183873 03/29/2010 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: $440.00
INDIANAPOLIS IN 46204
CHECK NUMBER: 183873
CHECK DATE: 3/29/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4358800 19348 200606 110.00 'TESTING FEES
1201 R4358800 19348 200753 55.00 TESTING FEES
1201 R4358800 19348 200845 220.00 TESTING FEES
1201 R4358800 19346 200897 55.00 TESTING FEES
Midwest Toxicofogy Invoice
offl DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204
3/15/2010 200606
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 2 Non -DOT Drug Test 55.00 110.00
Collected at Community Occupational Health Center
03/11/10
Ronald Hart
Matt Larson
k l 1
MAR
z6 t
By
A finance charge will be assessed on ail 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 $110.00
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 wrvw nudwesttoaicology.com.
Widwest Tx�cotogy Invoice
o Inc
DATE INVOICE
'603 East Washington Street, Suite 200, Indianapolis, IN 46204 3/16/2010 200753
BILL TO: SHIP TO:
City of Carmel
Attn: Jim Spelbring
1 Civic. Square
Carmel, IN 46032
MMD
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
03 /1 0/2010
Connor J. Murphy- 6956
Q L' —N
MAR 2 6 i
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. Tota $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 www.midwesttoxicology.com.
1R3��
9didwest 2'oadcology I nvo i c e
Serv�tces, Inc. DATE INVOICE
U a 3/18/2010 200897
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
Still Mail results to Jim
Carmel, IN 46032
LW
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT
ND Drug Test 1 Non -DOT Drug Test 55.00 55.00
Collected Community Occ Health
3116110
Carole Gilbride
MAR 2 b zoto
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 $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 3.17- 262 -2222.
Be sure to visit our wehsite at www.midwesttoxicology.cont.
ri Mt
Widwest ToXicocogy Invoice
@Kwes, Inc. DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204
3/18/2010 200845
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
LW
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT
ND Drug Test 4 Non -DOT Drug Test 55.00 220.00
Collected at Community Occ Health
3/15/10
Nick Eckstein
Daniel Elmore
Mark Garrison
Andrew Helmkamp
MAR b 2010
By
A finance charge will be assessed on all invoices not paid in 30 days. Thank you for your business.
Thank you for your business! I Total $220.00
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 www.ntidwesttoxicology.com.
VOUCHER NO. WARRANT NO.
Midwest Toxicology ALLOWED 20
IN SUM OF
603 East Washington Street, Suite 200
Indianapolis, IN 46204
$440.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
19348 200606 43- 588.00 $110.00 1 hereby certify that the attached invoice(s), or
19348 200753 43- 588.00 $55.00 bill(s) is (are) true and correct and that the
19348 200897 43- 588.00 $55.00
materials or services itemized thereon for
19348 200845 43- 588.00 $220.00
which charge is made were ordered and
received except
Thursday, March 25, 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 n ote attac in v o ic e( s) or b il l( s))
03/15/10 200606 $110.00
03/16/10 200753 $55.00
03/18/10 200897 $55.00
03/18/10 200845 $220.00
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