181315 01/13/2010 c,, CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
4,I ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $199.00
x s'• A CARMEL, INDIANA 46032 603E WASHINGTON ST SUITE 200
`',;,,off t� INDIANAPOLIS IN 46204 CHECK NUMBER: 181315
CHECK DATE: 1/13/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4358800 19348 195425 199.00 TESTING FEES
p
Midwest ToxicoCogy invoice
Services, Inc.
L t DATE INVOICE
O y r9ufZx '(n A
12/28/2009 195425
603 East Washington Street, Suite 200, Indianapolis, IN 46204
BILL TO: SHIP TO:
City of Carmel Names location of collection
Attn: Jim. Spelbring on invoices no ss
1 Civic Square Email results to Barb Lamb cc Jim
Carmel, IN 46032 Still Mail results to Jim
CLZ
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT
DOT Test 1 DOT Drug Test 55.00 55.00
Collected at Community Occ. Health Center
12/04/09
Mark Carter
DOT Alcohol 1 DOT Breath Alcohol Test 28.00 28.00
Collected at Community Occ. Health Center
12/12/09
Mark Carter
BAT Surcharge 1 Please note that you are being charged an additional fee due to your 6.00 6.00
collection site breath alcohol charges.
ND Drug Test 2 Non -DOT Drug Test 55.00 110.00
Collected at Community Occ. Health Center
12/22/09
Michelle Harrington
James Haag
A finance charge will be assessed on all invoices not paid in 30 days. Thank you for your business.
For the purpose of client confidentiality we are no longer showing the full SSN on invoices. Total $199.00
Make Checks Payable. To: MIDWEST TOXICOLOGY SERVICES, INC.
For questions regarding this invoice, contact as at 317 262 -2200 or fax us at 317 -262 -2222.
Be sure to visit our website at w v v.nidwesttoxicologv.com.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Midwest Toxicology
IN SUM OF
603 East Washington Street, Suite 200
Indianapolis, IN 46204
$199.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
19348 I 195425 I 43- 588.00 I $199.00 I 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, January 08, 2010
Director, HR
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))
12/28/09 195425 Testing Fees $199.00
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