182461 02/17/2010 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC
CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200 CHECK AMOUNT: $193.00
o? INDIANAPOLIS IN 46204
CHECK NUMBER: 182461
CHECK DATE: 211712010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 84358800 19348 197437 55.00 TESTING FEES
1201 R4358800 19348 198225 55.00 TESTING FEES
1201 R4358800 19348 198304 83.00 TESTING FEES
r
r
Midwest 7axicotogy
Invoice
og DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 2/10/2010 198304
a.
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
KK
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT
ND Drug Test M... 1 Non -DOT Drug Test 55.00 55.00
Collected at Midwest Indianapolis
2/2110
Greg Park 3388
ND Alcohol MTS 1 Non -DOT Alcohol Test 28.00 28.00
Collected at Midwest Indianapolis
212110
Greg Park 3388
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 $83.00
Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC.
For questions regarding this invoice, contact us at 317- 262 -1200 or fax us at 317- 262 -2222.
Be sure to visit our website at www.niidwestio.vicoloD}.com.
Midwest 7oxicotogy SM Invo
-�Qk Set•►�ices, 1'nc. 1Z='1
DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 1/28/2010 197437
BILL TO: SHIP TO:
Names location of collection
City of Carmel
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
ND Drug Test CS 1 Non -DOT Drug Test 55.00 55.00
Collected at Community Occ. Health Center Carmel
01/25/10
Jared Kinney
D Q
FEB 15 2_010
By
A finance charge will be as 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 $55.00
Make Checks Payable To: MIDWEST TOXICOLOCY SERVICES, INC.
For questions regarding this invoice, contact us at 317- 262 -2200 or fax us at 317- 262 -2222.
Be sure to visit our website at www.midwesttoxicology.con
Midwest ToXicofogy
Inv
Inc.
o ffl w� DATE INVOICE
2/9/2010 198225
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
3 Civic Square Email results to Barb Lamb cc Jim
Still Mail results to Jim
Carmel, IN 46032
CLZ
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT
ND Drug Test CS 1 Non -DOT Drug Test 55.00 55.00
Collected at Community Occupational Health Center
02/05/10
Elizabeth Ginther
Lr
FEB 15 I'Vio
ay
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 $55.00
Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC.
For questions regarding this invoice, contact us at 317 262 -2200 or fax us at 317 -262 -2222.
Be sure to visit our website at rnwm.►nidwesttoaicology.con:.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Midwest Toxicology
IN SUM OF
603 East Washington Street, Suite 200
Indianapolis, IN 46204
$193.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
19 q 197437 43- 588.00 $55.00 i hereby certify that the attached invoice(s), or
198225 43- 588.00 $55.00 bill(s) is (are) true and correct and that the
1'i 3- 198304 I 43- 588.00 I $83.00
materials or services itemized thereon for
which charge is made were ordered and
received except
f'
S
i
Monday, February 15, 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))
01/28/10 197437 $55.00
02/09/10 198225 $55.00
02/10/10 198304 $83.00
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