182935 03/03/2010 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $89.00
CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200
INDIANAPOLIS IN 46204
CHECK NUMBER: 182935
CHECK DATE: 3/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4358800 19348 198510 89.00 TESTING FEES
Widwest 7oxicotogy
1� 34;� Invoi
@4;R DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 2�15/2o1a 198510
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
ND Drug Test CS 1 Non -DOT Drug Test 55.00 55.00
Collected at Community Occupational Health Center
02J12/10
Todd Luckoski
ND Alcohol CS 1 Non -DOT Breath Alcohol Test 28.00 28.00
Collected at Community Occupational Health Center
02/12/10
Todd Luckoski
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.
D
MAR 0 1 2010
By
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 $89.00
Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC.
For questions regarding this invoice, contact its at 317- 262 -2200 or fax us at 317- 262 -2222.
Be sure to visit our website at ws+ H.nridwesttoxicolagy.canr.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Midwest Toxicology
IN SUM OF
603 East Washington Street, Suite 200
Indianapolis, IN 46204
$89.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO# Dept. INVOICE NO. I ACCT /TITLE I AMOUNT Board Members
19348 I 198510 I 43- 588.00 I $89.00 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
T ursday, February 25, 2010
Director, H
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
t
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER t
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))
02/15/10 198510 $89.00
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