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Home My WebLink About184399 04/14/2010 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: $1,079.00 INDIANAPOLIS IN 46204 CHECK NUMBER: 184399 CHECK DATE: 4/1412010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 84358800 19348 201192 220.00 TESTING FEES 1201 R4358800 19348 201639 110.00 TESTING FEES 1201 R4358800 19348 201842 55.00 TESTING FEES 1201 R4358800 19348 202376 694.00 TESTING FEES 7Vlidwest To-Ticology Invoi Services, Inc. DATE INVOICE 4/6/2010 202376 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 ANB CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT DOT Test CS NC 1 DOT Drug Test 55.00 55.00 Collected at Community Occ. Health Center Carmel 3130110 Nathaniel Morris ND Drug Test CS 11 Non -DOT Drug Test 55.00 605.00 Collected at Community Occ. Health Center Carmel 3129/10 David Friesen (specimen 31884696) David Friesen (specimen 31884697) 3/30/10 Jill Joseph Shannon Minnaar 3/31110 Kathleen Vasil Ryan Kiddey 4/1/10 Michelle Chapman Donna Brown D Joanette Greaser APR 1 X010 4/2/10 Jonathan Palmer Brad Worrell By DOT Alcohol CS 1 DOT Breath Alcohol Test 28.00 28.00 Collected at Community Occ. Health Center Carmel 3/30/10 Nathaniel Morris A finance charge will be assessed on all invoices not paid in 30 days. Thank you for your business. Thank you for your business! Tota 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 ►vww.midwesnoxicologj> eons. Page 1 Midwest Toxicofogy Invoi �Q� Services, Inc. O�p� DATE INVOICE V€ 603 East Washington Street, Suite 200, Indianapolis, IN 46204 4/6/2010 202376 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 ANB CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 6628 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT 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. A finance charge will be assessed on al! invoices not paid in 30 days. Thank you for your business. Thank you for your business! Total $694.00 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.midwesttoaicoiogy.cont. Page 2 Midwest 7o.XicoCoBy n3q� Invoice Services, Inc. DATE INVOICE 3/30/2010 201842 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 ANB 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, IN 3126/10 Eric Groganz D Q APR 12 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. Tota $55.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this invoice, contact us at 317- 262 -2200 or far us at 317 262 -2222. Be sure to visit our website at www.midwesaoxicology.com. Midwest Toxicology I nvoice 0A Mi g 0 DATE INVOICE 3/22/201 201192 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 NMI CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT ND Drug Test CS 4 Non -DOT Drug Test 55.00 220.00 Collected at Community Occ. Health Center Carmel 3115/10 Daniel J. Elmore 3/16/10 Matthew J. Eckstein 3/17/10 Daniel J. Elmore 3/19/10 Michael R. Baringer /'Z LJ U APR 12 1010 By Y 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 $220.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this invoice, contact as at 317- 262 -2200 or firs us at 317 -262 -2222. Be sure to visit our website at www.midwesitosicology.com. 1T1 Widwest To.Xicofogy Inv Services, Inc. tQ DATE INVOICE 3/29/2010 201639 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 AA CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 6628 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 Occ. Health Center Carmel 3123/10 Nicholas B. Scott 3/25110 Ethan B. Dove DQ° APR 12 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! Total $110.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this invoice, contact its at 3.17 -262 -2200 or fax us at 317- 262 -2222. Be sure to visit our website at www nlidwesttoxicology.comi. VOUCHER NO. WARRANT NO. ALLOWED 20 Midwest Toxicology IN SUM OF 603 East Washington Street, Suite 200 Indianapolis, IN 46204 $1,079.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members 19348 201192 I 43- 588.00 $220.00 1 hereby certify that the attached invoice(s), or 19348 201639 I 43- 588.00 $110.00 bill(s) is (are) true and correct and that the 19348 201842 43- 588.00 $55.00 materials or services itemized thereon for 19348 202376 43- 588.00 $694.00 which charge is made were ordered and received except Friday, April 09, 2010 o Director, HR Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Farm 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)) 03122/10 201192 Pre Employment Drug Screen $220.00 03/29/10 201639 Pre Employment Drug Screen $110.00 03/30/10 201842 Pre Employment Drug Screen $55.00 04/06/10 202376 Pre Employment Drug Screen $694.00 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