Year-to-Date Drs, ma ID 9wOp/DO apllm a ty coax com Exom9t Tex Amours,
r1J PAYMENTS,CREDITS'FEESANDACAUSMENTS Fees and Adjustments
Summary V MMDD; I (PAYMENT-,THANXYOU' ) E89AA,99B90. f
g MMIDD CREDIT AOJUSTYENTTOYgF1 ACCOUNT-' SB,9AB989 B0. A record of payments
A summary of MM�DD I LOYAL REWAJ SB,BAB,9B990.
;DISCOUNT �� you've made and credit 5
r total gallons this M�DD
PURCHASES AND DF9?S adjustments affecting
'
i statement period SU9ACCT999999LB NAME,
+ MMDDNY 888800Q123<59)29a MAN STREET ANYWHERE USA
and year-to-date �' 1 2T 993 GA ON BAO9D 9B9PB0�9�y 9W: .{8888,889.88 I 58,989.98998 your account
-- CARD NUMBER 0001 TOTAL.9B Y90 ,! � sRAV aBB� 3.1-1.... ' Remit Coupon 1
CARD NUMBER- -
MMMD 8888 123.58)1123a MAIN STREET ANYWHERE,USA 008080 a REG.,t ee,eBe,p9P8D S 988,98898 n
Tax Exemption 2T 993 GAL UNLEADED Identifies payment i
CARD NUMBER OIX¢TOTAL 99ee9e eAe99,mae9 �
_
TOTAL NAME, _ -'29898999.99
due date, new balance,
A summary of the any past due amount,
NOTICE:SEE REVERSE SIDE FOR IMPORTANT INFORMATION 0999 t ar X Be XX AA Thy Amwm,A leauod h 49mmer NA
.
tax exemption , „—,, ,„m�, . p „a p�,r�6a,,, = minimum payment
4 credits by state, city; e°ro.% �; due, and an area to
Ym„A-.F,NUmb°,A9999999999999999 1111111111111 IN 111111 IN 1111111111111111
county, and federal Q Shd,Flea PaCvd Invoice Number �. write in the amount
Payment Due Date .4`MOMh DD,YYYY
for qualified tax sT„�„�,�, Ne Balance ,$9,9B9°qw.� of your payment
exempt aCCOUntS PDT Pe ueAmoum` 59.999.999.09 j
m Payment Due 59999.99e.99 Discount Summary
Statement Enclosed - -
!Enclosed: ,,
Represents merchant a
���a"��Imda
funded and program
-•••9999 Amwm ck9 Pay,b a 1, -
Account
�� � Ex9mPtTQ discounts, Merchant
-„TRANSAOTIONS(cont.) o„an,ey - -- ---+- -
- �-
_�T A-
w,• n _. .. -- E2i.29 !III I I 'IIIIIIII"'II'II I'IIIII Pt,
PUPCNASESAND DENS/conU - - are broken down by
SUBACCT .7T'
NAME? <
CAPD„UMeFAOW� ,23AMAINSTREETANVW"ERE.uaA 5 0.89 s,9.BD - each merchant when
M_C e9:B0 1236581 SALES TAX .
t ACCESSORY s 2L.59 1Bi11 9 MI AAAAAAAA CCAD ,
applicable
tf` { 123A56741T"�rvaTaEPT Aturvrt,FAE,u9A S 2.00 I j s
M1.WD,�BB'.fA''� I-D 5 tl:af S 6'1.00 ACCOU M
19.'1 LLOB L O„LEADED 2 8.00 1, nt:»»..» »a 9999
I1 3 1&711 O/$COU •�J
5 y t 7q5„ cAPD NUMH£P 0001 TOTAL _ ----"-_ MSUMMARY
NUMe£R ma2.,..". STREET AM'W"F�iE USA P $38.51 I avcrmplbn Dmc Par
LJ
Y f�P2458T-19DS 165 ➢ED REGODA S AN°RC COUM YPe BeN9 cl
E IpDDD!BB98 11.165 Ora.uacar'
I gfPEETIINLEADEDPEGUWR 5-12.00 1 t8b0a 123¢M.911N ST_µY'-RE,USA D ONCX c.lre• unlm
p Mµpp BB.BB. 19eA58T San{mATMI�, TOTAL{1 29. arcA
} REET ANYVIHEPE,USA C U UNL D b.e J 1 t C�NR�yyyyg9�0992 NAME2I 988.898 1 MA1NS RFE R WHERE USA C 1 100209
t' B TOTAL Ie19AC !999.999 I U SUP 8gg,�, 1 Amgmt
1MAIN STREET q"+--"�•.•..•\-e-9UBT0-T_AL C U DSL S0 ( 999,999.999 ( m t
'4 1 GRAND TOTAL" NYR}rERR,:USA ( 39.59999999
` - ,�y � !294 MA.N eTrVFFTANyYmERE,USA I C 500 I 9�. � 1 S9
$BI¢w19�OW AU8,011za _� 1 I UN�L I 59,999
9 9 9g
1 Sal¢with AultgdTalDa S Kayed Sale w9n0ul AUDa1¢aUo C I U
p /•6aCt,00C Ii8110f1 +..`BUaTOTA1 SUP 999999999 {�"""-' 29.889988.89
S Messe9e CodeB: Ke�$aIe OTAI'SrE1CHANT ggL`yUN{ 999.999899 ij S99gg g5y.99
j > ••`-�-�'r_ TDR85�ON��Qe/I� ry^_ J___�( _ 35999999-99
vi99as
YEAR-IO-DATE SUMMARY . .s991p I
Oc PUroFm9e0 t199 SIa1ama TOTAL '�� D ALL ILI" 003 «.S9,B89999.99
4S Tp�IGafb �.�-� Ba9,sBS099 }}(�- 'F 11
Tool GeNOrrt'Purchesa0ln YfTY !t X/'I ._..�L-,�. 'I S85B5.599.g5
'TOTAL' - M 5UD_i=A1i IAl FUklS I(t 00250 i E9999939.A,
TA%EXEMPTION SUMMARY - - __r
DeamlPtbn _. TOTAL
DI$ �`�, .--ter 1 (Ss 599.959.59 Ir $9999999.59 ;
4 - - _ Dac Tme_X_vacenl CDUNT
X$TATE NAME(STATE MOTOR FUELTAX _t'”-+__�j� 59988888 g9
1 8sa ssa9,L oRS GASOIJI_�E __� •- -----� - �- z ParUM I SB 889,98898 ,
�B S659GPLLO7S DIESEL FUEL (,' �.. '¢B:D.pamr Sema 59999,999.99
I (aTATE NAME)STATE MOTOR FUEL TRX_
9pGrvE _
t 9s59s55GA>lNSS_ \� x
6B9GA11°r9a DlEaa.FUEL . _ '�-For'illustratfon,purposesordy. SH F2 TF HTR 10/13.�.
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
$865.24
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 I 65127193312 I 42-314.00 I $865.24 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
Friday, December 13, 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))
12/06/13 65127193312 monthly payment $865.24
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