227935 1/14/2014 CITY OF CARMEL, INDIANA VENDOR: 366015 Page 1 of 1
ONE CIVIC SQUARE WEX BANK CHECK AMOUNT: $563.19
o CARMEL, INDIANA 46032 PO BOX 6293
oM is CAROL STREAM IL 60197-6293 CHECK NUMBER: 227935
CHECK DATE: 1/14/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231400 35331671 563 . 19 0453-00-794629-6
FLEET SERVICES INVOICE/STATEMENT
INVOICE NUMBER: 35331671
ACCOUNT NAME: CARMEL FIRE DEPARTMENT
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMITDAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0453-00-794629-6 8100.00 31 12-31-2013 01-24-2014 563.19
.......................................
..
ACTIVITY DESCRIPTION HARGES/DE$IT5: PAYMENTS/CREDITS
PAYMENT RECEIVED-THANK YOU 616.30
t2,:3.;:2<}[:3::;;:;:;: RETAIL FUEL PURCHASES
3 ::;;::;:: MONTHLY CARD CHG
YOUR SAVINGS FROM DISCOUNTS THIS PERIOD
1.80
MI
RE NDER
PLEASE BE SURE TO INCLUDE REMITTANCE STUB WITH
YM
PA ENT. MAIL
TO THEA DRESS SH I
D OWN IN THE RIGHT
PORTION OF THE REMITTANCE STUB.B.
PURCHASES,RETURNS AND PAYMENTS MADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT INVOICE/STATEMENT
PREVIOUS BALANCE PAYMENTS +PURCHASES (+)DEBITS CREDITS (+)LATE FEE (=)NEW BALANCE
616.30 616.30 541.19 22.00 0.00 0.00 563.19
$39.00 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 monthly periodic rate of PERCENTAGE RATE of fee for this period which is
2.249 % 26.99 % 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 of 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.If your avoid late fees.
payment is not received and posted by the invoice payment due
date,you may be charged a late fee or other fees in accordance Online
with the terms in your Business Charge Card Account Agreement. Authorized users can elect to receive an email notification when an
invoice is ready for online viewing and payment.Log in or register to
How to Dispute Your Invoice set up an online account at www.wexonline.com.
Charges must be disputed in writing no later than sixty(60) Online payments scheduled by 3:00 PM ET(on business days)
days from the billing date or they will be considered final are credited to your account on the same day.There is no fee for
and binding.
online payments.
Phone
Card Issuer Call Customer Service and select the menu option for Billing
The card is issued and payable to WEX Bank under a-Business Inquiries.In addition to scheduling a-payment;you can also -
Charge Account Agreement with the cardholder named on the check your balance.
reverse. Payments scheduled by 3:00 PM ET(on business days)
are credited to your account on the same day.
Customer Service Be prepared with your fleet card account number and a sample
For account inquiries and correspondence regarding account check to enter your bank account number and routing number.
service or billing: There is no fee for phone payments.
• Call 1-888-387-5665, or Automated Clearing House(ACH)
• Fax to 1-800-395-0809,or To make a one-time electronic payment go to:
hftp://www.e-fleet.com
• Mail to P.O.Box 639, Portland, ME 04104 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
Be sure to include your account number on all correspondence. ACH payment.
ACCOUNT: CARMEL FIRE DEPARTMENT CLOSING DATE: 12-31-2013
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 -28.24 0.00 FEDERAL E85 154.400 467.60 0.18300
-7.57 0.00 FEDERAL__ GASOLINE 41.343 138.33 0.18300
FEIRA!«TtSTAl864 ,93 ...Qa8835 . .
IN 356000972 0.00 24.69 STATE EXCISE E85 154.400 467.60 0.16000
27.13 0.00 STATE SALES E85 154.400 467.60 0.07000
EN STATE FCJTALS
27 93 24'&9::
ACCOUNT TOTALS -62.94 24.69
(y WEX INC.2013 PAGE 1
FLEET SERVICES STANDARD REPORT
INVOICE NUMBER: 35331671
ACCOUNT NAME: CARMEL FIRE DEPARTMENT
PAGE 1 OF 2
ACCOUNT NUMBER CREDIT LIMIT I DAYS THIS PERIOD I BILL CLOSING DATE I PAYMENT DUE DATE AMOUNT DUE
0453-00-794629-6 8,100.00 31 12-31-2013 01-24-2014 563.19
CARD LOCATION DATE TIME DRIVER ODOMETER PRODUCT UNITS COST/ DISCOUNT ITEM TOTAL
NO. NO. UNIT TOTAL AMOUNT
0004 MH 001 074 12-08-2013 05:04 HABOUSH,DAVE 35,476 E85 17.020 2.989 -0.17 50.88 50.88
MH 001 050 12-20-2013 16:30 HABOUSH,DAVE 36,511 UNL 25.120 3.289 -0.25 82.61 82.61
MH 001 074 12-23-2013 23:44 HABOUSH,DAVE 36,840 E85 22.210 2.989 -0.22 66.39 66.39
MH 001 074 12-29-2013 19:55 HABOUSH,DAVE 37,120 E85 23.680 3.089 -0.24 73.14 73.14
CARD SUBTOTALS 88.030 -0.88 273.02
0007 MH 001 154 12-05-2013 14:51 SMITH,KEITH 26,481 E85 21.590 2.988 -0.22 64.51 64.51
MH 001 095 12-10-2013 19:03 SMITH,KEITH 26,711 E85 23.590 2.989 -0.24 70.52 70.52
MH 001 074 12-16-2013 17:44 SMITH,KEITH 26,956 E85 24.430 2.989 -0.24 73.02 73.02
MH 001095 12-27-2013 12:07 SMITH,KEITH 27,148 E85 21.880 3.089 -0.22 67.59 67.59
CARD SUBTOTALS 91.490 -0.92 275.64
4551 97 097 910 12-20-2013 10:49 VANVOORST,BOB 106,984 UNL 16.223 3.419 55.47 55.47
CARD SUBTOTALS 16.223 55.47
TOTAL PURCHASES 195.743 -1.80 604.13
Y-T-D PURCHASES 2,296.436 -8.37 7,346.96
SITES USED THIS MONTH NO.PURCHASES TOTAL AMOUNT
Location No. Brand Street City State Zip
MH 001 074 MEIJER 1426 W CARMEL DR CARMEL IN 46032 4 263.43
MH 001 095 MEIJER 8225 E 96TH ST INDIANAPOLIS IN 46256 2 138.11
MH 001 050 MEIJER 1675 HILLIARD-ROME COLUMBUS OH 43228 1 82.61
MH 001 154 MEIJER 17000 MERCANTILE RD NOBLESVILLE IN 46060 1 64.51
97 097 910 EXXONMOB 1960 S MOUNT PROSPEC DES PLAINES IL 60018 1 55.47
PRODUCTS: E85=ETHANL85 UNL=UNLEADED
FLEET SERVICES
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Wex Bank
IN SUM OF $
P.O. Box 6293
Carol Stream, IL 60197
$563.19
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 I 35331671 I 42-314.00 I $563.19 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
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Irescribed by State Board of Accounts City Form No.201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
Nn invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
nrhom, 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))
35331671 $563.19
1 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