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185359 05/11/2010 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1 ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $2,670.00 CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200 INDIANAPOLIS IN 46204 CHECK NUMBER: 185359 CHECK DATE: 5/1112010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUM AMOUNT DESCRIPTION 1201 R4358800 19348 197437 55.00 TESTING FEES 1201 4358800 197438 -55.00 TESTING FEES 1201 4358800 198225 -55.00 TESTING FEES 1201 R4358800 19348 198225 55.00 TESTING FEES 1201 4358800 198304 -55.00 TESTING FEES 1201 R4358800 19348 198304 55.00 TESTING FEES 1201 R4358800 19348 203534 1,183.00 TESTING FEES 1201 R4358800 19348 203685 660.00 TESTING FEES 1201 R4358800 19348 203748 717.00 TESTING FEES 1201 R4358800 19348 203985 55.00 TESTING FEES 1201 R4358800 19348 204348 55.00 TESTING FEES 1�3�ss Widwest To-�icofogy Invoice DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 4/30/2010 204348 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 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 4/29/10 Nicholas R. Robinson D Q MAY 10 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 $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.con,. Widwest 7 Invo services, Inc. Q� DATE INVOICE 4/26/2010 203748 603 East Washington Street, Suite 200, Indianapolis, IN 46104 BILL TO: SHIP TO: City of Carmel Names location of collection Attn: Jim Spelbring on invoices no ss Email results to Barb Lamb cc Jim 1 Civic Square Still Mail results to Jim Carmel, IN 46032 KK CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT DOT Test OS 8 DOT Drug Test 55.00 440.00 Collected Onsite 4115110 Timothy Coffey Street Gary Jones Street Richard Walden Street Shaun Privett Street Kristi Clark Snyder Street Brad Henderson Street Tim Browning Street Michael Williamson Street DOT Alcohol OS 4 DOT Breath Alcohol Test 28.00 112.00 Collected Onsite 4115110 Gary Jones Street Shaun Privett Street Brad Henderson Street Michael Williamson Street ND Drug Test OS 3 Non -DOT Drug Test 55.00 165.00 Collected Onsite 4115110 Wes Nicley -Fire Bradley Marcum Fire Brad Sombke Fire MAY 10 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 $717.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this involve, contact us at 317- 262 -2200 or fax us at 317- 262 -2222. Be sure to visit our website at www.ntidwesttoxicology.cont. 19 3 1 Midwest To.Xicology I nvo i ce @Nffii DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46104 4/22/2010 '203685 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 2 DOT Drug Test 55.00 110.00 Collected at Community Occupational Health Carmel 4119/10 Eric Russell Kristi Clark Snyder ND Drug Test CS 10 Non -DOT Drug Test 55.00 550.00 Collected at Community Occupational Health Carmel 4115110 William Akers Chad Utzig 4116110 Nicholas Southerland 4119/10 Kristopher Anthis Gregory Loveall Harland McNair 4/20110 Renee Butts Timothy Green Richard Thomas Scott Woodburn MAY 9 Q cuiU By A finance charge will be assessed on all invoices Trot paid in 30 days. Thank you for your business. Thank you for your business! Total $660.00 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 wrvN ntidwesttoxicology.cont. ;.4 Midwest Toxicofogy Invo om wi;i DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 4/20/2010 203534 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 OS 10 Non -DOT Drug Test 55.00 550.00 Collected Onsite 4113!10 Christopher Rohr Fire Gary Fisher Fire Thomas Payne Fire Stephen Reeves Fire Darcy Case CCCC Kent Paulin CCCC Marvin Stewart. 11 CCCC James Herron Police Scott Morrow Police Greg Park Police ND Drug Test OS 10 Non -DOT Drug Test 55.00 550.00 Collected Onsite 4!14!10 Kerri Wrin Police Timothy Fagin Fire Robert Locke Police Steven Frye Fire Marc Gehlbach Fire William Stites Police Johnathon Gwaltney Utilities Jeffery Bondurant Fire James Buttler Fire Teresa Anderson Police DOT Test OS 1 DOT Drug Test 55.00 55.00 Collected Onsite 4!14!10 Larry Eidson Jr Utilities A finance charge willbe assessed on all invoices notpaid in 30 days. Thank you for your business. Thank you for your business! I Total Make Checks Pavable 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.midwesnoxicology.com. Pagel %fidwest Toxicology Invo ic e DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 4/20/2010 203534 BILL TO: SHIP TO: City of Carmel Names location of collection Attn: Jim Spelbring on invoices no ss #N 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 DOT Alcohol OS 1 DOT Breath Alcohol Test 28.00 28.00 Collected Onsite 4114110 Larry Eidson Jr Utilities D MAY 3 0 2010 By A finance charge wili be assessed on ail invoices notpaid in 30 days. Thank you for your business. Thank you for your business! Total $1,183.00 Make Checks Payable To: MLDWEST 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 rvww.niidrvesttoxicology.com. Page 2 VOUCHER NO. WARRANT NO. ALLOWED 20 Midwest Toxicology IN SUM OF 603 East Washington Street, Suite 200 Indianapolis, IN 46204 $2,780.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO# Dept. INVOICE NO. ACCT #rTITLE AMOUNT Board Members 19348 1 203534 I 43- 588.00 I $1,183.00 1 hereby certify that the attached invoice(s), or 203685 43 588.00 I $660.00 bill(s) is (are) true and correct and that the 203748 1 43- 588.001 $717.Ofl I II materials or services itemized thereon for 19 3,�$ 203985 43 .00 11 which charge is made were ordered and �c73z }g 204155 43- 588.00 $"55 -00 3 204348 43='588_0 $55.00 received except Monday, May 10, 2010 7 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)) 04/20/10 203534 $1,183.00 04/22/10 203685 $660.00 04/26/10 203748 $717.00 04/27/10 203985 $110.00 04/28/10 204155 $55.00 04/30/10 204348 $55.00 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